Unlocking Access and Collaboration: The Benefits of Employer-Pharma Relationships

In this enlightening episode of The Only Healthcare Podcast, hosts Michael Navin and Dr. Randy Vogenberg, PhD, dive deep into the crucial need for employer-manufacturer collaboration in the commercial healthcare market exploring:

• Data Transparency: Why both employers and manufacturers must share data to create more informed, efficient, and impactful benefit plans.
• Equitable Access: The challenges and opportunities in balancing network limitations, production costs, and patient affordability.
• Whole Person Care: Understanding how patient-centered care improves clinical outcomes, reduces costs, and mitigates risks.

Dr. Vogenberg and Michael discuss how recent trends, including increased spending on patient access programs and the ongoing struggle for data transparency, have highlighted the importance of innovative partnerships. They emphasize the value of collaborative efforts to design better healthcare plans that serve both patients and stakeholders effectively. Tune in for insightful discussions and strategies to navigate the evolving healthcare landscape.

Hosted by:
Michael Navin & Dr. Randy Vogenberg

Michael's LinkedIn

Randy's LinkedIn

Sponsored by:
Peek: A game-changing prescription shopping solution that allows its members to view all their prescription cost options across cash discount programs and their insurance in one easy-to-use platform. Peek is currently being offered to organizations to help both employees and plan sponsors save money on their prescription spend. https://peekmeds.com/.

Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.

Music by:
Hanu Dixit, https://www.youtube.com/hanudixit

Transcript

00:00:00:00 - 00:00:34:11 

Welcome to the Only Healthcare podcast. Our episode today features contacts towards solutions through conversations around commercial market needs and the benefits of employer and manufacturer collaboration. We really want to specifically look at opportunities for solutions on data, equitable access, and whole person care. As a reminder, you can always connect with us on www.onlyhealthcarepodcast.com and subscribe to stay informed and be part of the conversation on how we can drive positive change in the healthcare system. 

00:00:34:12 - 00:01:28:12 

Now, I'd like to introduce my co-host, doctor Randy Valkenburg, who will start this conversation and the episode Randy. Thanks, Michael. I'd like to, kick our conversation off on is the why and the need for this collaboration. Why are we talking about these things? So some of the key points that that we'll be exploring in this episode is looking at the data and demand for transparency in data, the equitable access within employer benefit plans, and when things may be mismanaged and how that can deter, the members of those plans from gaining access to optimal outcomes and more whole person care, which is representative of the consumer and market pressure, for looking at things 

00:01:28:12 - 00:02:06:04 

more holistically, in providing and delivering care. And finally, the balance between clinical care outcomes and economic outcomes. So to kind of set the stage and the three major categories that Michael mentioned, I'll start off first talking about some of the benefits of employer manufacturer collaboration and looking at data. So with data, neither party has access to what really each one needs that precious data that really informs on the situation. 

00:02:06:05 - 00:02:55:08 

How is the performance of the products or the therapy doing in the real world marketplace and data that leads to more informed decisions, particularly around better plans as plan coverage and the performance criteria that would typically go into designing a good benefit program that meets the needs of the members. The second area deals with equitable access and some of the, opportunities here in the benefits for collaboration revolve around handling the demands around the precision required due to the production, distribution, and network limitations for a lot of the the next generation therapies. 

00:02:55:09 - 00:03:22:06 

So what is that going to look like? How does that affect the benefit plans? How is it affecting the manufacturers as well as obviously the patients who are members of the planned? The third area for some of the benefits are in the area of whole person care. And this is where you have a care centered around the patient, not the PBM or any other third party. 

00:03:22:08 - 00:03:50:00 

And the result of this is to help improve the clinical pathways as well as the care outcomes, while reducing the health care risk and the cost associated with that risk, which is what commercial insurance is covering. So with that basic context, Michael, let's talk a little bit more about data and the benefits where collaboration could improve, where the marketplace currently sits. 

00:03:50:01 - 00:04:21:11 

Well, what's been some of your experience around the issues of data and opportunities for collaboration? So what we've seen is really an incredible amount of investment in data on the manufacturer side on the outcomes. A lot of these manufacturers have groups called HCR called Health Economics and Outcomes Research Groups. These groups are primarily in place to create the value proposition beyond, the FDA approval of the product. 


00:04:21:12 - 00:04:44:09 

This is where there's some real world evidence, things of that nature, to show the impact that they're having. And so I think from a clinical data perspective, from my experience, I'm just speaking from my experience, I think there's a tremendous amount of information out there and a tremendous amount of money being spent to prove out the value of these products. 

