October 14, 2025 • 14 mins
Prices that used to hide in the shadows are stepping into the light—and it’s changing how patients get their medicines. We dive deep into the PBM reckoning: why scrutiny is mounting, how California’s new law opens the books on rebates and reimbursements, and what more than 30 states signal for the future of drug access. From there, we chart the path pharma is taking to meet the moment—standing up direct-to-consumer channels, publishing clear cash prices for GLP-1s and insulin, and using digital tools to support patients at the exact moment they need guidance.
We unpack the incentives that got us here—spread pricing, formulary gatekeeping, and opaque negotiations—and then show how transparency reshapes behavior across the board. When a payer can see a cash price, the math behind rebates changes. When a patient can tap a support team, dose questions and refills don’t become barriers. And when adherence and symptom data flow securely into connected systems, trial churn falls and real-world evidence grows stronger. It’s not just a commercial pivot; it’s an outcomes strategy that relies on timely education, affordability support, and trust built one interaction at a time.
You’ll hear a clear game plan for leaders across pharma: align patient support, access, IT/security, and procurement around HIPAA-compliant, interoperable platforms; embed copay and affordability tools where decisions happen; and design companion experiences early so launches are patient-ready on day one. Over the next two to three years, transparency will be a differentiator, D2C will scale fast, and “digital” will simply be how care is coordinated. If you’re ready to lead in a post-PBM landscape—and prove it with measurable results—hit play, subscribe, and share your take. Your feedback helps us spotlight what’s working and where the industry should go next.
PostScripts Rx is not intended to constitute medical advice, nor is it intended to influence prescribing decisions or any other medical or clinical decision-making. All medical and clinical judgment and decision-making, prescribing decisions, and all related considerations remain exclusively the responsibility of providers and patients.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:00):
Welcome to Postscripts, the podcast
exploring the latest innovationsin patient access, support,
digital tools, HCP engagement,and pharma marketing that we all
hope drive better outcomes forpatients.
This podcast is forinformational purposes only and
does not constitute the givingout of any medical advice, nor
should it be used to influenceany clinical decision making.
Patients should always consulttheir healthcare professionals.
(00:21):
Welcome to the podcast.
My name is Brian Carm from theMetaSafe team.
Although any opinions expressedhere are my own and not
necessarily those of MetaSafe orits partners, we are seeing a
tectonic shift in pharmacybenefit manager regulation this
week.
These are called PBMs, right?
This is a seismic movementhappening here in the U.S.
healthcare landscape.
It's centered around theseincreasingly scrutinized
(00:43):
practices of the PBMs.
In recent years, you may haveseen state and federal
legislators here in the U.S.
have taken aim at thelongstanding opacity and pricing
power PBMs have held overpharmaceutical manufacturers,
the payers, pharmacists,ultimately patients.
These shakeups that we're seeingnow really do promise a new era
of pharmaceutical access,pricing transparency, digital
(01:04):
engagement directly withpatients and pharmacies, right?
So California this week signedinto law a significant bill that
adds new oversight to PBM'spricing contracts and rebate
clawbacks.
More on that in a bit.
So according to FierceHealthcare, the bill requires
PBMs to register with theState's Department of Managed
Care, DMHC is what it's called,and opens them up to audits that
(01:27):
bring transparency to consumerdrug pricing and ensure payer
negotiations.
You should expect other statesto follow suit.
And in total, over 30 statesalready have introduced PBM
regulation bills since 2023alone.
But what does it really mean forpharma marketing, patient
engagement, and accessstrategies when you see this
legislative momentum happening?
(01:48):
And how can innovative digitaltools like MetaSafe and others
really empower pharma teams toseize this opportunity with
direct-to-consumer andconnectivity right to patients?
But first, how do we get here?
So PBMs originally were createdto streamline prescriptions,
make drugs more affordablethrough their formulary
management, and reallyaggressive price negotiation on
behalf of large communities ofpatients, right?
(02:09):
Whether it be uh you know thosefrom a simple insurance company
or unions, et cetera, et cetera.
So, however, over the pastdecades, PBMs really did evolve
into powerful intermediaries.
For example, today are the topthree PBMs, which was CVS
CareMark, Optim RX, and ExpressStrips, that control over 80% of
the prescription drug market,according to the Drug Channels
(02:30):
Institute.
