Paying for Cures Webinar

Could the new CMS Rule on Medicaid Best Price make gene therapy value-based pricing common?

Paying for Cures Workshop

Could the new CMS Rule on Medicaid Best Price make gene therapy value-based pricing common?

Durable, potentially curative cell and gene therapies with short term treatment regimens promise to transform care for some conditions, but present significant financial risks and uncertain long term efficacy.

One of the biggest challenges to new financing models for innovative therapies the 1990 Medicaid “best price” rules, which ensures that the Medicaid program receives discounts at least as large as commercial payers. But CMS is implementing a new rule in January 2023 for tiered MBP reporting based on performance.

Important questions about implementation, participation, and pricing persist. Panelists in this webinar will bring both quantitative analysis and practical experience perspectives to bear on the issues.

July 21, 2022

11:00am – 12:00pm Eastern
Panel discussion and Q&A
Web conference

In this one hour webinar you will:

Explore the use of alternative payment approaches managing financial risk associated with curative therapies
Learn how the new CMS rule could lead to widespread feasibility and adoption of Value-Based Purchasing Arrangements
Learn what challenges remain and how they can be overcome by a combination of clever implementation and eventually, legislative enhancements to the Medicaid Drug Rebate Program

Ideal for:

Biopharmaceutical market access and government affairs
Payer pharmacy benefits and contracting
Employer benefits managers and benefits consultants
Specialty pharmacy and channel intermediaries
Policymakers
Patient advocates
…and all those interested in drug payment innovation

Hosted by MIT Center for Biomedical Innovation NEWDIGS Initiative

Panelists

Mike Ciarametaro, MBA
Vice President Research,
National Pharmaceutical Council

Michael Ciarametaro serves as the National Pharmaceutical Council's vice president of research. In this position, Mr. Ciarametaro conducts health policy research focused on addressing rising health spending and better aligning stakeholder incentives with value.

Mr. Ciarametaro has 20 years of experience creating value in the health care system through policy, research and leadership. His cross-disciplinary expertise spans multiple roles (policy researcher, strategic value and market access consultant, financial analyst, operations and process designer) and multiple areas of the health care ecosystem (health policy research organization, biopharmaceutical industry, private payers, public payers). For the past six-plus years, Mr. Ciarametaro has been focused on health policy research with an emphasis on addressing rising health spending and better aligning stakeholder incentives with value.

Mr. Ciarametaro holds a Bachelor of Science from the University of Virginia and received his MBA from George Mason University.

Dorothy Hoffman
External Engagement and Access Policy Lead,
Pfizer

Dorothy Hoffman leads the External Engagement and Access Policy team in Pfizer’s Healthcare Innovation Center. She is responsible for leading Pfizer’s Enterprise strategy on access policy with a focus on value-based healthcare, digital health, and equitable access to health.

Dorothy has over 18 years of experience in the pharmaceutical and managed care industries. Previously, she was Vice President of Prescription Drug Policy at UnitedHealth Group. Her team was responsible for implementing the company’s pharmacy care services transformation and growth initiative with federal and state health programs.

Dorothy started her career at Eli Lilly and Company where she held multiple roles of increasing impact and management responsibility in Corporate HQ, the US affiliate, the United Kingdom, and Belgium.

Dorothy has a Masters in Public Policy. She lives in the New York City area with her husband and son.

Gail Ryan, PharmD
Director, Pharmaceutical Transformation, Clinical Innovation
Point32Health

Gail Ryan is the Director of Pharmaceutical Transformation at Point32Health, the parent organization of Harvard Pilgrim Health Care and Tufts Health Plan, two of New England’s most iconic nonprofit health care companies. Point32Health serves over 2 million lives and is an industry leader in innovation and value-based contracting. As a clinical pharmacist with 20 years of managed care experience, Gail’s practice has spanned the pharmacy benefit, medical drug policy, trend analysis, cost management initiatives and clinical innovation. In her current role and through partnerships with multi-stakeholders, she is driving equitable access to high-quality, transformative therapies while addressing emerging trends, challenges, and financial risk. Gail holds a Bachelor of Science Degree and a Doctor of Pharmacy, both from the Massachusetts College of Pharmacy and Health Sciences.

