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Getting from multichannel marketing to customer-centric marketing

In exchange for his support of Donald Trump’s candidacy for president, Robert F. Kennedy threw his own name into the mix, and has officially been nominated by the president-elect as the as next Secretary of Health and Human Services. His stated objective is to focus on food safety, referencing the proliferation of processed foods and additives, and tackle the increase in chronic diseases.

However, given RFK’s reputation as a vaccine denier, putting him in this position could scare some. Setting RFK’s candidacy aside, is there a need to develop a better integrated policy that addresses population health issues and disease prevention with a critical look at our food supply and breaking out of food and pharmaceutical silos?

There is significant evidence that many of the ingredients in food products that we find on the shelves in supermarkets are simply unhealthy. Widespread consumption of high-fructose corn syrup has contributed to multiple health consequences, such as insulin resistance, obesity, liver disorders, and diabetes.

 Poor metabolic health has further been linked to diabetes, cancer and Alzheimer’s disease.

 Many other ingredients in our food products have been found to have a negative impact on our health. Propylene glycol, an emulsifier, is widely used in, for example, low-fat salad dressings and the main ingredient in some deodorants. It can cause very severe allergies, which do not clearly show up in allergy skin tests.

 Ironically, most of the dermatological prescription ointments used to treat the resulting eczema also contain propylene glycol. There is a long list of food ingredients that the FDA deems non-toxic, but that are, nevertheless, causing damage. California has started to ban

 a number of ingredients from public school foods and beverages. In my opinion, the FDA seems to act as a follower rather than a leader in this area.

As mentioned, metabolic disease is thought to be a major contributor in cardiovascular disease, cancer, and Alzheimer’s disease. With a third of the US population being obese, and an additional third overweight, the need for good treatments is humanistically and economically crucial. Alzheimer’s disease alone is projected to bankrupt Medicare,

 state Medicaid programs, and individual patients if effective treatments are not found.

The pharmaceutical industry has been able to provide many new treatment options for debilitating diseases. Some anti-cancer drugs have been able to significantly alter the course of the disease. Progress has been made with Alzheimer’s disease drugs as well, but we are still far off from widespread meaningful treatment solutions for these and many other diseases, some of which are believed to be primarily caused by our unhealthy lifestyles and the foods that we consume.

The glucagon-like peptide-1 (GLP-1) agonists semaglutide and high-dose liraglutide are FDA-approved drugs to help the treatment of obesity. Beyond obese patients, these drugs have helped many overweight and individuals reverse the impact of poor nutrition and lifestyle habits, but we need to ask ourselves whether weight losses are sustainable in the long term and whether they further accommodate poor diets.

Provider organizations are increasingly considering the need for social care for patients in addition to their medical treatments, emphasizing relationships between housing, social setting, and therapy outcomes. Social care programs, such as the National Diabetes Prevention Program, assist patients with getting access to food, housing, healthcare, and other social services.

On a government level, we may also need a better integration between all health-related policies, including food (FDA-approved ingredients and related communications), prevention- and treatment-focused medical care, and sports/recreational investments. Individuals have a personal responsibility to make the right choices, but today, choices may simply not be available or insufficiently communicated and incentivized. Is clear labeling enough, or should certain ingredients (such as the aforementioned high-fructose corn syrup) be banned from foods?

The pharmaceutical industry is currently benefiting from the GLP-1 hype and it may save lives of individual patients. However, what will be the longer-term impact on population health? The next generation of obesity drugs may be very safe and effective, but wouldn’t it be better if less than two-thirds of the population need them?

Ed Schoonveld is a value & access advisor for Schoonveld Advisory and author of The Price of Global Health.