00:04:44:11 - 00:05:22:04 

Some of the challenge with that is when you get to a purist perspective, they want to see things like longitudinal, you know, ten year outcomes studies, things like that. And as you can imagine, in a post-marketing situation, it's very difficult to to prove that information out. Right. So, I think what they've done has been creative with their ability to produce some level of data that's showing reduction in hospitalizations, reduction in multiple medication use, where they can they can trim down their usage from, you know, maybe five medicines to 2 or 3. 


00:05:22:05 - 00:05:47:13 

And, you know, obviously working with providers who are seeing, you know, the experience. So I think the data is there. I think there might be a gap in how that data is getting communicated and who it's getting communicated to. I also think that the health plans and the PBMs do invest in data as well. Right. And so they look at it as a non-biased view of of the data. 

00:05:47:15 - 00:06:11:04 

And look at maybe the patient as a whole, given multiple conditions or whatever condition they're focused on. So if it's diabetes with downstream cardiovascular effects, things like that, then those, they're looking at that whole patient and saying, you know what? What are they how are they benefiting from the medicine they're on and how are they maintaining that treatment? 

00:06:11:05 - 00:06:41:10 

I also think with star ratings that were introduced, I guess ten plus years ago now, the star ratings do require some level of reporting to show quality metrics in the care. So I think again, the data is there. I think it's a matter of connecting the data and information to all the key parties. Yeah. I think you, hit on an important point there, Michael, that the sharing of data has really been problematic. 

00:06:41:11 - 00:07:27:11 

Particularly from the employer perspective and the brokers or consultants that work with these employers. It's been a an ongoing battle to really get the true information and to get to the true cost. Also understand what is the clinical performance, which I think is a real opportunity for manufacturers to help close some of those gaps, and to utilize a lot of the information that they're collecting and, and really match it up and share it where the employer has some of the other pieces of the puzzle, particularly when it interfaces with plan design and coverage decisions, which is where we get into the good problem of equitable access. 

00:07:27:12 - 00:08:01:12 

If you're really not able to make informed contract decisions or plan operation decisions, you really have a problem. But typically with the the newer therapies and being able to handle those demands within your benefit program, what have been some of the, areas that you've seen or issues you've heard about, around this issue of patients or members of a plan having access to a variety of products? 

00:08:01:14 - 00:08:30:07 

Well, it's a good question. I think I'd probably answer that with another question is back to you, which is you made the statement equitable access and to maybe have you provide a little bit more definition around it. But as far as getting access, I think there has been a tremendous amount of money spent on acquiring patients. And if you think about a drug manufacturer and the way they spend money, obviously it's the research and development first and foremost. 

00:08:30:09 - 00:09:05:12 

Then they have a marketing and promotion budget, and then they have a reimbursement budget. Right? Over the years, as patient responsibility is shifted back to the patient, more of those dollars are being spent tremendously. And we just saw some data, this this year that showed from 2019 through 2023, manufacturers spent $12 billion in patient access programs and 20 in 2019, they spent 24,000,000,000 in 2023. 
 
00:09:05:14 - 00:09:34:07 

That's a 100% increase in four years. And I think that's showing you, number one, they're vested in getting helping get patients on the drugs. But they're also a victim of the system a little bit right where it's it's they're being so restricted to get use of their medicine that they're becoming the, the number one payer so that a provider can get access to the drug to give to the patient so that they can see the positive outcomes and benefits of that drug. 

00:09:34:08 - 00:10:06:08 

And so I think there's been an an unequal shift from the patient to the manufacturer and the and still the PBMs still enjoy the rebates. Regardless. Right. And so it's really it's not the relationship is not symbiotic any, any longer. And I think that's a challenge that is is truly needs addressing. I think actually, you answered part of your own question about what is equitable access. 

00:10:06:09 - 00:10:52:04 

And equitable access is part of what your description is around these network limitations, as well as coverage limitations, which are causing manufacturers to provide additional rebates, discounts, patient assistance. And so forth, kind of working around the system as opposed to working with the system. And that's really the point of that employer manufacturer collaboration to understand and where where is the balance and the equity around access to therapies or products that makes sense for all parties, in which today we have a very convoluted and distorted system that is not aligned properly. 

00:10:52:06 - 00:11:19:08 

And so that's causing problems for for patients, as you pointed out, as well as for the manufacturers. And at the same time, the employers as plan sponsors or purchasers of of a plan, are left with very draconian decisions to make because they can't afford the current system. And so that's really the whole issue around equitable access from the different perspectives and how it's playing out today. 

