Nirali Rana, PharmD, RPh, CCMP™, Prosci®

Monday Motivation! Hope everyone had a great weekend, and a Happy Mother's Day to all that celebrated. Sharing a little bit of data this morning to get you thinking. If ~45% of all mental health screenings are done by NPs and PAs, wouldn't it make sense to include them in your marketing plans? Wouldn't it make sense to engage them and educate them on your products? Reach out - let's work together. #mentalhealthawareness #healthcaremarketing #mondaymotivation

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Last Friday, The New York Times reporters Rebecca Robbins and Reed Abelson published the first article in a series about “how pharmacy benefit managers prioritize their interests, often at the expense of patients, employers and taxpayers.” This piece, informed by hundreds of interviews, is a highlight reel for anyone familiar with the ongoing drug pricing debate. It points out several key issues: 💡 Perverse system incentives favor prescription medicines with higher list prices and larger rebates rather than lower-cost options. 💡 Consolidation in the health care system results in patients cycling between different divisions of three vertically-integrated companies for care and reimbursement. 💡 There is a steady increase in discounts, rebates, and fees paid by manufacturers, but there is no way to ensure those increases are used to help patients access and afford the medications they need in the form of lower copays or cost-sharing. At Sanofi, we see these dynamics first-hand and bring these concerns to light in our annual Pricing Principles report to advocate for a better, patient-focused system. In 2023, Sanofi had a 15% increase in fees – or service charges – paid on top of negotiated rebates to PBMs and health plans in Managed Care, Medicare Part D, and Managed Medicaid agreements. In total, we paid about $1.4 billion more in negotiated rebates and fees than in 2022 – almost an 18% increase year-over-year. Yet, too many patients still struggle to afford their medicines.  The issues discussed may not surprise those who study the disconnect between the rebates, discounts, and fees the industry pays to PBMs and the price patients pay at the pharmacy counter. However, there are millions of people who now have a better understanding of what a PBM is—and many of those readers experience firsthand the issues exposed in the article. Will this be the spark that pushes PBM reform over the finish line? I look forward to seeing what Rebecca and Reed publish next. https://lnkd.in/gyVs35x5

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An oldie but a goodie, and this was 5 years ago. Highlights: -Enormous Revenue: The five biggest companies (Anthem, Cigna, CVS Health, Humana, and UnitedHealth Group) are expected to generate nearly $787 billion in revenue in 2019, surpassing the combined earnings of major tech giants like Facebook, Amazon, Apple, Netflix, and Google. -Prioritizing Profits Over Public Health: Although these healthcare companies are less profitable than the tech companies, they still make substantial profits by controlling a significant portion of America's healthcare and pharmaceutical sectors. This includes owning surgery centers, doctors' offices, and data analysis firms, which all contribute to their profit-making strategies, potentially at the expense of public health interests. -Lobbying Efforts: The passage suggests that these companies are actively lobbying to delay or repeal taxes that could reduce healthcare costs for consumers. Instead, they aim to increase their own financial gains. -Consolidation and Market Control: Through mergers and acquisitions (e.g., CVS buying Aetna, Anthem creating its own PBM), these companies have gained significant control over both health insurance and pharmacy benefits for more than 125 million Americans. This consolidation raises concerns about reduced competition and potential negative impacts on consumer choice and costs. #PBMreform

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This post is intended for a US audience only: We can’t eliminate lung cancer as a cause of death, unless every high-risk person has access to early screening and diagnosis – including the communities that surround our US Oncology headquarters. AstraZeneca is partnering with the University of Maryland Medicine to expand lung cancer screening access across the state. Working with a state-based steering committee of academic, industry and community groups, our investment over five years will help to:  Expand screening programs and tobacco cessation programs  Improve early detection in at-risk populations  Drive research in cancer health disparities, especially for minority and rural communities  Today, only 3% of Marylanders who should be screened for lung cancer are actually having regular scans. That enormous gap in care means that many people are missing the opportunity to find their lung cancer earlier, when they have more treatment options available. These patients are our neighbors, family and friends – we have to seize this chance to connect them to potentially lifesaving interventions. It’s not enough for AstraZeneca to develop powerful lung cancer therapies. We believe that every patient at every stage deserves full-circle support, regardless of where they live or their ability to pay for screening or treatment. And this partnership is another way we can act on our commitment to patients and make a meaningful impact in our own backyard.  #AstraZenecaUS #AZUS  https://lnkd.in/e8_Nf2Gn