1. Samuels B. Trump Says He’ll Let RFK Jr. ‘Go Wild’ on Health and Food in Potential Second Term. 

https://thehill.com/homenews/campaign/4956319-trump-says-hell-let-rfk-jr-go-wild-on-health-and-food-in-potential-second-term/

2. Mai, B.H.; Yan, L.J. The Negative and Detrimental Effects of High Fructose on the Liver, With Special Reference to Metabolic Disorders. 

 https://pubmed.ncbi.nlm.nih.gov/31213868/

Outlive: The Science of Art and Longevity.

https://www.euronews.com/green/2019/01/07/the-truth-behind-propylene-glycol#:~:text=Allergy%20risk%20of%20propylene%20glycol&text=The%20US%20Food%20and%20Drug,reported%20in%20the%20scientific%20literature

5. Wick, J.Y. And the Allergen Winner is: Propylene Glycol! 

https://www.contemporaryclinic.com/view/and-the-allergen-winner-is-propylene-glycol

6. Siegner, C. California Bans More Ingredients. 

https://www.foodbusinessnews.net/articles/26905-california-bans-more-ingredients#:~:text=Beginning%20on%20Jan.,Missouri%2C%20New%20York%20and%20Washington

7. Alzheimer’s Association’s Most Expensive Disease Handout. Alzheimer’s Association

https://act.alz.org/site/DocServer/112114_Most_Expensive_Disease_Handout.pdf?docID=40161

Is the potential of a more formal policy integration for health issues and disease prevention a scary suggestion or a good idea?

Policy and Population Health

Copay, Reimbursement, and Access Congress—an Informa Connect conference held in Philadelphia this past November—provided an essential forum for healthcare professionals, policy experts, and industry leaders to tackle some of the most pressing challenges in the evolving access and reimbursement landscape. With a diverse array of panel discussions and presentations, the three-day conference shed light on national policy trends, strategic solutions, and best practices for advancing patient access to care and optimizing stakeholder reimbursement strategies.

Among the standout sessions were two presentations focusing on key legislative and regulatory updates and actionable strategies to enhance access and affordability for medical benefit products.

The session titled "Legislative and Regulatory Update: Executive Policy Address" was delivered by Mark Gooding, managing director at Avalere Health, and Kate Sikora, deputy vice president of policy and research at the Pharmaceutical Research and Manufacturers of America (PhRMA). This presentation centered on the impact of shifting healthcare policies and legislative changes, particularly in anticipation of the new Congress and Presidential administration set to take shape this month.

The panel discussion focused on two key topics:

State of play across key healthcare policies

: Gooding and Sikora detailed several critical issues influencing patient access, including copay adjustment programs (accumulators and maximizers), alternative funding programs (AFPs), and ongoing pharmacy benefit manager (PBM) reforms. Additionally, the speakers highlighted the Inflation Reduction Act policies set to launch in 2025, such as the Medicare Prescription Payment Plan (also known as Part D out-of-pocket smoothing), and the potential impacts on drug pricing.

Post-election landscape and legislative priorities

: The session also explored how the 2024 elections outcomes will lead to an expected shift in priorities. Both speakers addressed the likelihood of increased legislative activity around transparency in copay support, PBM payment structures, and additional state-level restrictions on accumulator programs (see Figure 1).

Gooding emphasized that stakeholders, including manufacturers and payers, need to prepare for regulatory uncertainties and the evolving policy environment. Sikora reiterated the importance of tracking legislative developments, particularly state-level reforms that often serve as precursors to federal action.

Another session at the Congress, “Optimizing Coding and Billing Strategies to Enhance Access in Programs for Medical Benefit Products,” featured Jessica Cortez, principal at Avalere Health; Ticia Cawley, vice president of client solutions at ConnectiveRx; and Lilian Buch, director of reimbursement strategy at Amgen. This session focused on the role of coding and billing in ensuring seamless access to medical benefit products and reducing barriers for patients.

Three key areas that were highlighted in the session include the following.

Understanding coding systems and their relevance

: The panel outlined common coding frameworks, including the Healthcare Common Procedure Coding System (HCPCS), Current Procedural Terminology (CPT), and the National Drug Codes (NDCs). They emphasized the importance of precise coding for coverage and reimbursement. Cortez noted that codes start translating the patient journey into payer language, while inaccurate coding can impact coverage decisions, reimbursement rates, and the financial health of providers and patients.