So this outsized influenceallows a couple of things here.
One, they can negotiate massiverebates with manufacturers,
often keeping portions forthemselves rather than passing
the savings on to patients,right?
They can also determine whichdrugs make the formularies.
Despite clinical equivalencyacross the options, they may opt
for the less expensivemedication that has been on the
(02:52):
market for a bit, as opposed tothe new one that came out that
has equivalency at even if it'sa lower price, they can decide
which is the winners and losers,right?
They can utilize more spreadpricing.
So charging payers more thanthey reimburse the pharmacies
because they want to keep alittle bit for themselves,
right?
So that can all they can alsorestrict innovative therapies,
right, from coverage, delayingaccess for patients.
(03:14):
So these practices havecontributed to a growing
frustration among policymakers,patient advocates, and
increasingly the pharmacompanies themselves looking to
directly engage consumers withtransparent pricing and
streamlined access to therapies.
You can imagine the pharmacompanies, especially here in
the U.S., are getting poundedfor the prices that they're
charging, right?
So you saw in May, the U.S.
administration put out rulesthat they want most favored
(03:37):
nation pricing for Americans sothat no American pays more than
anywhere else in the developedworld for their medications.
And especially for Medicare,Medicaid programs where they
have to pay MOS and on thesedrugs, right?
So the you saw that come to thefore.
And what the pharma companieswere saying is to the
administration, and we knowthis, they actually said,
listen, if you cut out themiddleman here, the PBMs, we
(03:58):
would allow it allow us to goright to the consumers for many
of these medications, we canactually deliver that overnight,
right?
And so we actually saw, we nowhave D2C with some of the major
pharma companies, particularlyin the GLP1 space and insulin as
well.
You can buy medications verysoon on Trump RX and other
websites where the price will belisted there, and it'll be the
equivalent that you can getelsewhere in the world, right?
(04:19):
So that is pricing transparency.
Now the point there is mostpeople are not going to go to
those websites and buy theirmedications here in the U.S.
Why?
Because they are already undereither a policy with Medicare,
Medicaid or their insurancecompany that they get through
work to pay a$20 to$30 copay forthose medications or$10,
whatever it is, as opposed tobuying a full price off of a
website.
The point, though, is thetransparency of the prices are
(04:41):
being shown, right?
So that you can see the impactof a transparent price on what
it would have with thenegotiating power of a pharmacy
benefit manager who's wants tocharge$400 for that medication,
where the payer may be like,well, I can get it off Trump RX
for$200 right now.
Why am I going to pay you?
Well, we're going to give you arebate for$200.
Well, no, no, no.
That's money out of my pocketthat makes your books look
(05:03):
better because you're seeing ahigher revenue come in, but then
you're just going to give itback to me, or you're going to
give a portion back to me, andsome of it maybe to the patient.
That's where that transparencyis really going to be most
effective, right?
So what you're seeing thisfracking opening of the PBM
black box, and the legislationis catching up, admittedly,
right?
So the inflation reduction actyou may have seen a few years
back, you recall it here in theU.S.
(05:24):
as the insulin prices were goingto be capped at, I think it was
$35 per dose.
That was part of the inflationreduction act at the federal
level that really didn't makethe headlines for Medicare in
particular, pricing reforms,particularly on insulin, as I
recall them.
State action has been equallytransformative.
So California, this new lawcreates this transparency rules
(05:44):
effective immediately, requiringthe disclosure of rebate
information and pharmacyreimbursements with enforcement
via auditing rights by thegovernment, right?
From the Department of ManagedHealthcare in California.
States like Arkansas, Georgia,and New York are enacting
similar provisions.
This is coming from the KaiserFamily Foundation.
This increased scrutiny givespharma manufacturers the green
light to acceleratedirect-to-consumer sales models,
(06:07):
right?
Deliver on price transparencyand therefore expand digital
tools that empower patientcontrol in understanding of
their therapies, right?
So let's talk about D2C,direct-to-consumer acceleration.
Pharma is definitely goingdirect.
These barriers are loosening onthe PBMs.
So for manufacturers, they'rerapidly, you've seen they're
unveiling direct-to-consumermodels.
