The Payer Exchange Podcast Episode 12: USA Special - Drake Reiter
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The Payer Exchange’s US focus continues with Drake Reiter, Director of Pharmacy Operations at Priority Health, bringing the perspective of a regional health plan across commercial, Medicare and Medicaid business. Where Episode 11 looked at practical payer operations, this conversation asks where the wider commercial model may be heading as Most-Favoured Nation (MFN), the Inflation Reduction Act (IRA) and Pharmacy Benefit Management (PBM) reform begin to change long-standing incentives.
Drake explores the erosion of the traditional rebate model, the growing importance of pricing transparency, the potential commercial spillover of Medicare Maximum Fair Prices, and how formulary strategy could change as MFP products receive stronger positioning. For a global audience, the discussion also reaches beyond the US: manufacturers may increasingly have to weigh protection of the US market against pricing and launch decisions elsewhere.
Key themes:
• MFN, GUARD and GLOBE from a regional health plan perspective
• The erosion of rebate-led contracting through IRA and PBM reform
• Commercial spillover from Medicare Maximum Fair Prices
• Transparency as a new source of negotiating leverage
• Formulary strategy and preferred positioning for MFP products
• Whether the market needs to redefine value beyond price and rebate
“The combination of these things we’re talking about brings up a great question; do we have to start reframing how we think about value?”
Share your perspective on The Payer Exchange
We’re always looking to hear from current and former payers, healthcare decision-makers and policy experts from around the world.
If you’d like to take part in a future episode of The Payer Exchange or join Verpora’s global payer network, get in touch with Omar Ali, Verpora’s Head of Payers, by email omar.ali@verpora.com or via DM on LinkedIn.
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About The Payer Exchange
The Payer Exchange is a podcast from Verpora exploring the people, policies and decisions shaping pharmaceutical market access around the world. Hosted by Omar Ali, Verpora’s Head of Payers, each episode features an in-depth one-to-one conversation with payers, policy experts and healthcare leaders, offering direct insight into pricing, reimbursement, access and the practical pressures shaping healthcare systems and pharmaceutical strategy.
At Verpora, we’re all about access strategy, and The Payer Exchange was developed as a way to share discussions we are having every day with payers, policy experts and life science organisations.
Verpora helps pharmaceutical companies bridge the gap between the value of innovation and the realities of healthcare funding. Through our global payer network, evidence, data and strategic market access expertise, we support better decisions, stronger partnerships and, ultimately, better patient access.
If this episode’s conversation has raised questions about your own challenges in market access, pricing, value-based agreements or innovative contracting, or you’d simply like to continue the discussion, we’d be delighted to hear from you - email omar.ali@verpora.com
Disclaimer: This presentation is for educational and informational purposes only, and is not intended as legal or policy advice. This presentation is based on non-confidential intelligence. Views expressed by the speakers are personal opinions and should not be attributed to anyone else or any organization. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.