Affordability programs and product launch considerations

: Buch shared best practices for aligning affordability programs with product-specific coding and billing strategies. She stressed tailoring support to address payer requirements and ensuring that benefit verification processes are streamlined. Cawley discussed emerging trends in buy-and-bill claims, assignment of benefits (AOB) processes, and hybrid coverage models that combine pharmacy and medical benefits programs.

: A key takeaway here was the need to remain updated with evolving coding and billing standards. The panel highlighted risks, such as coding errors, misaligned documentation, and the impact of off-label use. Attendees were urged to implement robust environmental analysis of coding changes by following CMS for ICD-10 dockets, Physician Payment rulemaking, and the American Medical Association (AMA)’s CPT dockets and provider notices to understand how the evolution of the coding system will change their access and affordability program post-launch.

The panelists emphasized the importance of having clear communication between stakeholders—manufacturers, reimbursement teams, and field staff—to ensure successful program execution. Cawley recommended leveraging technology to track key performance indicators, such as claim patterns, average copay amounts, and persistency data to optimize access programs.

The importance of building resilience through strategic partnerships

The insights shared in both sessions underscored the interconnected nature of policy changes, coding strategies, and access optimization. Key takeaways include:

: Stakeholders must proactively monitor legislative and regulatory changes, particularly given the shifting political environment post-2025 elections.

: Accurate and efficient coding processes are critical to minimizing access barriers and improving affordability.

: Collaboration with expert organizations can help manufacturers and payers navigate complex policy shifts and operational challenges.

As the access and reimbursement landscape evolves, forums like the Copay, Reimbursement, and Access Congress are facilitating dialogue among stakeholders and sharing solutions. By embracing innovation, compliance, and strategic partnerships, industry stakeholders can ensure that patients maintain access to needed therapies while navigating an increasingly complex regulatory environment.

Jessica Cortez is a principal at Avalere Health with experience establishing partnerships with life sciences companies to drive strategic initiatives focused on transformation. Cortez leads the annual review of the Medicare Physician Fee Schedule (MPFS), specializing in coverage, coding, regulatory, and economics.

Mark Gooding, also of Avalere Health, is a managing director who provides life sciences companies strategic guidance on policy developments and reimbursement considerations. He analyzes federal- and state-level policies, and develops strategies to drive coverage and improve market access.

A forum intended for HCPs, policy experts, and industry leaders addresses pressing obstacles facing this sector of the industry today. 

Latest Conference Coverage

Navigating Access and Reimbursement Through Uncertainty 

Industry Challenges

PC: What have been some of your goals in terms of what you wanted to accomplish here at Trade & Channel Strategies?

I always look at Trade & Channel as a nice capstone to the year. It's a great time to assess what's been accomplished in the year and get ready for the coming year, and also connect with a lot of great industry colleagues to find out what the hot issues are. Obviously, our goals were to do all those things, and I think the biggest thing that happens is we use this meeting as a springboard into next year by setting the stage for addressing a lot of those key issues that are discussed here at the meeting.

PC: Have there been any sessions in particular that have caught your eye?

There are two that stand out right now. First is the keynote session, which is speaking to the issues that the industry is facing across stakeholders in terms of the pressure from regulatory and the impact from the Inflation Reduction Act. It’s getting challenging now in terms of margin compression and regulatory issues that have to be dealt with in compliance. There’s also a number of headwinds ahead, primarily from a standpoint of more GenMed and what I would call tweener therapies. There’s still room to maneuver from the standpoint of specialty therapies and infuse therapies in the pipeline.

I would say that in general, the main context is how are we dealing with some of these and what structural changes do we need to make to be able to still be profitable, competitive, and grow in this more challenging environment. The other is just around data, obviously AI, and the impact of AI on everything we do is upon us. There was a great session on data and analytics that I just attended. Where do we apply AI, where do we start first when we're trying to enhance and create new structures for data governance and data management?