Several major firms, Eli Lilly,Nobo Nordisk, and others,
(06:28):
they've uh launched their D2Cprescription access websites,
particularly in the GLP1 space,alongside major list price
reductions in, you know, insulinprice caps, for example, right?
So these are aiming to removePBM middlemen and women uh from
their administrative burdens offrom just the pharma
administrative burdens if theydon't even have to go through
the middle and then negotiatethat way, right?
(06:49):
Also offer transparent pricingstructure aligned with consumer
expectations, okay?
Build stronger brand loyalty andmedication inherence through the
digital touch points withpatients.
You can imagine if you're apatient, you may be in a you may
put in a place where, hey, we'regonna charge you, we're gonna
take you down and have this lessexpensive medication.
And you as a patient want tofight for, no, no, I want to
(07:10):
stay with the brand I'm on.
I know the supply chain, I knowit's made in the USA, for
example.
I know it's I already have acare team that I talk to at the
tap of a button on my digitalapp that I can talk to anyone at
the brand name, brand team, oryou know, patient support team
if I have any questions.
If I go off the medication,that's not gonna be available.
So that type of brand loyaltyand patient connection with
(07:31):
pharma to really kind of reversewhat some patients think about
pharma companies now and reallyturn into a positive brand
loyalty could be a veryinteresting market, especially
with that digital connectivitythat circumvents the PBM
managers and has patients,doctors, and pharma all in the
same place, right?
So it does really, for pharmacompanies, think about it, it
really depends on pairing thosedigital strategies and platforms
(07:51):
that keep patients reallyengaged, informed about their
journey, especially as patientsnow become the primary buyer
rather than just payers orproviders, right?
So pharma is really meeting theempowered patient.
As you see patients assumegreater ownership over their
healthcare choices, pharmacompanies are digitally enabling
that shift.
You see platforms like MetaSafeand others already leading this
(08:11):
type of revolution where you'vegot, you know, you've got even
voice agents that can contact apatient on MetaSafe and ask a
linear question, do a symptomcheck, do an appointment check,
everything like that.
It's all integrated about theprocess of managing their
journey and helping out thatway.
And you can think of the optionsto really seek provider support
at the tap of a button.
So if you can imagine digitalsupport tools where, hey, I have
(08:33):
a question about my medication,I need a refill, or for some
reason I like whatever I want totap to contact my support team
right now.
Boom, done.
And that support team can be apharma-based support team that
has answers questions about,yeah, I'm supposed to take my
medication out 45 minutes beforeI dose.
This one's been sitting out foran hour and a half.
Is that okay to take?
Let me just talk to my supportteam right now.
Those type of questions.
(08:53):
Really get that loyalty going,right?
You know, and and what canhappen is these so you're seeing
personalized, evenwhite-labeled, if need be,
communications, bi-directionalcommunications with digital
pharma companies and doctorsreally offer support at critical
moments in that treatmentjourney, all the way from
titration and onboarding to therenewal of the script and uh
refill, right?
So when you see, once these PBM,we'll call them blockages are
(09:16):
removed, pharma firms can justuse digital tools to really
deliver price transparencythrough in-app pricing
information, right?
You might want to, hey, by theway, this this medication is
available for$239 a month.
You might want to check, seewhat you're getting charged for
it.
Granted, it's a$30 copay foryou, but if you it's on top of
what else is going into it,that's gonna be apparent.
Like, oh, the my insurancecompany charges$400 for
(09:38):
something they get$239 for,which most patients are gonna
say, well, that's trickling downinto my premiums, right?
So that's gonna be interesting.
You could attach the copaycards, right?
So the manufacturer's savingscards, copay assistance within
digital journeys, right?
So copay cards already exist,but now you have it within your
app.
And if you're asking questions,saying, Well, yeah, I'm thinking
of going to this othermedication, or I want to tell,
(09:59):
well, here's a copay card thatmakes you revenue neutral, you
know, cost neutral by stayingwith us and your loyal team,
right?
You can do it in the moment.
Obviously, pharma companies cantrack patient inherence and
provide real-time insights intothe therapy effectiveness, or
even what's discontinuation,right?
So those triggers ofdiscontinuation, if you've got
that direct relationship withthe patient, why did you switch
to the generic?
Or why did you come off of,well, my pharma company, my
(10:21):
insurance company told me to, oryou know, I was getting
whatever, what whateverreaction, or I'm just off of it,
it did its work.
