Episodes
Recent Episodes
February 27, 2024
15. Biosimilar’s Role in Improving Patient Access
Biosimilars are entering the market at their fastest pace ever. In this episode, we interview a renowned health economist and an expert consultant in biosimilar distribution and patient support to explore the complex landscape of biosimilars, including examining the hurdles and breakthroughs in achieving acceptance by payers and providers and how best to improve patient access and affordability in a market dominated by established brands.
The Biologics Price Competition and Innovation Act of 2009
PBMs (Pharmacy Benefit Managers)
“brown bagging and white bagging”
electronic health record (EHR) system
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January 30, 2024
14. 2024 Policy Preview: An Interview with Dr. Mark McClellan
Scott and Mark welcome Dr. Mark McClellan, a distinguished health policy expert who has served as the Commissioner of the FDA and the Administrator of CMS, to look ahead at the major policy activities in 2024. They discuss how the government’s role as regulator and purchaser of drugs will influence the drug industry and the patient’s ability to access and afford medicines this year. They also discuss the challenges and opportunities for improving public health and the emerging role of artificial intelligence.
Pharmacy Benefit Managers (PBMs)
The Ryan White HIV/AIDS Program (RWHAP) Part B
FDA’s Office of Regulatory Affairs
Centers for Medicare & Medicaid Services (CMS)
Centers for Disease Control and Prevention (CDC)
Per Member Per Month (PMPM) billing
Questions or comments?
Email us at comments@prescriptionforbetteraccess.com.
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December 22, 2023
13. The Sustainability of Innovation: An Interview with Rachel King, CEO, BIO
In our 2023 podcasts, there have been a series of revelations about the complexity and unintended consequences related to drug access and affordability. This episode explores the essential underlying tension between the notion that affordability and access are deteriorating while science is advancing so rapidly. We interview Rachel King, CEO of Biotechnology Innovation Organization (BIO), to explore the priorities for the industry and how the challenges related to patient access and affordability could jeopardize innovation for patients today and in the future.
Rachel King, CEO, BIO (Biotechnology Innovation Organization)
John Crowley, Executive Chairman, Amicus Therapeutics
PBM (pharmacy benefit management)
Therapies mentioned in this episode:
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November 17, 2023
12: How Alternative Funding Programs Exploit Patient Assistance Programs
In this episode, we investigate the rise of Alternative Funding Programs (AFPs) that bypass coverage for vital specialty drugs. Kyle Crowell, an expert consultant on AFPs, discusses how payers avoid their responsibility for costs by collaborating with third-party companies to exclude specific drug coverage and directing patients towards manufacturer-sponsored patient assistance programs (PAPs). Patient advocate, Amy Niles from the PAN Foundation, describes how the mounting tension caused by AFPs are leaving patients to navigate the uncertain waters of their medication coverage and access, potentially risking their health and even their lives.
Kyle Crowell, Principal (Partner) at ZS Associates
Amy Niles, Chief Advocacy and Engagement Officer, PAN Foundation
Patient Assistance programs (PAPs)
Alternative funding programs (AFPs)
“Pharma faces tough choices as alternative funding programs exploit charitable giving”
“AbbVie sues a behind-the-scenes company for exploiting its patient assistance program”
Carl Schmidt from the HIV and Hepatitis Policy Institute
Copay Accumulator Adjustment Programs Lawsuit
Like this episode and want to hear more? Listen to past episodes here!
Do you have a prescription for better access? Share your comments and episode ideas with us at:
comments@prescriptionforbetteraccess.com.
Find us on social media! We’re on X as @RX4BetterAccess, LinkedIn and YouTube.
October 17, 2023
11. Obesity Week 2023: An Interview with Dr. Angela Fitch, President, OMA
Patients are experiencing remarkable weight loss thanks to the new generation of GLP-1’s and the downstream health benefits may go well beyond diabetes. In spite of the dramatic results for patients, insurance plans have started to put up more barriers and are even denying the drugs on a more consistent basis. For this special Obesity Week 2023 episode, we interview Dr. Angela Fitch, President of the Obesity Medicine Association, a faculty member at Harvard Medical School and most recently a Co-Founder and Chief Medical Officer for knownwell, a new obesity-focused primary care company.
Show Notes:
Dr. Angela Fitch, President, OMA
Dr. Fitch’s patient care center: Knownwell
Seeking treatment for obesity? Find a clinician here or here.
The Treat and Reduce Obesity Act of 2023
The drugs discussed in this episode:
An article on the use of “bootlegged” Semaglitude: Demand Rising for ‘Bootlegged’ Weight-Loss Drug | MedPage Today
Questions or comments?
Email us at comments@prescriptionforbetteraccess.com.
Find us on social media! We’re on X as @RX4BetterAccess, LinkedIn and YouTube.
October 3, 2023
10: Empowering Employers to Improve Patient Access
Employers are discovering this fall that they are expected to shoulder a 6% health insurance increase for 2024. What can employers do to combat the accelerating cost of health insurance without jeopardizing access to vital drugs? In this podcast episode, we talk with Matt Ohrt, a former HR executive who achieved a 20% reduction in health insurance costs for his employer. Matt has a new book and new company to help other self-funded employers strategically lower their sponsored health insurance costs for 2024 while ensuring employees have optimal access to care and treatments. This is an essential listen for employers seeking to balance cost-efficiency with the provision of comprehensive, high-quality healthcare benefits to their employees.
August 10, 2023
9. Physician Offices: Fighting for Patient Access
Many of the most beneficial therapies are prescribed or administered within physician offices yet these providers face a multitude of challenges attempting to get authorization and coverage. In this podcast, we interview a practice manager who is not only on the frontlines of the battle to help patients but is also an award-winning advocate for access. This episode will explore the barriers faced by providers and their offices and what can be done to win the day-to-day battles with insurance companies and PBM’s so patients can access and remain on treatment.
July 6, 2023
8. Washington’s Influence on Patient Access
This episode delves into the intricate web of Washington’s influence on patient access, exploring the multifaceted factors that shape healthcare legislation, policies and their impact on patients, other key stakeholders and drug pricing. With an insightful interview from one of Washington’s top healthcare experts, listeners gain insight to the complexities of legislation, such as the Affordable Care Act and Inflation Reduction Act. This is certainly the “wonkiest” podcast episode as we attempt to provide an understanding of the current landscape of patient access and look ahead to how Washington’s decisions will shape the future of patient access.
June 1, 2023
7. Tackling Copay Accumulators and Maximizers
In this podcast, we interview a consultant and a leading patient advocate to better understand and explore the challenges of copay accumulator and maximizer programs for specialty drugs. We discuss the difference between the two programs and their impact on the various stakeholders including the overwhelming burden placed on patients. We also discuss the legal issues and potential policy changes that could eliminate these programs or minimize their impact on patients. Ultimately, our goal is to shed light on this important issue and identify strategies for improving access to critical medications for patients who need them.
May 9, 2023
6. PBM Perspective: An Interview with Industry Veteran Mesfin Tegenu
Pharmacy benefit managers (PBM’s) manage the drug benefits for millions of Americans and as a result, they can have a positive or negative impact on patient access. Mesfin Tegenu, an early pioneer in the PBM industry, is interviewed by Scott and Mark and offers his candid perspective on what PBM’s do, their impact on stakeholders and how the PBM industry could evolve over the next few years to better serve patients, employers, health plans and government payers.
