Understanding the Role of Rebates in Prescription Drug Pricing

Gerard Anderson, Ph.D., is a professor of health policy and management and director of the Johns Hopkins Center for Hospital Finance and Management. Prior to coming to Johns Hopkins in 1983, he worked in the Office of the Secretary of the US Department of Health and Human Services from 1978 to 1983. While in the Office of the Secretary, Dr. Anderson worked primarily on health care financing issues and was one of the principle architects of the Medicare Prospective Payment System. Dr. Anderson is currently conducting research on drug pricing, chronic conditions, comparative insurance systems, medical education, health care payment reform, and technology diffusion. He has directed reviews of health care systems for the World Bank, World Health Organization and USAID in multiple countries and has directed over 100 research projects. He has authored two books on health care payment policy, published 300 peer-reviewed articles, testified in Congress 50 times, and serves on multiple editorial committees.

 

Lida Etemad, Pharm.D., M.S., is the vice president of Pharmacy Management Strategies for United HealthcareEmployer & Individual, Community & State. In this role, she is accountable for identification and development of programs and products that enhance the value of the commercial and Medicaid pharmacy benefits. Dr. Etemad has been with UnitedHealth group since 2002. She joined the company with OptumInsight (then Ingenix), conducting pharmacoeconomic research studies as a consultant to pharmaceutical manufacturers. In 2005, she started consulting for United Healthcare leading analytics for development of the Prescription Drug List (PDL). In 2007, Dr. Etemad moved to United Healthcare and has held several roles with increasing responsibility within pharmacy management—including analytics, PDL product development, drugs covered under the medical benefit and pharmaceutical manufacturer relationships. In her current position, she manages a diverse team of business leads, analysts, and pharmacists. Dr. Etemad received her PharmD from North Dakota State University. Subsequently, she completed a fellowship at the University of Southern California in conjunction with Wellpoint and (then) Pharmacia. She holds a Master’s of Science degree in Pharmaceutical Economics and Policy.

 

Lance Grady is the vice president and team lead at Avalere Health. He devises commercialization strategies focused on value, access, and reimbursement. With a focus on oncology and over 20 years of experience in policy, access, reimbursement strategy and execution, and point-of-care, he is passionate about providing practical and meaningful solutions that are viable to all healthcare stakeholders. Lance delivers proven, measurable outcomes by creating integrative and sustainable solutions in functional areas pertaining to: patient access strategy and services; physician-administered reimbursement strategy and support; value-based and risk-based payment models; CMS policy strategy; Medicare payment models; commercial health plan formulary, medical policy, and utilization management; benefit design; drug-dollar-data flow; oncology pathways; specialty channel strategies – pharmacy, GPO, and wholesaler distribution.

 

Jack Hoadley, Ph.D., M.A., is a research professor emeritus at Georgetown University’s Health Policy Institute. He retired in 2017 but continues to conduct research on a part-time basis.  In 35 years as a health policy researcher, he has studied a wide range of health financing topics focusing on Medicare, Medicaid, and private health insurance.  Recent papers have addressed access, costs, and coverage for prescription drugs; Medicaid coverage for children and families in small towns and rural areas; the Medicare Part D drug benefit; insurance exchanges under the Affordable Care Act; and consumer protections around surprise medical bills.  Dr. Hoadley has completed six years as a commissioner on the Medicare Payment Advisory Commission (MedPAC).  He holds a Ph.D. in political science.  Prior to arriving at Georgetown in 2002, he held staff positions at the Department of Health and Human Services, MedPAC, the Physician Payment Review Commission, and the National Health Policy Forum.

 

Ross Margulies, J.D., MPH, is an associate at Foley Hoag LLP. He helps innovative healthcare and life sciences companies to advance their strategic business goals in a heavily regulated industry undergoing rapid change and disruption. His clients include community health centers, healthcare startups, biopharmaceutical manufacturers, long-term care providers, pharmaceutical benefit managers, pharmacies, large health systems, insurers and technology companies. Ross has a special expertise in helping his clients navigate complex issues related to the Medicaid program at both the State and Federal levels. Ross’ practice emphasizes strategic counseling on regulatory and administrative processes and reimbursement matters. His focus includes coverage and reimbursement issues before the Centers for Medicare and Medicaid Services (CMS); legal, regulatory and strategic advice to health care companies; and compliance advice and analysis related to State and Federal fraud and abuse laws. Ross has also developed specific capabilities in counseling clients on the multiple changes to health care laws that occurred as part of the enactment of the Affordable Care Act in 2010, and subsequent amendments to the law. Ross serves on the board of Certified Naturally Grown and provides regular pro-bono advice to healthcare providers serving disadvantaged populations, including Community of Hope in Washington, DC.

 

Moderator

Sarah J. Dash, MPH, is the president and chief executive officer at the Alliance for Health Policy. She drives the mission and vision of the Alliance, as well as advances and maintains the reputation of the organization as the leading nonpartisan resource for policymakers and health leaders in an evolving health policy environment. Sarah joined the Alliance in 2014 as the vice president for policy and became president and CEO in May 2017. Sarah has long been an influential force in shaping health policy, having served as a senior aide on Capitol Hill and as a member of the research faculty at the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms. Sarah holds a master’s degree in public health from Yale School of Public Health and a Bachelor of Science in chemistry and literature from Massachusetts Institute of Technology. Sarah also holds an Executive Certificate in Nonprofit Management from Georgetown University.