At Health Evolution’s 2023 Connect, health care executives convened to address crucial issues across the industry, including pivotal challenges facing the pharmaceutical market. In our Big Discussion, “Pharmaceutical Market in the Spotlight: Balancing Affordability, Availability, and Innovation,” moderator George Barrett, Founder of The Overtone Group and former Chairman & CEO of Cardinal Health, and discussion leaders Rob Andrews, CEO of Health Transformation Alliance; Steve Collis, Chairman & CEO of Cencora; and Erin Satterwhite, CEO of Optum Specialty Pharmacy, delved into the complexities of the pharmaceutical industry and explored ways to ensure innovative treatments are accessible and affordable.
Reflecting on the urgency of these issues, Barrett remarked, “Pharmaceuticals drug pricing remains very much on people’s minds, from consumers to business organizations to legislators. We struggle with questions of affordability and access and, of course, equity.”
Participants noted that health care executives are facing critical questions when it comes to crafting the future of pharmaceuticals, including how leaders can balance affordability and innovation and how to ensure broad access to treatments while avoiding supply chain disruptions.
Harnessing AI to Revolutionize the Industry
Leaders noted that recent advancements in AI could have a substantial impact on pharmaceutical development and innovation, and they called on executives to embrace new AI tools. Collis charged, “If the next generation of AI can potentially solve complex health issues, such as cancer, it’s imperative that we invest in these technologies.”
But AI’s potential goes beyond assisting in research and development to create new treatments, Collis said. New AI technologies also could be used to solve other challenges facing the pharmaceutical industry, such as supply chain and logistics hurdles that can make treatments difficult to access. “AI could enable us to start managing more of the whole environment all the way through the supply chain, essentially down to what’s on our customers’ shelves,” he said.
Pharmaceutical companies also could use AI to enhance the ways they understand and care for patients, leaders said. For example, Collis said companies could use AI tools “to look at patient reactions and understand how we can do a better job.”
Andrews added that AI tools could allow companies to better understand patient behavior, and therefore tailor treatments to be more effective. “If I had one wish, it would be to see generative AI confront a very old problem: the lack of self-esteem and behavioral issues with weight, diet, exercise, etc.,” he said. “We’re going to figure out what motivates somebody to eat better, exercise more, and take care of themselves.”
In addition, Satterwhite said AI tools could help researchers and providers better understand which patients would benefit from targeted therapeutics, such as gene therapies. For example, “there are companies that are looking at obesity phenotype and looking at whether patients will be long-term responders to certain medications or whether they should have a different treatment path,” she said, “and in pharmacogenomics more broadly, it’s starting to be normal practice that when someone is going to be prescribed an antidepressant, providers figure out whether their body actually is going to respond to a certain drug or whether they should be prescribed something that’s more tailored for them.” Satterwhite continued, “I think we’re starting to see a normalization of the use of precision medicine in certain areas and that’s going to start to become a more common practice with advancements in AI.”
With all the potential these new technologies hold, leaders said health care executives must invest in AI to harness its potential to revolutionize the industry.
Precision Medicine: Pioneering Personalized Care
But even beyond AI, Satterwhite emphasized the tremendous potential of precision medicine to provide more effective patient care. “Gene therapies and pharmacogenomics are revolutionizing the health care landscape,” she noted.
However, Satterwhite recognized that the health care system currently does not have a sustainable way to pay for high-cost, precision treatments and ensure patients in need can access them. “The industry really requires new models of care, new models of pharmacy support, and new models of payment,” she said.
These highly effective treatments mark a turning point in health care, in some instances curing previously uncurable, chronic conditions, leaders noted. However, industry executives must collaborate on new models to integrate these groundbreaking advancements into patient care in ways that focus on value and outcomes, they said.
Data Transparency: A Path to Affordable, Equitable, Value-Based Treatments
Leaders agreed that increased data transparency across the health care ecosystem could help stakeholders advance new models to administer and pay for emerging treatments—and drive further innovation in the pharmaceutical market.
Andrews emphatically stressed the need for all companies across the industry to embrace data transparency. “We all support data transparency, but often hesitate to share our own data. Achieving true transparency requires collective effort,” he said.
Health care CEOs must recognize data transparency as an urgent priority, leaders said, because the lack of transparency hinders the industry’s ability to demonstrate the value it provides. With increased transparency, health care executives could begin to better understand and address concerns around high-priced treatments and create new care and payment models that focus on value.
“We can either argue that pricing is fair on a per unit basis, or we can derive and execute on a set of principles that says, ‘let’s measure the value in terms of outcome and total cost of care for this drug,’” Andrews said.
By fostering data transparency and dialogue about pricing, executives can work toward creating value-based models that center on optimizing patient care, reducing costs, driving innovation, and ensuring equitable access to treatments, leaders said.
Satterwhite further pushed executives to take a long-term view when having conversations about and making investments in value-based models for pharmaceuticals. “The prevalent focus on annual or quarterly value realization appears to discourage embracing a longer-term perspective,” she said, “but there’s a crucial need to advocate for a broader view to instigate the necessary changes.”
Health care CEOs should champion the adoption of value-based models that emphasize return on investment over a patient’s lifetime and across the entire health care ecosystem, rather than focusing on any one entity or moment in a patient’s journey. By doing so, executives can create a health care system that truly focuses on improving patient outcomes and quality of care, leaders said.
Architects of Change: The Crucial Shift in Pharmaceuticals
Overall, leaders emphasized the necessity for visionary leadership to embrace new pharmaceutical innovations and create models that will ensure emerging treatments are affordable and accessible. Leveraging new technologies, advocating for transparency, and collaborating across the health care industry to develop value-based care and payment models for pharmaceuticals are imperative for transforming the industry and charting an equitable and sustainable future.
“In recognizing the tremendous care benefits of pharmaceuticals, it becomes evident that choosing a drug over hospitalization or physician visits makes practical sense,” Collis remarked. “Let’s not overlook the invaluable advantages pharmaceuticals offer and preserve these benefits.”
