Asembia’s AXS23 Summit wrapped up last Thursday after three days of insightful discussions, continued education, and networking. The annual access to pharmacy conference welcomed thousands of the nation’s leading pharmacy and pharmaceutical industry decision-makers to Las Vegas, including 14 Syneos Health value and access attendees.
Below are the top trends we saw that are shaping the market access industry.
1. The Inflation Reduction Act
The Inflation Reduction Act (IRA) was a hot topic at AXS23, with many sessions discussing its implications on the pharmaceutical industry. For pharmaceutical manufacturers specifically, there are a few key elements that will likely have great impact. First, the Part D improvements and re-design will shift liabilities away from The Centers for Medicare and Medicaid Services to payers and manufacturers. The prescription drug inflation rebates will result in a penalty paid to CMS for price increases that exceed CPI-U. And finally, the maximum patient pharmacy out-of-pocket limit is now set at $2,000 annually.
The IRA has created an existential moment throughout the industry, and we’re watching the impact of it closely.
2. Biosimilars
Biosimilars are biologic medical products that are almost an identical copy of an original product that is manufactured by a different company. These biologics increase access to lifesaving medications at potentially lower costs, and the pharmaceutical industry has jumped at the opportunity to offer lower-cost drugs to patients who need them.
Since 2007, 30 biosimilars have launched in the U.S. with 10 more approved and set to launch in the U.S. by the end of 2023. The pharmaceutical industry is at the precipice of something industry-changing with biosimilars, and we predict that this conversation has only just begun.
3. Value-Based Care
Value-based care is a fundamental shift in the healthcare system that’s changing how care is paid for. On VBC models, payers and providers are incentivized to focus on the quality of care metrics and sometimes health outcomes, as opposed to the traditional volume-based Fee-For-Service (FFS) model. While there are pros and cons to this new model, VBC was a constant discussion throughout the conference.
4. Patient Access Disparities
The cost of specialty drugs is high, and patients from low-income backgrounds or with limited insurance coverage often face the greatest barriers in accessing and paying for specialty drugs. Access to specialty drugs can be limited by factors including geography, race, ethnicity, and gender. Many panels discussed solutions and market access opportunities for diversity and inclusion, while acknowledging that there’s a very long way to go. Addressing patient access disparities is a complex, yet necessary challenge, and we’re hopeful that these industry conversations spark real, lasting change for patients.
5. Expanding Payer Control
Payer control of new launch products continues to increase over time, making it harder for brands to convert patient demand into volume. This increasing control is impacting patient care, with 9 out of 10 physician's reporting that prior authorizations cause delays in patient care. (Source: Modernize Prior Authorization to Ensure Access to Care. Rheumatology.org.)
Growing specialty control has pressured demand at every turn, and the pharmaceutical industry is in a unique, challenging time.
If you’re interested in discussing these trends with our market access experts, reach out to Melissa Bojorquez at [email protected] to start the conversation.
