Insights From an Expert Advisory Board: The Trends Driving Changes in Managed Care

OBJECTIVES: With a myriad of healthcare dynamics moving through the US healthcare system, this study delineates the capacity of these dynamics to influence utilization and cost. Ranging from the implications of the Inflation Reduction Act (IRA) to the escalating use of high-cost biologics for chronic diseases, our advisory panel evaluated and ranked these trend drivers on their potential to impact medication access for US patients.

METHODS: Following in-depth secondary research that encompassed a comprehensive review of the US healthcare landscape, an initial outline of the potential dynamics that will influence medical cost and utilization was established. These dynamics served as the cornerstone for the formation of an advisory board of five decision-makers from US managed care organizations. Their focus was to identify the dynamics that posed the most significant concerns to managed care organizations and those that would have the most substantial impact on patient access and care. To ensure the validity of the advisory board’s findings, we conducted 15 quantitative surveys with pharmacy and medical directors. These directors represent a significant portion of the US population, approximately 120 million lives.

RESULTS: In the short term (2024), the increasing trend of using biologics in chronic disease, shifting to new pharmacy distribution partners, and the emergence of obesity coverage present improved medication access for patients. However, both the managed care and pharmaceutical industries will be forced to adapt to these changes. The integration of Artificial Intelligence is ranked as a significant trend that will ripple through the industry. Longer-term trends include the increasing need for price transparency and the rise of patient-driven care models.

CONCLUSIONS: The results underscore the dynamic nature of the pharmaceutical industry and the need for strategic planning in response to evolving market events and drivers.