This year is set to bring some challenges and exciting opportunities for the healthcare landscape, and I would like to highlight those that are top of mind.
First, we expect a robust 2025 specialty drug pipeline to overtake a disparate percentage of the healthcare dollar. This financial impact is fueled by continued growth in medical specialty drug spend particularly in Cell and Gene, Rare, and Oncology therapies via new drug approvals. With the new administration, we expect significant pressure on biopharmaceutical companies for value pricing as well as shakeups in the FDA. As biopharmaceutical companies navigate these value discussions, health economics and clinical impact will be critical levers for new alternative models as opposed to traditional rebate pay to play. Value-based agreements (VBA) will play a more prominent role in driving both clinical and economic value. We see payers leveraging new strategies as illustrated with Independence Blue Cross’ approach to coverage of products with accelerated approvals. Understanding that accelerated approvals impact oncology and rare diseases, innovation is critical to ensure access to these new medicines while delivering improved patient outcomes with value. Sapere Health works with our customers offering market insights and innovative approaches to navigate these challenges.
Second, new changes introduced with the Inflation Reduction Act (IRA) could significantly impact Medicare Advantage plan sponsors’ profitability in 2025 resulting in possible continued operational downsizing and lower reimbursement to their provider groups. On the commercial side, the consequences of drug negotiations may result in higher new drug launch pricing and lower rebates. With the new administration, we also anticipate changes to ACA risk pooling and incentives for health plans to expand their value-based arrangements. Clinical and advocacy strategies will be critical for navigating challenges anticipated on this front.
Lastly, we see significant pressure on the supply chain for transparency which has been focused on PBMs. However, health system and 340Bs will be heating up this year as we saw manufacturers increasing HRSA litigation efforts. Expect new models for 340B purchasing to evolve into the 2025 landscape. The supply chain is complex with many stakeholders. Considerations need to include a broader ecosystem balance that results in improved transparency and patient outcomes.
While these trends are currently top of mind, there are many others we will share in our upcoming publications. At Sapere Health Solutions, we are excited to partner and consult with clients across clinical, access and reimbursement, health economics, and specialty distribution.
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