You're gonna have the data a lotmore effectively and direct
one-on-one, right?
So this data-driven impact canreally just bring clarity and
with adherence and really doesgive great outcomes for the
pharma companies to use and someof their other conversations
they're having with, say,efficacy conversations with the
federal government.
(10:41):
So you see the shift to D to Cand digital engagement.
It's a commercial strategy, notonly commercial, but it's an
outcomes strategy as well.
You know, even patients usingour platform, you know, have a
much higher medication adherencerate.
You know, we've seen 20% plusadherence rate over a 12-month
period compared to those whoaren't using uh the digital
companion support.
This can this can mean reducedhospitalization risk, improve
(11:04):
persistence, and you know,pharma manufacturers are also
leveraging, you know, digitalsolutions for clinical trials.
Why?
Because the number one problemthat's good clinical trials is
churn, right?
You brought a bunch of patientsin.
For some reason they're notstaying on the trials, so you
can't measure them across,right?
You get digital connectivitydirectly with that patient in a
much more aggressive way toreally keep in track on a
day-to-day basis.
You can significantly reducethose churns.
(11:25):
We've seen those, you know,patient-reported outcomes and
churn rates go downsignificantly with some clinical
trial studies that we've donehere at MetaSafe, right?
And you can really enable theentire pharma org.
It's not just a marketingchallenge.
You know, pharma digitalevolution post-PBM reform can
impact patient support teams,right?
So new tools that increase touchpoints, supply adherence, right,
uh programs, and monitorreal-time escalation triggers
(11:48):
can be done with the supportteams, right?
IT, security teams.
They have to ensure HIPAAcompliance, secure health data
insights, integrate datapipelines into CRMs and
real-world evidence systems,right?
So as we go more to digital,those IT and security protocols
must be met by major partnersand vendors like ourselves that
have been doing it and haveexperience doing it, right?
Patient access teams, right?
You're gonna want to coordinatecopay, hub enrollment,
(12:10):
affordability directly withpatients, bypassing PBMs where
feasible, right?
Procurement, evaluate digitalhealth partnerships for that
team and uh integrations thatare, you know, that are
obviously compliant, have ISOsecurity protocols and quality
standards.
That's gonna be key for the uhas we expand digitally with the
pharma patient relationshipdirectly, right?
(12:31):
Then innovation and RD teams canconsider that they're
incentivized to support pipelinetherapies with companion tools
early in development, ensuringthat patient readiness at
launch, right?
We're seeing this already wherenew medications may not be
launching for six or ten months,but pharma companies are getting
patients ready for that launchahead of time before it's even
(12:51):
available public, so they canidentify them and talk to them
in a way when the launch brandcomes out more effectively,
right?
So as PBM oversight reallyexpands federally and across
states, expect a cascade ofeffects across pharmaceutical
commercial and patientengagement models.
These D2C channels are gonnagrow rapidly through the next
two to three years.
Pricing transparency has becomea commercial differentiator.
(13:13):
Digital solutions are gonnabecome table stakes for meeting
patient expectations.
You know, it's interesting.
I had someone say the other day,we used to call it uh online
banking, and then it was, oh,it's mobile banking, right?
And now we just call it banking,right?
So when you're gonna have thesame thing happen, the same go
through with pharma companies.
You know, it used to be uh, youknow, medication management.
Now it's just gonna be simply Idon't have to manage it on my
(13:34):
mobile devices, it's gonna bethis is how I manage my
treatment journey, right?
All the way across.
So it's just gonna be tablestakes, right?
So it's not just compliancedriven, it's business driven.
Pharma brands who are alreadyembracing transparency, patient
centricity, integrated tech aregonna be far better positioned
right now in this post-BBMlandscape.
So if you're not how pharma canreally lead in the post-BBM era,
(13:54):
uh is you're seeing these shiftsto really succeed.
There's a couple of things theyshould do.
Develop D2C pricing and accesschannels is armed with savings,
offers, transparency tools.
You already see this happeningalready, with some of the
announcements.
Then leverage digital platformsto keep patients informed,
inherent, and connected in casethere's any changes or trends
that data that uh pharmacompanies are seeing and they
can make interventions possible,right?
(14:16):
Integrate that digital data intocommercial and clinical
roadmaps, right?
