In this episode, Our guest is MARC RYAN, who has extensive leadership experience across the healthcare industry. Most recently, he was a founding executive and President of MedHOK (MHK, acquired by Hearst Health). He has launched and operated multiple health plans. Marc served in senior policy roles in state and federal government, including as state management secretary of Connecticut and helping build Medicare Part D’s relationship with state drug assistance programs in 2006. He created Connecticut’s Medicaid and children’s health managed care programs and its long-term care continuum. Marc is the author of The Healthcare Labyrinth: A Guide To Navigating Health Plans and Fixing American Health Insurance and the host of the Healthcare Labyrinth Podcast.
Topics covered:
(1) What are the trends in drug spending and the impact on all types of insurance products -- Medicare, Medicaid, commercial/employer -- cost trends for medical and retail
(2) What is driving the major increases in drug costs/spending?
(3) How are GLP-1s treated across various products? And will coverage change?
(4) American drug prices compared with others? Can you discuss how we compare vs. other developed countries and why (more than twice -- in many cases 3, 4, and 5 times more -- impacts on employer, Medicare, etc. -- rising percentage of healthcare as well as employer)
(5) Medicare drug price negotiations -- what it is and what has happened so far? where do you stand?
(6) A lot is occurring in plans on PA, formularies, benefit design, PBM reform -- a very hot topic -can you tell us more about this and what you predict? (7) Can you explain the traditional PBMs vs. transparent ones? FTC lawsuit against PBMs and drug supply channel issues
(8) There have been major changes to Part D and it is impacting Medicare Advantage and Part D -- what is happening for 2025 benefits as well as can you tell us a little on a study that questioned the value of Part D?
(9a) Medication Adherence in the Star program for MA and Part D plans -- key. Can you tell us more here? 9(b) How could pharmacists in the community support medication adherence etc -- Will discuss trends from health plans about recognizing the best way to ensure medication reconciliation and adherence is teaming up with pharmacists.
Guest - Marc Ryan
Host - Hillary Blackburn, PharmD, MBA