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From YouTube: Biotechnology and State Roles
Description
Biotech research is growing fast. In Massachusetts, more than 63,000 biopharma employees are working on more than 1,600 potential new medicines. In this video from NCSL's 2017 Legislative Summit in Boston, learn how new models for pricing and research are hoping to bring down the cost.
A
So
I
really
want
to
just
kick
this
off
with
a
few
comments
to
introduce
our
moderator,
Susan
dentzer.
As
you
can
see
from
the
information
she
is
president
and
CEO
of
the
network
for
a
elegance
and
excuse
me.
Excellence
in
health
innovation
based
here
in
Boston,
but
before
she
came
to
any
hi
denser,
was
the
editor-in-chief
of
health
affairs,
one
of
the
leading
journals
of
health
policy
as
well
as
working
as
an
advisor
to
Robert,
Wood
Johnson,
and
you
may
also
know
her
as
an
on-air,
correspondent
and
speaker
on
PBS
newshour
for
many
years.
B
Thank
you
very
much,
dick
and
actually
I,
think
Network
for
elegance
and
health.
Innovation
would
be
a
wonderful
name
too,
as
well
as
excellent.
So
thank
you
it's
great
to
be
here
with
all
of
you
in
here
in
Boston
and
in
Massachusetts,
and
today
we
are
gonna
start
off,
obviously
talking
about
what
is
going
on
in
Massachusetts
in
various
respects,
but
it's
very
important
for
the
panel
to
offer
this
by
way
of
allowing
for
discussion
about
whether
what
is
going
on
in
Massachusetts
is
generalizable
to
the
other
states
of
the
union.
B
I
live
in
Washington
DC.
Are
we
have
an
office
up
here
in
Boston,
so
starting
a
little
bit
over
a
year
ago,
I
was
coming
up
to
Boston
very
frequently
after
having
been
away
for
some
time.
I
had
a
fellowship
here
at
Harvard
years
ago,
but
it'd
been
been
a
while,
since
I'd
been
spending
much
time
in
Massachusetts
and
when
you
come
back
to
Massachusetts
today,
I
draw
the
analogy:
it's
a
little
bit
with
respect
to
health
care
like
walking
into
a
big
Cineplex
where
multiple
blockbuster
movies
are
playing
and
their
blockbusters
most
of
them.
B
There's
some
Indies
independent
movies.
It's
all
quite
interesting.
For
example,
one
blockbuster
movie
playing
in
the
healthcare
sector
in
Massachusetts
currently
is
what's
going
on
in
life
sciences,
as
we'll
be
discussing
today,
Massachusetts
has
more
than
600
life
sciences,
companies
now
and
research
organizations
employing
more
than
60,000
people
in
the
Commonwealth
and
a
combined
payroll
that
exceeds
7
billion
dollars
a
year.
B
In
recent
years,
Massachusetts
has
drawn
more
than
20%
of
all
the
venture
capital
going
into
biotechs
nationally,
and
a
great
deal
of
momentum
came
from
an
initiative
of
the
prior
administration
of
the
Deval
Patrick
administration,
which
invested
a
billion
dollars
in
the
life
sciences
sector,
beginning
in
2008
and
as
we'll
hear
today.
Out
of
all
of
this
is
coming
an
amazing
product
stream
of
therapies
that
have
the
power
to
save
lives
and
transform
lives.
So
that's
one
blockbuster
movie,
that's
playing
in
the
state.
B
Another
blockbuster
movie
in
this
healthcare
Cineplex
in
Massachusetts
is
more
of
an
indie
movie.
Well,
it's
what's
going
on
in
the
digital
health
sector
and
as
with
life
sciences
a
decade
ago,
the
state
is
making
major
investments
to
stimulate
the
formation
of
digital
health
industry
in
the
state,
bringing
together
health
information
technology.
B
Other
advances
in
computer
science,
machine
learning,
everything
you
can
think
of
that
goes
under
the
rubric
now
information
and
Health
Sciences
to
bear
on
building
this.