Invest in patients-firsttechnologies with secure
interoperability andoutcomes-driven metrics, right?
So from brand teams to theC-suite, everyone has a role in
enabling this transformationthat's already coming, right?
Because it's a new question,isn't whether pharma can engage
patients digitally?
It's how fast they can, howtransparent say they will, and
(14:36):
how well they can prove itworks, right?
So thank you very much forjoining us on PostScripts.
If you found this conversationvaluable, follow or subscribe
for more insights as we talkabout the intersection of pharma
tech and patient impact.
Until next time, keep lookingforward.
The real work begins when thosescripts are written.
Welcome to Postscripts, the podcast
exploring the latest innovationsin patient access, support,
digital tools, HCP engagement,and pharma marketing that we all
hope drive better outcomes forpatients.
This podcast is forinformational purposes only and
does not constitute the givingout of any medical advice, nor
should it be used to influenceany clinical decision making.
Patients should always consulttheir healthcare professionals.
(00:21):
Welcome to the podcast.
My name is Brian Carm from theMetaSafe team.
Although any opinions expressedhere are my own and not
necessarily those of MetaSafe orits partners, we are seeing a
tectonic shift in pharmacybenefit manager regulation this
week.
These are called PBMs, right?
This is a seismic movementhappening here in the U.S.
healthcare landscape.
It's centered around theseincreasingly scrutinized
(00:43):
practices of the PBMs.
In recent years, you may haveseen state and federal
legislators here in the U.S.
have taken aim at thelongstanding opacity and pricing
power PBMs have held overpharmaceutical manufacturers,
the payers, pharmacists,ultimately patients.
These shakeups that we're seeingnow really do promise a new era
of pharmaceutical access,pricing transparency, digital
(01:04):
engagement directly withpatients and pharmacies, right?
So California this week signedinto law a significant bill that
adds new oversight to PBM'spricing contracts and rebate
clawbacks.
More on that in a bit.
So according to FierceHealthcare, the bill requires
PBMs to register with theState's Department of Managed
Care, DMHC is what it's called,and opens them up to audits that
(01:27):
bring transparency to consumerdrug pricing and ensure payer
negotiations.
You should expect other statesto follow suit.
And in total, over 30 statesalready have introduced PBM
regulation bills since 2023alone.
But what does it really mean forpharma marketing, patient
engagement, and accessstrategies when you see this
legislative momentum happening?
(01:48):
And how can innovative digitaltools like MetaSafe and others
really empower pharma teams toseize this opportunity with
direct-to-consumer andconnectivity right to patients?
But first, how do we get here?
So PBMs originally were createdto streamline prescriptions,
make drugs more affordablethrough their formulary
management, and reallyaggressive price negotiation on
behalf of large communities ofpatients, right?
(02:09):
Whether it be uh you know thosefrom a simple insurance company
or unions, et cetera, et cetera.
So, however, over the pastdecades, PBMs really did evolve
into powerful intermediaries.
For example, today are the topthree PBMs, which was CVS
CareMark, Optim RX, and ExpressStrips, that control over 80% of
the prescription drug market,according to the Drug Channels
(02:30):
Institute.
So this outsized influenceallows a couple of things here.
One, they can negotiate massiverebates with manufacturers,
often keeping portions forthemselves rather than passing
the savings on to patients,right?
They can also determine whichdrugs make the formularies.
Despite clinical equivalencyacross the options, they may opt
for the less expensivemedication that has been on the
(02:52):
market for a bit, as opposed tothe new one that came out that
has equivalency at even if it'sa lower price, they can decide
which is the winners and losers,right?
They can utilize more spreadpricing.
So charging payers more thanthey reimburse the pharmacies
because they want to keep alittle bit for themselves,
right?
So that can all they can alsorestrict innovative therapies,
right, from coverage, delayingaccess for patients.
(03:14):
So these practices havecontributed to a growing
frustration among policymakers,patient advocates, and
increasingly the pharmacompanies themselves looking to
directly engage consumers withtransparent pricing and
streamlined access to therapies.
You can imagine the pharmacompanies, especially here in
the U.S., are getting poundedfor the prices that they're
charging, right?
So you saw in May, the U.S.
administration put out rulesthat they want most favored
(03:37):
nation pricing for Americans sothat no American pays more than
anywhere else in the developedworld for their medications.
