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Expert Insight

How purchasers are tackling the affordability crisis of high-cost drugs

Innovation in drug development is making extraordinary (but high-cost) therapies available. To build foundations for affordable patient access, purchasers are trying aggressive cost management strategies that upend drug business norms, from Medicare’s inaugural year of price negotiation to health plans’ restructuring of PBM contracts.

Drug challenges

Drug innovation continues to revolutionize the way we treat patients — presenting the opportunity to cure previously uncurable conditions. Cell and gene therapies offer curative treatments for conditions that had few or no options before, and the approval of GLP-1s for weight loss has opened the doors for a new era of obesity care.

But these innovations come with huge costs, forcing our industry to grapple with questions of access, affordability, and equity. The growth in drug spending has outpaced the growth of spending for both inpatient and outpatient care over the past three years. By 2023, the median list price for a new drug jumped 35% from the previous year to a price tag of $300K.1

 


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AFTER YOU READ THIS
  • You will understand the implications of the Medicare Maximum Fair Price Statute.
  • You will learn about how individual states are tackling PBM costs.
  • You will learn about private payer innovations around PBM contracting.

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