What
it
has
hoped
will
be
a
very
vibrant,
new
digital
health
sector
and,
along
with
that,
the
state
has
created
a
digital
Healthcare
Council,
which
is
a
public-private
partnership
that
will
advise
the
administration
of
the
current
governor
Baker
on
the
evolution
of
this
industry.
So
that's
another
blood,
indie
movie,
but
possibly
someday
to
be
a
blockbuster
movie.
You
see
playing
out
here
in
the
state.
B
Some
Massachusetts
far
and
away
the
state
with
the
highest
level
of
health
insurance
coverage
versus
the
National
uninsurance
rate
according
to
census,
as
you
know,
still
of
nine
point,
four
percent,
and
apparently
now
climbing
so
again,
just
a
real
blockbuster
success
story
of
coverage
within
the
state.
Then
there
are
other
blockbuster
movies.
One
of
them
has
to
do
with
high
health
care
costs.
B
Massachusetts
has
the
second
highest
level
of
health
spending
in
the
nation.
Second,
only
to
Alaska
the
state
expenditures
there
I
should
say
expenditures
total
within
the
state
in
2016
we're
thirty
one
percent
above
the
national
average
on
a
per
person
basis,
the
per
capita
cost
being
about
ten
thousand
five
hundred
dollars,
and
these
costs
disproportionately
fall
on
low
and
middle
income
families.
In
fact,
the
state's
health
policy
Commission
has
calculated
that
total
spending
on
health
care,
including
contributions
made
by
employers
to
their
employees
and
dependents.
B
Health
insurance
coverage,
can
be
as
high
as
thirty
percent
of
income
for
a
family.
That's
living
at
three
times
the
federal
poverty
level
for
a
family
of
three.
That's
sixty
one
thousand
dollars
this
year.
So
if
thirty
percent
of
overall
family
income
is
in
effect
going
to
health
care,
you
have
a
situation
which,
obviously,
for
many
elements
of
the
population
is
untenable.
B
Now
what
is
striking
about
all
of
these
blockbuster
movies
is
that
they
all
seem
to
be
proceeding
along
they're,
separate
lines
without
a
whole
lot
of
interconnection
among
the
there's,
no
cross-cutting
movie.
That
explains
how
healthcare
spending
can
be
moderated
in
a
state
that
has
a
blockbuster
life
sciences
sector,
producing
dramatic,
dramatically
effective
in
many
instances,
therapies
at
dramatic
prices.
B
Maybe
there
is
a
cross-cutting
movie
to
be
found
if
we
take
some
of
the
topics
that
we're
going
to
discuss
today,
for
example,
discussions
among
payers
and
life
sciences
companies
about
how
to
do
value-based
contracting
around
some
of
these
very
important
new
therapies.
Maybe
that
will
prove
to
be
the
movie
that
connects
the
dots
we
will
see
at
any
rate,
our
panel
today
is
going
to
dive
into
all
of
this,
particularly
the
biotechnology
piece
to
focus
on
what
will
happen
with
1,600
new
medicines
in
the
pipeline
and,
besides
that
area
of
innovation.
B
These
efforts
to
negotiate
new
value-based
contracts,
how
come
base
contracts
risk
based
contracts
to
see
whether
we
can
bring
all
of
this
new
activity
in
healthcare
into
the
value
equation.
That
much
of
the
rest
of
us
healthcare
is
slowly
coming
in
to
so
let
us
go
to
our
panelists
now,
I'll
introduce
them
all
briefly.
You
have
their
fuller
BIOS
in
your
packet.
B
He
served
as
Undersecretary
of
economic
development
in
governor
Patrick's
administration
and
before
that
he
was
a
state
representative
to
the
11th
Norfolk
district,
for
three
terms
when
he
focused
largely
on
health
care
and
economic
development.
So
Bob,
it's
great
to
have
you
with
us
after
Bob
burger,
hear
from
Alice
Moore
who's
Undersecretary
of
Health
in
the
executive
office
of
Health
and
Human
Services
here
in
Massachusetts,
in
her
position,
she's
responsible
for
creating
implementing
and
managing
policy
legislation
and
operations
for
this
Secretariat,
which
is
the
largest
in
the
state
government.