Mark Trusheim, MS
Strategic Director, NEWDIGS;
Visiting Scientist, Sloan School of Management,
Massachusetts Institute of Technology

Mark Trusheim is a Visiting Scientist and Executive-In-Residence at the MIT Sloan School of Management. He has been a Special Government Employee for the FDA’s Office of the Commissioner and is the Founder and President of Co-Bio Consulting, LLC. He holds degrees in Chemistry from Stanford University and Management from MIT. His research focuses on the economics of stratified (personalized) medicines, particularly the integrated quantitative modeling of stratified medicine development and commercialization, to inform public policy, corporate strategy and individual product development programs. Together with the FDA and industry, he led a multi-disciplinary consortium to examine the economic challenges of co-development of companion diagnostics and therapeutics whose work was covered by the Nature Review Drug Discovery.

In addition, he has been a frequent invited speaker on stratified medicine at international conferences and conducts confidential workshops and analyses for biopharmaceutical and diagnostic firms. Prior to his work in stratified medicine, he was a Board Member and Interim President of the Massachusetts Biotechnology Council. As an entrepreneur, he founded and was the first President and CEO of Cantata Laboratories which developed and marketed biochemical profiling clinical diagnostics and pharmaceutical biomarker services.

Prior to Cantata, he worked at Monsanto/Pharmacia, culminating his career there as Co-President and Chief Operating Officer of Cereon Genomics, LLC-a 5 year, $500M collaboration with Millennium Pharmaceuticals, and held roles of Vice President in the Health & Wellness Sector, Marketing Director in Searle Pharmaceutical and Director in Agriculture Division Strategy. He spent the first half of his career in the high tech industry at both Wang Laboratories in computer hardware and the start-up Kenan Systems Corporation which focused on developing quantitative models and artificial intelligence based applications for large corporations and government agencies.

Agenda

Welcome and introductions

Mark Trusheim, Strategic Director, NEWDIGS; FoCUS Project Lead; Visiting Scientist at MIT Sloan School of Management
Gigi Hirsch, Executive Director, MIT Center for Biomedical Innovation (CBI); Director, NEWDIGS Initiative at MIT

Framing the Issues
Definition of Cell and Gene Therapies and their unique challenges/risks for self-insured employers including toolkit.

Mark Hansan, President and CEO, CareMetx

Drug development pipeline
Currently approved treatments and near-term pipeline of expected products

Colin Young, Director, Drug Development Pipeline Research, NEWDIGS FoCUS Project

Implications for stop-loss coverage

Jane Barlow, Senior Advisor, NEWDIGS FoCUS Project and Moderator

New commercial solutions

Jane Barlow, Senior Advisor, NEWDIGS FoCUS Project and Moderator

PANEL & DISCUSSION

Actions self-insured employers can take today

Jane Barlow, Senior Advisor, NEWDIGS FoCUS Project and Moderator

Recap and conclusion

Mark Trusheim, Strategic Director, NEWDIGS; FoCUS Project Lead; Visiting Scientist at MIT Sloan School of Management

Registration

Thursday, July 21
11:00am – 12:00pm Eastern
Web conference: Panel discussion and Q&A
Registration is free

NEWDIGS

NEWDIGS

Paying for Cures Webinar

Could the new CMS Rule on Medicaid Best Price make gene therapy value-based pricing common?

Paying for Cures Workshop

Could the new CMS Rule on Medicaid Best Price make gene therapy value-based pricing common?

July 21, 2022

PANEL & DISCUSSION

Thanks in advance

Help shape NEWDIGS tools and resources for the future