Sara Drake RPh, MPH, MBA
@SaraDrakeRx
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I help state Medicaid programs project and manage their prescription drug expenditures. Medicaid | Pharmacy | Consultant | Leader
Saint Paul, Minnesota
Joined June 2022
The Inflation Reduction Act is now law and includes provisions that will affect Medicaid programs. Let's talk about it.
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A3: Some private plan sponsors have explored financing models like pay over time for high cost drugs. Challenges in the #Medicaid rebate structure have made similar models challenging to implement. #MercerChats
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A3: Speaking of Sovaldi and Hep C @samespinosa_mmc , some #Medicaid programs have been successful with implementation of subscription models for select drug classes such as #HepatitisC. There may be potential for similar models for #PrEP or #HIV. #MercerChats
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A3: At the same time as presenting clinical opportunity, #GeneTherapy will create financing challenges to employers and state Medicaid programs. Payers will need to explore risk mitigation solutions to align with program and budget goals. #MercerChats
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A2: The availability of #biosimilars for some blockbuster drugs has the potential to be a game changer. For the employer market, it’s a potential decrease in benefit cost. For the Medicaid market, it’s an opportunity for increased rebate negotiations. #MercerChats
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A2: Manufacturers are pushing back on #340B through restrictions on sales to contract pharmacies despite pressure from federal regulators. Any #DrugPriceReform package needs to include a vision for a path forward on #340B. #MercerChats
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A2: I think we are approaching a #340B crossroads. The program has grown exponentially over the last decade and now accounts for nearly 15% of total drug sales. #MercerChats 340B Program Continues to Grow While Contract Pharmacy Restrictions Take Effect - IQVIA
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A2: As we wind down from the #PHE, many individuals will move from Medicaid back to employer or exchange coverage. Governments, employers, and #PBMs need to coordinate to make the process seamless. #MercerChats
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A1: Government and employer markets alike are exploring new innovations in financing high cost drugs. The new @CMS VBP rule may streamline the process for outcomes based contracting. #MercerChats
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A1: Government market is really beginning to question and redefine the role of the #PBM in #Medicaid managed care. States are seeking increased #PBMTransparency to better understand how #Medicaid pharmacy dollars are used. #MercerChats
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A1: Despite uncertain efficacy and durability, patients, employers, and governments are being charged high prices for accelerated approval drugs. #MercerChats
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A1: The complexity of the pharmacy benefit is a significant challenge facing payers. #PBMs, rebates, GER/BER reconciliations, administrative fees, copay maximizers, spread pricing, #340B. To navigate the challenges, you first need to learn the language. #MercerChats
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Join us tomorrow for an engaging discussion on the challenges and opportunities in the pharmacy benefit space! #Mercerchats
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The Medicaid drug rebate and 340B structure provides a disincentive for manufacturers to increase drug prices for existing products over time. Unfortunately, that creates an incentive for high launch price. #drugpricereform
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We aren't imagining it -- prices for new drugs at launch are going up, with no end in sight. #drugpricereform
nbcnews.com
The launch prices of new drugs rose, on average, by 11 percent every year from 2008 through 2021, researchers found.
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Check out our state policy preconference on family caregiving and the direct care workforce on Sept 12
Early bird registration for #NASHPCONF22 is OPEN! Join hundreds of state leaders from all over the country for insightful conversations, engaging sessions, and meaningful connections:
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