Show Me the Money: Reimbursement in an ACA World

A panel at the BIO CEO & Investor Conference focused on reimbursement discussed value from a variety of perspectives and agreed that the landscape is shifting dramatically. The reimbursement roundtable featured payors, providers, and other stakeholders discussing Affordable Care Act (ACA) implementation and the wider reimbursement landscape.

With many key provisions of the ACA slated to take effect in 2013 and beyond, the industry is facing sweeping changes to the managed care and reimbursement road map.  This new environment will affect relationships between patients, payors, providers and biopharma companies.

Rena Conti, PhD, Assistant Professor of Health Policy & Economics at the University of Chicago asserted, “It’s not just guideline-based care, it’s value-based care now.”

From a payor perspective, panelists agreed that there are both economic and quality objectives being carefully weighed. As Peter Bach, MD, MAPP, Director of the Center for Health Policy and Outcomes at the Memorial Sloan-Kettering Cancer Center was quick to point out that ‘we can make good decisions for patients that also make good sense financially.’

Bach went on to say that the value conversation can be all-encompassing – “Nobody can define value so everybody gets to claim it.” Bach also noted that there is a veneer, or general impression, that there is assessment being conducted.

Conti added, “We don’t have one institution to provide assessment and I don’t think we’ll have one in the near term.”

Roger Longman, Chief Executive Officer of Real Endpoints moderated the session, and raised Pharmacy and Therapeutics (P&T) Committees as ‘possibly the most influential assessment groups.’

Cynthia Smith, Vice President of Market Access & Commercial Development at Affymax suggested that within the next five years, we must ensure that approvals and assessment are well defined, adding that it investors need to pay more attention to the reimbursement landscape that lies ahead.

Bach closed the session by emphasizing that the approach to reimbursement must be focused on the best course of treatment for patients.

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