Jon Hamrick, partner, Curatio Scientia Advisors, discusses upcoming industry challenges at this year's Trade & Channel Strategies Conference in Philadelphia. 

Trade & Channel Strategies 2024: Navigating Industry Challenges

Today, there are various health-related social needs (HRSNs) that oftentimes go unmet—such as food insecurity, transportation challenges, housing instability, and utility obstacles—which can impact a person’s health. With healthcare being considered a shared responsibility that spans multiples sectors and contributes to enhancing both the health of the population and health equity, efforts—specifically in the United States—have been underway to design a system that utilizes social care to tackle HRSNs, while reducing health inequities.

When it comes to physicians, addressing HRSNs in a clinical practice setting could include screening and connecting patients to social services,

 and interestingly enough, their engagement when it comes to addressing HRSNs has not been fully measured thus far. Keeping that in mind, a cross-sectional study published in 

 sought to not only determine physicians’ engagement in addressing HRSNs, but do so while also examining its association with burnout.

 The study authors also noted that currently, there is limited understanding regarding how different subgroups of physicians spend time addressing these HRSNs.

The aforementioned study used the 2022 Association of American Medical Colleges National Sample Survey of Physicians (NSSP), which is a nationally representative survey of active, practicing physicians in the US that was conducted from May to November 2022. It measures various physician workforce characteristics.

The method for sampling was broken down into the following steps:

The process of including all eligible respondents from the NSSP 2019 survey

Filling the cohort through with the use of stratified random sampling, with strata consisting of physician gender, specialty group, age group, and rural status.

Overall, in the study totaling 5,447 physicians, the mean (SD) age was 50.9 (11.7) years, with 3,735 (68.6%) identifying either as men or transgender men. Also, 34.3% of physicians reported high HRSN engagement, with variability being based on physician characteristics. When being compared to no HRSN engagement, low to moderate HRSN engagement (adjusted odds ratio [AOR], 1.33; 95% confidence interview or CI, 1.03-1.72; 

 = .03) and high HRSN engagement (AOR, 1.72; 95% CI, 1.39-2.27; 

 < .001) were significantly associated with high burnout.

However, the study did present its share of limitations, specifically pertaining to its design. As a result of it being cross-sectional, the investigators were unsuccessful in finding a causal relationship between physicians’ engagement in addressing social needs and burnout. Another limitation included the fact that because physician-reported frequency of addressing HRSNs based on the 2022 NPPS item was used as a way to represent their engagement, the results may not necessarily reflect physicians’ involvement in addressing HRSNs in an accurate manner.

“ … We identified variability in physicians’ engagement in addressing HRSNs and found that a higher degree of engagement was associated with burnout, concluded the study investigators. “As growing numbers of health equity strategies are developed and implemented, our study findings offer insight into strategies for mitigating physician burnout and suggest the need for a thorough assessment of the potential unintended consequences of physicians’ engagement in addressing HRSNs on their well-being.”

1. Tabata-Kelly M, Hu X, Dill MJ, et al. Physician Engagement in Addressing Health-Related Social Needs and Burnout. 

2. Kreuter MW﻿, Thompson T﻿, McQueen A﻿, Garg R﻿. Addressing Social Needs in Health Care Settings: Evidence, Challenges, and Opportunities for Public Health.

Is this level of involvement with HRSNs associated with higher burnout? 

The Connection Between Physician Engagement and Tackling Health-Related Social Needs 

The third and final day of Trade & Channel Strategies in Philadelphia continued its slate of thought-provoking content with a morning session on “Balancing the GTN Bubble with Market Access Priorities.”

 Moderated by Jake McDowell, VP of market access, Partner Therapeutics, he was joined by Mike Rowland, senior director of pricing contracts and analytics, Acadia Pharmaceuticals, and Tom Evegan, principal, strategy & management consulting, RSM US.