And especially for Medicare,Medicaid programs where they
have to pay MOS and on thesedrugs, right?
So the you saw that come to thefore.
And what the pharma companieswere saying is to the
administration, and we knowthis, they actually said,
listen, if you cut out themiddleman here, the PBMs, we
(03:58):
would allow it allow us to goright to the consumers for many
of these medications, we canactually deliver that overnight,
right?
And so we actually saw, we nowhave D2C with some of the major
pharma companies, particularlyin the GLP1 space and insulin as
well.
You can buy medications verysoon on Trump RX and other
websites where the price will belisted there, and it'll be the
equivalent that you can getelsewhere in the world, right?
(04:19):
So that is pricing transparency.
Now the point there is mostpeople are not going to go to
those websites and buy theirmedications here in the U.S.
Why?
Because they are already undereither a policy with Medicare,
Medicaid or their insurancecompany that they get through
work to pay a$20 to$30 copay forthose medications or$10,
whatever it is, as opposed tobuying a full price off of a
website.
The point, though, is thetransparency of the prices are
(04:41):
being shown, right?
So that you can see the impactof a transparent price on what
it would have with thenegotiating power of a pharmacy
benefit manager who's wants tocharge$400 for that medication,
where the payer may be like,well, I can get it off Trump RX
for$200 right now.
Why am I going to pay you?
Well, we're going to give you arebate for$200.
Well, no, no, no.
That's money out of my pocketthat makes your books look
(05:03):
better because you're seeing ahigher revenue come in, but then
you're just going to give itback to me, or you're going to
give a portion back to me, andsome of it maybe to the patient.
That's where that transparencyis really going to be most
effective, right?
So what you're seeing thisfracking opening of the PBM
black box, and the legislationis catching up, admittedly,
right?
So the inflation reduction actyou may have seen a few years
back, you recall it here in theU.S.
(05:24):
as the insulin prices were goingto be capped at, I think it was
$35 per dose.
That was part of the inflationreduction act at the federal
level that really didn't makethe headlines for Medicare in
particular, pricing reforms,particularly on insulin, as I
recall them.
State action has been equallytransformative.
So California, this new lawcreates this transparency rules
(05:44):
effective immediately, requiringthe disclosure of rebate
information and pharmacyreimbursements with enforcement
via auditing rights by thegovernment, right?
From the Department of ManagedHealthcare in California.
States like Arkansas, Georgia,and New York are enacting
similar provisions.
This is coming from the KaiserFamily Foundation.
This increased scrutiny givespharma manufacturers the green
light to acceleratedirect-to-consumer sales models,
(06:07):
right?
Deliver on price transparencyand therefore expand digital
tools that empower patientcontrol in understanding of
their therapies, right?
So let's talk about D2C,direct-to-consumer acceleration.
Pharma is definitely goingdirect.
These barriers are loosening onthe PBMs.
So for manufacturers, they'rerapidly, you've seen they're
unveiling direct-to-consumermodels.
Several major firms, Eli Lilly,Nobo Nordisk, and others,
(06:28):
they've uh launched their D2Cprescription access websites,
particularly in the GLP1 space,alongside major list price
reductions in, you know, insulinprice caps, for example, right?
So these are aiming to removePBM middlemen and women uh from
their administrative burdens offrom just the pharma
administrative burdens if theydon't even have to go through
the middle and then negotiatethat way, right?
(06:49):
Also offer transparent pricingstructure aligned with consumer
expectations, okay?
Build stronger brand loyalty andmedication inherence through the
digital touch points withpatients.
You can imagine if you're apatient, you may be in a you may
put in a place where, hey, we'regonna charge you, we're gonna
take you down and have this lessexpensive medication.
And you as a patient want tofight for, no, no, I want to
(07:10):
stay with the brand I'm on.
I know the supply chain, I knowit's made in the USA, for
example.
I know it's I already have acare team that I talk to at the
tap of a button on my digitalapp that I can talk to anyone at
the brand name, brand team, oryou know, patient support team
if I have any questions.
If I go off the medication,that's not gonna be available.
