Pharmaphorum Podcast Highlights the Nuwae of Doing Things
Nuwae president Ralph Pisano and Goodroot CEO Mike Waterbury recently joined host Jonah Comstock on the pharmaphorum podcast to discuss drug pricing, the unsustainable continuous increase of healthcare premiums, the outlook for biosimilars on pharmacy spend and more.
The podcast gave Ralph and Mike a great opportunity to provide an overview of how Nuwae is providing cutting-edge solutions that control the cost of prescription drugs and the factors in the pharmaceutical industry that led to Nuwae’s unique approach. Below are some of the highlights of what Mike and Ralph had to say.
Listen to the full episode on the pharmaphorum podcast.
Ralph on how we got here: “If we look back in history and see the evolution of PBMs and how they interacted with pharmaceutical manufacturers, the early-on intent was processing claims more efficiently and electronically, and bringing discounts to save money on premiums and patient out-of-pocket costs. Along the way, many PBMs realized that they have a lot of leverage and power over pharmaceutical manufacturers. If we were to build a system today, I don't think it would be a system of leveraging pharmaceutical manufacturers.”
Ralph on transparency: “We want to be a fully transparent model, eliminate those middlemen, hands that are out, and bring that money back to the patient and payer where it was originally intended to be, and lower out-of-pocket costs to make drugs more affordable and accessible for patients in the United States.”
Ralph on the status quo: “We're going up against a very powerful old way — no pun intended there — but a lot of forces that are in charge are very happy with the current system. Many manufacturers have to deal with three organizations that control many of the prescriptions that flow through this country. Our differentiation is that we are fully transparent. We want to negotiate the best discount on list price for our patients. The target is self-funded employer groups right now. Eventually we hope that base will grow and move them away from the old system by lowering their overall spend on drugs and changing the benefit to what it used to be many years ago when we first started out.”
Mike on gross to net: “Inside a pharmaceutical company, they look at the gross price, the gross list price, and then they manage themselves to the net money that they receive after they pay everyone in between them and the patient. That's all they care about; “gross to net” was this term we kept hearing. And sometimes it's a very significant discount when you give out a big rebate, and you pay for copay assistance and financial assistance and free drugs. There's like seven or eight categories that go into this difference between their list price and the net price. How do we deliver the gross-to-net price directly to the patient? That's the concept. That's the big idea. And whoever can do that, without having to pay any of the fees in between, probably can reduce the drug price, we think in excess of 60-65 percent across the board, and eliminate all these challenges around changing formularies.”
Mike on what Nuwae can do: “We see the Mark Cubans of the world they should be customers of Nuwae. Because what we're going to deliver in terms of these relationships and contracts with the manufacturers of which we already have some key ones, is exactly what they should be doing. And maybe they're sort of trying to get to the same endpoint. But without that strategic, contractual relationship with a manufacturer that aligns with their objectives, some of these games will still exist. What we're going to be doing is delivering a net price point on pharmacy to employers, for their employees, that will be more than half the cost of what they're paying today. And whether or not the broker can understand it or communicate it to the benefit consultant, we're very prepared to try to find those right partners.”
Mike on unsustainability: “When you look at the financials of these companies, the health care piece is going down and the pharmacy piece is going up. So at some point that's not sustainable. When you have a family premium that's, on average, $25,000 a year, you look out 10, 20, 30 years, you're talking about close to $100,000 a year with the way it's growing. How do you have a workforce that pays $100,000 for their health care for their family. It's not obviously sustainable.”
Mike on the two things you need: “You have to have a commitment to do it. That's first and foremost. And then you have to have a pretty detailed working knowledge of the problems. We have that, and we have the commitment. So without those two things, god knows you don't have a shot.”
Mike on Nuwae’s future: “We believe that Nuwae is the solution. We have a technology platform that can deliver it to patients. We're very familiar with all the players and how decisions are made. We're looking at it and saying, in the next five years we better be able to do it because we can't just keep spending money forever to try to get there. But that's how we talk about it. So I think we're probably one of the only companies that's in that position.”
Ralph on biosimilars: “When you look at biosimilars, people compare that to generic drugs on the traditional side. So when Lipitor goes generic, after the exclusivity period, multiple drugs come out onto the market. Then that price point lowers down to about an 80 percent discount on generic and it becomes very affordable for the patients. Unfortunately, biologics are more expensive to make. They're very unique. There's a lot of legislation around interchangeability, which is very clunky. It's not similar to the traditional side where you have a generic and it's automatically substitutable. It has to be a specific interchangeable designation, which costs a lot of money for a biologic manufacturer to get.”
Ralph on biosimilar ‘discounts’: “We have not seen, traditionally, when biosimilars come out onto the marketplace, these big huge discounts. We see 25-30 percent difference between the innovative product. Some of the older biosimilars, we're seeing greater discounts in the 60s. It is our belief that we won't see that happen so quickly with Humira, because of all the things we talked about. You have to match copay cards, you have to have patient assistance and any of these clinical-type programs. If you're matching them, each of those things costs money, so they're going to keep the price of the drug up.”
Ralph on how biosimilars can move the needle: “We don't believe you're gonna see a lot of movement until someone has a strategy of preferring a biosimilar first. They're gonna forgo the rebates and the money. Or they can put it on a different tier, meaning a generic tier that’s lower out of pocket, or a preferential specialty tier where they pay less than they would pay for a branded biologic. I think we're the only company out there that is saying we're going to negotiate similar to what they do on a generic size, that branded-drug discount even on specialty drugs, and bring that directly to the patient.”