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Social determinants of health (SDOH) are becoming increasingly crucial in our already complex healthcare environment from a data collection, reporting, and action perspective. This week I’m sharing a link to a white paper I wrote about how patient service programs can incorporate actionable, tactical, and scalable solutions to help address SDOH challenges, advance health equity, and achieve better health outcomes for patients. Let’s connect if you’d like to discuss more… https://lnkd.in/ect4H9N3

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Do you feel like you are managing your 340B program all on your own? What if I told you #SUNRx clients enjoy a complete team of #340B experts who work with you to optimize your program to be as compliantly productive as possible? It's true! #SUNRx doesn't just supply you with data, but actually works your program with you. Reach out to me today to learn more!

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🌡️ Mandatory reading for #HEOR professionals Stewing on this blog from Scott Ramsey with the Curta team this week and appreciating the candor. At the same time, I played back an investor call for a company releasing pivotal data at #EHA. The first question from investors? It was about patient-reported outcomes. The second question? About EU access strategy. These are two subject areas where HEOR shines! As such, I agree with Scott’s conclusions… “As long as the organizations that pay for these products ask for the information that HEOR provides, pharma will be obliged to supply it.” Additionally, I believe we should dispense with box-checking exercises and focus on the research that: 1️⃣ Matters to patients first 2️⃣ Drives shared decision-making Thoughts are my own. No AI tools used. #biotech #patientreportedoutcomes #marketaccess #healtheconomics #medicalaffairs

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https://lnkd.in/eXCyJZTr Retail pharmacies accounted for $307.8 billion (42.6%) of total expenditures, mail-order pharmacies $206.6 billion (28.6%), clinics $135.7 billion (18.8%), and nonfederal hospitals $37.1 billion (5.1%). Drug cost inflation was marginal (2.9%) and for the fourth straight year lagged the 3.4% inflation in the overall economy as measured by the Consumer Price Index Spending for semaglutide doubled in 2023, making it the top-selling drug in the nation, replacing autoimmune disease drug adalimumab, which also saw sales growth despite the availability of cheaper biosimilars.

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Yesterday marked a monumental day as LucyRx officially launched into the PBM market—a space that has long needed fresh alternatives to the current model. I couldn't be more proud of the dedicated LucyRx team including Alexander Motola, Josh Lynn, Alexandria Valentino, Loriann Riviello, Martin Payne, Eric Estes and all of the supporting team members, who have tirelessly worked over the past 18 months and most recently sprinted to bring our vision to life - of course guided by the inspiring leadership of our CEO David Blair. In a short time, we have released superior analytics capabilities, assembled top talent, established valuable vendor partnerships and built programs to address the most concerning drug categories. At LucyRx, we pride ourselves on true autonomy and independence, breaking free from the restrictive financial constructs and supply chain arrangements that bind the big three and every other PBM that relies on them. Our cutting-edge technology isn’t just about transparency—it’s about empowering clients with real data and conflict-free choices. Discover the LucyRx difference, where innovation meets integrity, and transparency isn’t just a promise but a practice. Read the full press release to learn more about our journey and follow us to stay up to date on our progress. #LucyRx #PharmacyBenefitManagement #HealthcareInnovation #TransparencyMatters https://lnkd.in/eZ4QGEhG

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Military families often face significant healthcare challenges, with nearly half of U.S. military bases located in "health care deserts." This issue is not just about access—it's about the quality of life and readiness of our service members. Back in 2016, the VA empowered Nurse Practitioners (NPs) by granting them full practice authority within VA facilities. This bold move opened new doors for pharmaceutical companies to collaborate with NPs and leverage their essential role in patient care. Pharma marketers, now is the time to engage with these key providers to ensure that our troops and their families have access to the medications and care they deserve. Let's turn these challenges into opportunities for meaningful change. 🌟 Read more about how we can collectively make a difference: POCN Group LinkedIn Post #Healthcare #MilitarySupport #PharmaceuticalMarketing #NursePractitioners #PhysicianAssistants #Leadership

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There are endless barriers for patients to initiate and adhere to their specialty medications, from cost to insurance approvals and beyond. In our recent #blog, we break down some of these barriers and discuss the ways in which innovative technologies can help patients and providers accelerate enrollment and achieve better outcomes. ⚡ Check it out! #specialtypharmacy #digitalhealth #medaccess