The goal of the panel was to analyze the gross-to-net (GTN) bubble across multiple product mixes, including but not limited to brand, biosimilars, and generics; support the needs of the stakeholders by deliberating distribution networks and market access while determining ways for company profitability; and explore pricing's role when it comes to access. The GTN bubble is a term coined by Adam Fein, PhD, of the Drug Channels Institute, that has since become widely used to describe the growing gap between gross and net sales for drug manufacturers.

, Bill Roth succinctly refers to the GTN bubble as “the widening gap between the gross revenue (the total sales at list price) and the net revenue (the amount received by the manufacturer after discounts, rebates, fees, and other adjustments). This gap has been expanding significantly in recent years due to changes in regulations surrounding pricing in the industry; expansion of government programs; expansion of the use of programs such as 340B; and increased demands for rebates from pharmacy benefit managers (PBMs) and insurers.”

Keeping this in mind, the panel began with a dive into the some of the new factors that are impacting the gross-to-net specifically within the marketplace, growing that bubble.

“I think the easy one to always focus on from a larger chunk of growth-to-net is always managed care. I think any organization—large or small—is more than likely to have those conversations,” explained Rowland. “Regarding the distribution piece of it too, there's a sharper focus on that as well. I think of PHS specifically, along with contract pharmacy policy, as being really big and interesting one, as well as the rebate models that have recently been proposed. I think as PHS continues to grow as part of most manufacturers’ books, the ability to try to temper that a little bit is where you're seeing a lot of focus. I know most of the larger manufacturers are the ones that are going after that now, but with some of the recent legislative wins on the manufacturer side—as well as the one that's coming up with HHS—I think you might start to see a lot of the smaller and mid ones start to follow.

Evegan was in agreement, and noted the impact the 340B will continue to have in the immediate future.

“340B is going to be something that everyone in this room and back at your companies are going to be dealing with for quite some time,” he explained. “I think that the legislative aspects right now are still being debated in court. You probably have seen some cases that are out there: J&J filed, then withdrew, and then came back with their rebate model. A couple of other manufacturers have followed suit. I think the rebate model in 340B is going to change. There was interesting news that was brought up yesterday about the removal of pharmacies from that vertical integration model—it’s going to be interesting to see where that winds up, because I think that's going to impact quite a bit of 340B business moving forward.

“The key crux of the issue is that the government has not defined what a patient is for that program, so that's actually being held up legislatively, and that's important because any patient can actually show up to an outpatient facility, receive the drug, and then the institution receives the discount; for rebate, the manufacturers pay back versus the actual patient receiving any benefit. We’re seeing spillover in Medicare as well. … I did do some polling with some of our clients. We've actually seen 12 Medicare Part B states now coming online that are invoicing drug manufacturers in Medicaid. It's just something to think about as we talk about all these channels: what are the different nuances that we're seeing? One thing that gets a little bit overlooked—and relates or is tangential to the gross-to-net waterfall—is that there's also state transparency compliance. When you launch a new drug, we have to ensure there's compliance.”

Other points that were covered during the session included: the distribution models that are popping up as a result of these aforementioned factors; the product archetype and how that changes perspective as one looks at distribution and managing that accordingly; how the Inflation Reduction Act impacts GTN; and the impact that pricing is now having on gross-to-net, along with restrictions.

Editor's note: This article was updated on December 19, 2024 to reflect that the "gross-to-net bubble" is a term originally defined by Adam Fein of the Drug Channels Institute. 

1. Evegan T, McDowell J, Rowland M. Balancing the GTN Bubble with Market Access Priorities. December 12, 2024. Trade & Channel Strategies, Philadelphia. 

https://informaconnect.com/trade-channel/

2. Roth B. Going Inside the Gross-to-Net Bubble and Its Nuances. 

https://www.pharmaceuticalcommerce.com/view/going-inside-the-gross-to-net-bubble-and-its-nuances

A panel examines the gross-to-net bubble across various product mixes, how pricing impacts market access, and more.  

