The Payer Exchange Podcast Episode 14: USA - Ross Margulies
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In the final episode of the US-focused Payer Exchange podcast series, we shift our perspective to that of to the policy and legal forces behind many of the changes discussed so far. Omar Ali speaks with Ross Margulies of Manatt Health, whose work sits at the intersection of healthcare law, federal policy and strategic market access.
Ross examines the durability of Most Favoured Nation (MFN) pricing and international reference pricing, the legal position of GUARD and GLOBE, and the move from CMS guidance towards formal rulemaking in the Medicare Drug Price Negotiation Program.
Crucially for a global audience, the discussion shows how US policy is already influencing ex-US launch sequencing, international pricing strategy and decisions about where and when manufacturers make new medicines available.
Key themes:
Whether international reference pricing and MFN are becoming durable US policy
GUARD, GLOBE and the legal limits of federal demonstration authority
Manufacturer responses, including delayed or sequenced ex-US launches
CMS drug price negotiations moving from guidance towards formal rulemaking
Part B medicines, buy-and-bill economics and potential provider behaviour
Building MFN, IRA and international pricing into global launch and lifecycle planning
“I think international efforts will be successful in increasing the prices paid by foreign countries, but I also think it’s likely that there’s going to be bleed over of ultimately lower international reference prices into US pricing”
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.