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#representationmatters. Cheers to each of those recognized for putting themselves out there -- and showing the next generation there is a seat for them at the table. Check out the article to learn more about the #Biopharma #leaders charting a path for the industry's #LGBTQ+ community: Endpoints News

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There continues to be challenges on the battle fronts of community-based pharmacies. On the heels of the DIR cliff and now newly applied PBM true ups from claims three years ago, a "new program" that continues the opaqueness, convoluted, and complicated system of health plans and their pharmacy benefits has been initiated. This integrated pharmacy benefit with a national drug discount card company and its' additional fees may be the final death knell for many community-based pharmacies leading to more closures and pharmacy deserts. https://lnkd.in/gnRj3pXq

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While #ISPORAnnual is wrapping up, one of the key themes was #healthforall and #healthequity. To contribute to the discussion about if, when and how information about #healthdisparities can be reliably integrated in #regulatory and #HTA submissions, we share our just published manuscript presenting results from an environmental scanning of publicly available population #datasets utilizing disaggregated data to investigate and quantify the scope of #healthinequalities. Interactive interfaces (e.g. #WHO #HealthInequalityDataRepository, Canada’s #HealthInequalityDataTool and England’s #HealthInequalityDashboard) can serve as valuable tools in healthcare decision-making. Lydia Vinals Amruta Radhakrishnan https://lnkd.in/gwSUuj6U

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A Call for more Market Access programs. I woke up unhappy at the widening inequity in healthcare access and one more potentially inevitable source of inequity popped up in my mind. The question that came to my mind was could weight loss medications such as Ozempic further worsen the gap in health outcomes of the rich and the poor? The question is valid because poor people, unemployed people, underemployed people tend to have inadequate access to healthcare, they also tend to be less healthy, they tend to be more likely to eat "junk food" and be obese, these combination tend to increase their risk of diabetes, Hypertension and chronic kidney disease. Unfortunately, they also do not have adequate health insurance to provide access to medications like Ozempic and other medications that prevent chronic diseases like diabetes, Hypertension and Chronic kidney diseases. In the end, the rich and well to do get healthier while the poor are less healthy. Global Pharmaceutical Companies, Global Health Organizations need to do more to improve access to life saving medicines. We need more Market Access Programs.

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Shift happens I noted a couple of intriguing posts this week that seem to chronicle not-so-subtle organizational shifts in life-sciences companies. The first, John Graham’s post (https://lnkd.in/g5R-j2pR) highlighting Scott Ramsay’s observations on potentially bumpy roads for HEOR and the second, Alexander Bedenkov’s post (https://lnkd.in/gyH8x8fs) on the evolved role of Medical Affairs. I was waiting for a third post chronicling related shifts associated with innovative uses for data and technology in pharma, but I suspect it wouldn’t take much digging to find that one. We are clearly in a transformational time in our industry and, as a result, (organizational) shift happens. As I see it, it’s healthy and can be a true win:win:win scenario, for patients, providers, and pharma (and maybe even payers) in terms of better clinical, economic, and humanistic outcomes. Life-sciences companies will always grapple with the financial challenges associated with development failures, and many decisions based on short-term realities will be difficult to recover from. But the focus on documenting and communicating the potential for improved outcomes and value has never been more important in product development and commercialization: the trick is figuring out the optimal organizational structure and processes that can deliver on this focus. Scott notes that work traditionally “owned” by HEOR seems to be shifting toward different departments; namely, Medical Affairs and Market Access. As a founding member of ISPOR, I’ve been proud of the Society’s role in advancing health economic methodology, but I’ve always been concerned that we’re not doing enough to demonstrate the value of the HEOR function and to equip the HEOR professional with tools to optimize their organizational role. Alexander’s article on the crucial role of Medical Affairs reflects my observation that --- particularly when it comes to RWE and RWD --- the sun is shining on Medical Affairs, and effectively bridges the organizational gap between Clinical Development and Commercialization. Yet, I found it interesting when attending the ISPOR Annual Meeting last month that RWE, RWD, AI and other related topics were fairly prominent alongside of “meat and potatoes” HEOR subjects. The need for compelling and scientifically sound real-world data has never been greater than now and, as a result, pharma is going to find the optimal organizational structure to ensure that product value is documented and communicated to the right decisionmakers. I continue to advocate for a Chief Evidence Officer position, with the requisite authority to ensure that processes are optimized over the entire continuum of the life-sciences company…  

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