#BIO2013 Affordable Care Act is Here to Stay


Day 3 here at BIO, the session I am covering today is focused on Patient Protection and the Affordable Care Act (ACA). The ACA includes key provisions that could lead to new and improved treatments, cures and cost savings for patients. All of these changes will impact the biotechnology industry and the future of patient access to needed medicines.

The panel this morning will address significant questions concerning the future of biotechnology under ACA and provide insights on what these changes mean for the industry, such as the impact of ACA on patient access to prescription drugs, biologics, and vaccines as well as implications of State decisions on Exchanges, benchmark benefit plans, and Medicaid expansion.

The ACA has been a popular topic of discussion since it passed in 2010. Some of our questions have been answered but the full impact will not be known until the policy is fully implemented. Below I will provide some snippets from the panel, please excuse any poor grammar or typos.

We are pushing for not more expensive care but but quality of care. Jonathan Blum

We are concerned about Deliver system issues, provider access to information, what are the essential health benefits, how do we define it and how do we make it inclusive. Marc Boutin

It's not the what, but the how, how it is being implemented, that is the source of questions. Patient safety must be central to the process, at a the center of cost, access, and incentivizing innovation. But we can't just focus on one part. Scott Carmer

ACA has already impacted access to capital for small companies. Lack of clarity, and uncertainty of how ACA impacts the community makes raising capital harder as investors are more risk adverse. VC community is very concerned about how a produce with be reimbursed. Kristine Peterson

From a Medicare perspective we want our doctors to thinking about their patients 12 months out of the year, and keep them out of doctors offices. Focus on keeping patients healthy and out of hospitals. We want to align and incentifive the whole healthcare pipeline to keep patients healthy. Jonathan Blum

We need to look at how we realign these process incentives and move it to patient incentives. I encourage the industry to partner with patient advocacy organizations to help address this issue. Marc Boutin

I get tripped up on value, what cost and what cost utilities are important to payers? We need to learn these so as we are going through trials we have the data ready when we submit. Scott Carmer

The is one thing that is very important we talk about at BIO. Small start up companies need to learn, and compare their reimbursement strategy, even if they are planning on being acquired by larger Pharma. Investors and acquisition targets are increasingly looking to reimbursement strategy as part of the valuation. Kristine Peterson

(Responding to how incentives to payers to reduce cost will impact access.) We have built in checks and balances in the ACO similar to part d, to make sure that patients have access to the most innovative products. We don't try to restrict coverage, our goal is to improve the lives of the patients. Jonathan Blum

Behaviors are driven by incentives. Scott Carmer

Your industry is going to pay more no matter what. We need to incentivize the development around specific needs. Marc Boutin

I am really worried about the long term impact on innnovation when you look at changing Part D. Reducing reimbursement lowers what we can make and that money has to come from some place. Kristine Peterson

Big risk needs to have big rewards. With out those rewards, no one will invest in risky innovative therapies and products. Marc Boutin

(Respondiong to question about the president lowering the IPAB threshold) I see IPAB as a check and balance on the CMS. So far we have not triggered their threshold. I think that we need to have that oversight on cost. Jonathan Blum

When we look at IPAB we analyzing it based on its ability to do three things, impact of access, impact on innovation, and impact on cost management, and we do not see it being effective on those fronts. Marc Boutin

It is the lack of clarity and transparency that worries us. We have dealed with NICE (?) and we are worried that IPAB will turn out to be the same. Kristine Peterson

This was a great session. So what's happening in Illinois? Earlier this month Illinois received a $115 million federal grant designed to help the state build and promote a functioning health insurance exchange for residents. The state plans to have a functioning health insurance exchange in place by January 1, 2014. This exchange will begin open enrollment in October of this year. There is going to be a big marketing blitz leading up to enrollment this fall, which will use up most of the $115 million federal grant.

This is a conversation, not an editorial. Did I forget something, get it wrong or do you agree? Please Comment, Like, Re-Tweet and Share.


2 thoughts on “#BIO2013 Affordable Care Act is Here to Stay

  1. Had I not had to manage some high-priority client issues, this and the Demystifying Alzheimer’s Disease were the two sessions I was most looking forward to this morning. Thanks for sharing. I hope you do the same with my man Fareed’s Super Session.

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