AH019 - Wrestling with Coverage of High-Cost CGTs, GLP-1s, and How to Meet Regulators' Intent, with Casey Stockman, PharmD

On this episode of the Astonishing Healthcare podcast, Casey Stockman, PharmD, Vice President of PBA Services, joins host Justin Venneri and shares her insights on the complexities of high-cost cell and gene therapies (CGTs), glucagon-like peptides (GLP-1s), and much more. Given the advancements in drug development and million-dollar-plus price tags for many of the CGTs, it is crucial for health plans to navigate the challenges of covering these therapies. Casey discusses outcomes-based agreements, annuity or mortgage models for payment plans, and the concept of risk pooling.She addresses concerns surrounding GLP-1s, specifically the expanded FDA approval for reducing major cardiovascular events, affordability and overall uptake of GLP-1s among Medicare patients, and the potential impact of rising utilization on total medical expenses. Casey also emphasizes the benefits of modern technology, such as JUDI®, in solving real hurdles for health plans by improving the coordination of benefits for dual-eligible members and having the flexibility to meet regulators' intent.Last, Casey shares an astonishing journey from provider to payer to patient.For more information and this episode's transcript, visit Capital Rx Insights!