The reality is that non-price factors, including several players, are causing net prices to decline and retail prices to increase. Those players include employers, health plans, and pharmacy benefit managers (PBMs), all of whom have continuously circumvented the system through loopholes and complicated systems of reimbursement that tend to hurt patients
About Gauri Binoy
Gauri Binoy is a research assistant at Pioneer. She graduated from Cornell University with a BA in Biological Sciences and Developmental Sociology in May 2021. She pursued research during her collegiate career in Cognitive Neuroscience, and completed her four years with a honors thesis and was selected amongst many students to receive an accolade of outstanding thesis in behavior. She has also done a plethora of work in the public healthcare sector, with an emphasis on access to care for the underprivileged and uninsured. Currently, she works as a healthcare analyst for Huron, working with hospitals and healthcare systems to create optimal solutions and improved workflows. She also volunteers in her free time for community organizations in the Boston area. Her future interests are deeply rooted in life sciences and healthcare policy, with hopes to work in spaces that will facilitate structural changes to lead to more equitable solutions.
Entries by Gauri Binoy
Utilization Management (UM) was originally a strategy designed to improve the safety, quality, and cost-effectiveness of physician prescribing. However, UM has grown exponentially over the last decade, becoming more a tactic for Pharmacy Benefit Managers (PBMs) to manage costs to benefit their bottom line.
Healthcare policy is an all-encompassing term. It plays a role in every individual’s life; how it is curated, developed, and maintained has a significant long-term impact on the quality of life of any given community. It is critical that policymakers consistently adapt and amend healthcare policies in the ever-changing global pricing and affordability environment while providing funding support for optimal quality of care.
Policymakers rely on accurate and timely data when implementing legislation or regulation to address biopharmaceutical spending in the U.S. Based on this research, policymakers may want to utilize other sources in addition to NHE data provided by CMS when making policy recommendations.