So that type of brand loyaltyand patient connection with
(07:31):
pharma to really kind of reversewhat some patients think about
pharma companies now and reallyturn into a positive brand
loyalty could be a veryinteresting market, especially
with that digital connectivitythat circumvents the PBM
managers and has patients,doctors, and pharma all in the
same place, right?
So it does really, for pharmacompanies, think about it, it
really depends on pairing thosedigital strategies and platforms
(07:51):
that keep patients reallyengaged, informed about their
journey, especially as patientsnow become the primary buyer
rather than just payers orproviders, right?
So pharma is really meeting theempowered patient.
As you see patients assumegreater ownership over their
healthcare choices, pharmacompanies are digitally enabling
that shift.
You see platforms like MetaSafeand others already leading this
(08:11):
type of revolution where you'vegot, you know, you've got even
voice agents that can contact apatient on MetaSafe and ask a
linear question, do a symptomcheck, do an appointment check,
everything like that.
It's all integrated about theprocess of managing their
journey and helping out thatway.
And you can think of the optionsto really seek provider support
at the tap of a button.
So if you can imagine digitalsupport tools where, hey, I have
(08:33):
a question about my medication,I need a refill, or for some
reason I like whatever I want totap to contact my support team
right now.
Boom, done.
And that support team can be apharma-based support team that
has answers questions about,yeah, I'm supposed to take my
medication out 45 minutes beforeI dose.
This one's been sitting out foran hour and a half.
Is that okay to take?
Let me just talk to my supportteam right now.
Those type of questions.
(08:53):
Really get that loyalty going,right?
You know, and and what canhappen is these so you're seeing
personalized, evenwhite-labeled, if need be,
communications, bi-directionalcommunications with digital
pharma companies and doctorsreally offer support at critical
moments in that treatmentjourney, all the way from
titration and onboarding to therenewal of the script and uh
refill, right?
So when you see, once these PBM,we'll call them blockages are
(09:16):
removed, pharma firms can justuse digital tools to really
deliver price transparencythrough in-app pricing
information, right?
You might want to, hey, by theway, this this medication is
available for$239 a month.
You might want to check, seewhat you're getting charged for
it.
Granted, it's a$30 copay foryou, but if you it's on top of
what else is going into it,that's gonna be apparent.
Like, oh, the my insurancecompany charges$400 for
(09:38):
something they get$239 for,which most patients are gonna
say, well, that's trickling downinto my premiums, right?
So that's gonna be interesting.
You could attach the copaycards, right?
So the manufacturer's savingscards, copay assistance within
digital journeys, right?
So copay cards already exist,but now you have it within your
app.
And if you're asking questions,saying, Well, yeah, I'm thinking
of going to this othermedication, or I want to tell,
(09:59):
well, here's a copay card thatmakes you revenue neutral, you
know, cost neutral by stayingwith us and your loyal team,
right?
You can do it in the moment.
Obviously, pharma companies cantrack patient inherence and
provide real-time insights intothe therapy effectiveness, or
even what's discontinuation,right?
So those triggers ofdiscontinuation, if you've got
that direct relationship withthe patient, why did you switch
to the generic?
Or why did you come off of,well, my pharma company, my
(10:21):
insurance company told me to, oryou know, I was getting
whatever, what whateverreaction, or I'm just off of it,
it did its work.
You're gonna have the data a lotmore effectively and direct
one-on-one, right?
So this data-driven impact canreally just bring clarity and
with adherence and really doesgive great outcomes for the
pharma companies to use and someof their other conversations
they're having with, say,efficacy conversations with the
federal government.
(10:41):
So you see the shift to D to Cand digital engagement.
It's a commercial strategy, notonly commercial, but it's an
outcomes strategy as well.
You know, even patients usingour platform, you know, have a
much higher medication adherencerate.
You know, we've seen 20% plusadherence rate over a 12-month
period compared to those whoaren't using uh the digital
companion support.
This can this can mean reducedhospitalization risk, improve
(11:04):
persistence, and you know,pharma manufacturers are also
leveraging, you know, digitalsolutions for clinical trials.
Why?
Because the number one problemthat's good clinical trials is
churn, right?
You brought a bunch of patientsin.
For some reason they're notstaying on the trials, so you
can't measure them across,right?
You get digital connectivitydirectly with that patient in a
much more aggressive way toreally keep in track on a
day-to-day basis.
You can significantly reducethose churns.