00:11:19:09 - 00:11:41:04 

Right. And there's a misperception that those programs are driving patients to more expensive treatments. But it's really not right. I mean, it's really getting getting them on their treatments. And if a provider sees that a patient needs something for some kind of condition, and it's what works and it's been proven right, they should be able to get access to that. 

00:11:41:05 - 00:12:16:04 

And yes, prices are of a concern, but because there are so many programs in place around pricing, it shouldn't really be anything that drives budgets. Through the roof. Exactly. Yeah. In fact, we just saw another piece of data like I won't, I won't say where it was from. But it was from a state and they did an analysis on the, on the total drug spend and rebates paid against the total drug spend, but it didn't include the fees. 

00:12:16:05 - 00:12:40:12 

And I think and the problem with that is where it might include, yes, rebate assumptions. It didn't include the fees along with it, which are significant. And so you don't see the total actual payment to the PBM. It's more of just, you know, sort of a pseudo rebate, aggregation assumption report versus what what else is on top of those fees? 

00:12:40:15 - 00:13:04:14 

And now those fees are, you know, they are paid usually by the manufacturer, not by the by the payer. But it's, there's a lot of dollars they that are being spent on, PBM, administration of pharmacy drugs. And there's also a lot of fees paid by the employer. So in essence, we have a lot of double dipping going on with fees. 

00:13:05:00 - 00:13:37:04 

And so that's another great point that's affecting access in a negative way. And it also kind of carries over into this concept of how do we really provide patient centered care, or whole person care. Part of it is the clinical pathways based on evidence based medicine. If the provider of care is following these clinical pathways, you would think that that would be the most beneficial solution in the therapy and deliver better outcomes. 

00:13:37:06 - 00:13:54:13 

But because of all the issues around access not being equitable, it really impacts whole person care. So what are some of the things that that you've heard and seen around this patient centered care from the different perspectives? 

00:13:54:14 - 00:14:21:00 

Well, from a, from I can speak to a couple areas I can't I'm not, really versed so much in and ecology, but in the, in sort of diabetes and cardiovascular disease, there's a lot of, programs that are centered on outcomes being not just delivered through the drug, but through different tools and resources. So technology that tracks hemoglobin A1, C, and that's easy for patients to use. 

00:14:21:00 - 00:15:03:10 

There has been, you know, sort of collaborative programs with different types of groups to show what kind of outcomes people are getting, chart reviews, things of that nature to see where the where the outcomes are. So more than just the prescribing and use of the product, it's also tracking and following the use. And so diabetes is a good example from my perspective because it has so many different, cohorts and also so many different ways metrics to show the reduction in cardiovascular disease, reduction in hemoglobin A1, C and how that all leads to better outcomes for other I can't speak to other conditions specifically, other than that, but but that's what I've 

00:15:03:10 - 00:15:46:08 

seen. Yeah, I think that illustrates nicely how the, the care is being delivered along some type of a guideline or pathway approach to achieve outcomes that could also not only improve the clinical performance of a plan, but reducing the cost or the risk of that health care plan as well. So there could be a lot of opportunities here, not only between employers and manufacturers in a collaborative way, but also those that would be more beneficial to the patients themselves in the promise of what we call patient centered care and whole person care. 

00:15:46:09 - 00:16:14:02 

Yeah. And that can be applied to a whole host of, conditions. As you pointed out, chronic conditions in particular are tailor made for that kind of an opportunity. Yep. So I think we we've done a good job in setting the stage and the background around some of the benefits of employer manufacturer collaborations in this particular episode, and we plan to explore this area further. 

00:16:14:03 - 00:16:32:01 

And some of our other episodes that will provide on the only health care podcast. So, Mike, I'll turn it back to you to, close it out. Yeah. And again, just to that point, we're going to have folks on who can speak to that more specifically. And some of the challenges that that each of those groups are facing. 

00:16:32:01 - 00:16:57:13 

So we're looking forward to those future conversations. So please tune in to the only Healthcare podcast and make sure you listen. Go to our website  

www.onlyhealthcarepodcast.com. You can subscribe to the use of our podcast, as well as you can follow us on Spotify and YouTube to see, the episodes. And also if you have a LinkedIn page we'll be advertising, clearly, on that as well. 

00:16:57:13 - 00:17:10:02 

So don't forget to tune in and listen and, get some good information. And finally, if you have feedback or material you'd like us to cover in future episodes, please let us know.