Trade & Channel Strategies 2024: A GTN Bubble Balancing Act

The Gap in DSCSA Readiness 

, Joe Lipari, direct of product management for Systech, dives into how the Drug Supply Chain Security Act (DSCSA), signed into law by President Obama in 2013, has actually been in development for nearly two decades, with earlier state-level efforts like California’s e-Pedigree push. Initially, the full implementation deadline was set for Nov. 27, 2023, marking the completion of serialization and traceability across the pharmaceutical supply chain. However, due to industry readiness issues, the FDA introduced a “stabilization period” to allow for testing and system adjustments. The stabilization period, meant to iron out bugs, turned into a series of delays, and the implementation date has been pushed back multiple times.

In October 2023, the FDA announced another delay, introducing a phased approach to DSCSA compliance. Manufacturers now have until May 2025 to meet requirements, wholesale distributors until August 2025, and mid-to-large dispensers until November 2025. Small dispensers, defined as those with 25 or fewer employees (including pharmacists and pharmacy technicians), have an extended deadline of November 2026. This phased approach allows different parts of the supply chain to comply gradually, but the full implementation will not be realized until at least 2026.

The FDA’s latest exemption allows eligible trading partners that have either completed or documented efforts to complete data exchange connections to be given some leeway in enforcement. This continues the trend of delays and phased compliance, highlighting ongoing challenges in fully implementing the DSCSA across the industry.

Lipari also explains the penalty for non-compliance, the likelihood that these deadlines put forth by the FDA will be met, and more.A transcript of Lipari’s conversation with

What do you believe the likelihood is that these deadlines put forth by the FDA will be met?

The funny thing is, we were having this conversation back in August and September. The HDA [Healthcare Distribution Allinace] does their Traceability Seminar in DC every year. You have the FDA there and a lot of different legal entities there, and that question continues to be asked of, what are you guys going to do? The answer was, no, there will not be any more delays. And a month later, we have the announcement. History has sort of shown us that any dates within the DSCSA implementation framework are subject to change.

If I was a betting man. I’d have to look at the track record of this implementation and say that I'm not sure if any of the dates will hold. But I mean, from my experience with Systech, we are more on the manufacturing side. A majority of our serialization customers are Big Pharma, mid-, mid-tier pharma. With our traceability platform, we have manufacturers, we have distributors, we have repackagers, CMOs. There is whole breadth of trade partners, but the manufacturers, for the most part, are ready. They've been serializing product for quite some time. They have systems in place to do verification. They have systems in place to handle tracing requests. They have systems in place to electronically share data. You hear from the wholesale distributor—from a KPI perspective—the wholesale distributors ramping up their enablement across their DCs.

In the beginning, you heard numbers and by the end of the stabilization period, definitely those numbers all went in the right direction, as far as how much was enabled, and then furthest downstream, you get to the dispensers. That's really where I think the main problem with readiness lies, and it's a tough space.

In the US, there's something to the tune of 90,000 different dispense locations. That ranges from the CVS and Costcos of the world—which are massive corporations—all the way to your mom and pops, those little pharmacies. I have one in my town, and they're independently owned, a single location, but that doesn't mean they're not exempt from DSCSA. They are the same prescription serialized drugs that are flowing through those facilities, just like CVS. It’s a tough space because of how many different types and the wide range of business types that exist in that space. There was a clear message that the dispense side was not going to be ready. If this thing did get pushed through, [there may have been] calls for patient safety, and what happens with quarantine product if you can't meet the letters of the law? I get that side of it, but there's a piece of me that feels we've been talking about this since 2013, and so how much further can we kick this can down the road?

In the final part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Joe Lipari, director of product management, Systech, predicts the probability that these DSCSA compliance deadlines put forth by the FDA will be met.

Pratap Khedkar, ZS Associates

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