(11:25):
We've seen those, you know,patient-reported outcomes and
churn rates go downsignificantly with some clinical
trial studies that we've donehere at MetaSafe, right?
And you can really enable theentire pharma org.
It's not just a marketingchallenge.
You know, pharma digitalevolution post-PBM reform can
impact patient support teams,right?
So new tools that increase touchpoints, supply adherence, right,
uh programs, and monitorreal-time escalation triggers
(11:48):
can be done with the supportteams, right?
IT, security teams.
They have to ensure HIPAAcompliance, secure health data
insights, integrate datapipelines into CRMs and
real-world evidence systems,right?
So as we go more to digital,those IT and security protocols
must be met by major partnersand vendors like ourselves that
have been doing it and haveexperience doing it, right?
Patient access teams, right?
You're gonna want to coordinatecopay, hub enrollment,
(12:10):
affordability directly withpatients, bypassing PBMs where
feasible, right?
Procurement, evaluate digitalhealth partnerships for that
team and uh integrations thatare, you know, that are
obviously compliant, have ISOsecurity protocols and quality
standards.
That's gonna be key for the uhas we expand digitally with the
pharma patient relationshipdirectly, right?
(12:31):
Then innovation and RD teams canconsider that they're
incentivized to support pipelinetherapies with companion tools
early in development, ensuringthat patient readiness at
launch, right?
We're seeing this already wherenew medications may not be
launching for six or ten months,but pharma companies are getting
patients ready for that launchahead of time before it's even
(12:51):
available public, so they canidentify them and talk to them
in a way when the launch brandcomes out more effectively,
right?
So as PBM oversight reallyexpands federally and across
states, expect a cascade ofeffects across pharmaceutical
commercial and patientengagement models.
These D2C channels are gonnagrow rapidly through the next
two to three years.
Pricing transparency has becomea commercial differentiator.
(13:13):
Digital solutions are gonnabecome table stakes for meeting
patient expectations.
You know, it's interesting.
I had someone say the other day,we used to call it uh online
banking, and then it was, oh,it's mobile banking, right?
And now we just call it banking,right?
So when you're gonna have thesame thing happen, the same go
through with pharma companies.
You know, it used to be uh, youknow, medication management.
Now it's just gonna be simply Idon't have to manage it on my
(13:34):
mobile devices, it's gonna bethis is how I manage my
treatment journey, right?
All the way across.
So it's just gonna be tablestakes, right?
So it's not just compliancedriven, it's business driven.
Pharma brands who are alreadyembracing transparency, patient
centricity, integrated tech aregonna be far better positioned
right now in this post-BBMlandscape.
So if you're not how pharma canreally lead in the post-BBM era,
(13:54):
uh is you're seeing these shiftsto really succeed.
There's a couple of things theyshould do.
Develop D2C pricing and accesschannels is armed with savings,
offers, transparency tools.
You already see this happeningalready, with some of the
announcements.
Then leverage digital platformsto keep patients informed,
inherent, and connected in casethere's any changes or trends
that data that uh pharmacompanies are seeing and they
can make interventions possible,right?
(14:16):
Integrate that digital data intocommercial and clinical
roadmaps, right?
Invest in patients-firsttechnologies with secure
interoperability andoutcomes-driven metrics, right?
So from brand teams to theC-suite, everyone has a role in
enabling this transformationthat's already coming, right?
Because it's a new question,isn't whether pharma can engage
patients digitally?
It's how fast they can, howtransparent say they will, and
(14:36):
how well they can prove itworks, right?
So thank you very much forjoining us on PostScripts.
If you found this conversationvaluable, follow or subscribe
for more insights as we talkabout the intersection of pharma
tech and patient impact.
Until next time, keep lookingforward.
The real work begins when thosescripts are written.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
CrimeLess: Hillbilly Heist
It’s 1996 in rural North Carolina, and an oddball crew makes history when they pull off America’s third largest cash heist. But it’s all downhill from there. Join host Johnny Knoxville as he unspools a wild and woolly tale about a group of regular ‘ol folks who risked it all for a chance at a better life. CrimeLess: Hillbilly Heist answers the question: what would you do with 17.3 million dollars? The answer includes diamond rings, mansions, velvet Elvis paintings, plus a run for the border, murder-for-hire-plots, and FBI busts.