B
After
Alice
speaks
will
hear
from
dr.
Michael
Sherman
he's
the
senior
vice
president
and
chief
medical
officer
at
Harvard
Pilgrim
health
care,
which
is
a
not-for-profit
health
plan
here
in
the
state
that
provides
a
variety
of
insurance
options
to
more
than
one
and
a
quarter
million
members
in
the
state,
as
well
as
in
New
Hampshire
and
Maine
and
Connecticut
Michael
is
responsible
for
Harvard
pilgrims,
medical
trend
management,
engagement
with
providers,
medical
informatics
and,
very
importantly,
he's
taken
the
lead
on
the
value-based
contracting
or
risk-based
contracting.
B
That
Harvard
Pilgrim
is
engaging
in
now
with
a
number
of
biopharmaceutical
companies
and
we'll
hear
more
about
that
shortly.
So
Michael
welcome
and
then
last
but
hardly
least,
we'll
hear
from
Martin
cigar
EMD
Martin
is
vice
president
of
global
health
economics
at
Amgen,
where
he
directs
the
planning,
execution
and
dissemination
of
economic
and
value
evidence
for
the
entire
product
portfolio
at
Amgen.
Going
all
the
way
from
the
earliest
stages
of
molecules
under
investigation
all
the
way
through
to
marketing
products.
B
Before
he
joined
Amgen
in
2005,
he
held
various
positions
at
Johnson,
&
Johnson
in
health,
economics,
medical
fairs
and
strategic
marketing
and
Amgen
has
been
on
the
other
side
of
a
lot
of
the
contracts
that
have
been
struck
in
the
value-based
or
outcome-based
arena,
so
Martin.
Thank
you
very
much
for
being
with
us.
Each
of
the
panelists
is
going
to
speak
for
about
five
minutes.
Then
we'll
have
some
robust
discussion
among
all
of
us
and
we'll
open
it
up
to
all
of
you
for
your
questions
and
comments
so
Bob
over
to
you.
C
C
But
seriously,
thank
you
and
welcome
in
Susan.
Thank
you
for
the
very
gracious
introduction
it
masked
by
a
weird
trade
association
that
represents
over
a
thousand
biotech
pharmaceutical
companies,
hospitals,
universities,
venture
capital
firms,
all
the
folks
that
make
up
all
the
ingredients
of
this
wonderful
recipe
that
we
have
here
in
the
life
sciences
and
I
just
wanted
to
throw
out
some
more
statistics
just
to
try
to
set
the
stage
here
and
then
give
you
real
briefly
my
thoughts
on
how
this
happens.
C
Okay,
because
it
didn't
happen
by
mistake,
a
lot
of
work
went
into
creating
this
culture
of
innovation
here
and
you
need
to
set
the
stage.
We've
experienced
thirty
thirty,
seven
percent
growth
and
employment
in
the
biotech
space
in
the
last
decade,
and
there
was
a
downturn
in
the
economy.
During
that
time,
we've
got
more
about
R&D
biotech
employment
than
any
other
state
and
I
love.
To
say
to
my
friends
in
California,
you
guys
are
six
times
bigger
than
us.
We
still
have
more
R&D
going
on
here
in
Massachusetts
why
o
Manufacturing's
grown
by
34%.
C
So
it's
not
just
all
science
jobs,
it's
not
all
R&D
jobs,
there's
also
great
manufacturing
jobs
that
have
been
created.
18
out
of
20
of
the
top
pharma
companies
now
have
a
significant
physical
presence.
In
Massachusetts
10
years
ago
there
was
only
a
couple
of
over
nine
million
square
feet
of
lab.
Space
has
been
a
in
the
last
10
years
about
4
million
of
that
since
2013,
and
it's
all
all
spoken
for
top
and
NIH
funding
per
capita
in
the
country.
C
On
top
of
the
four
out
of
the
top
four
and
five
out
of
the
top
six
NIH
funded
hospitals
are
here
in
Massachusetts,
but
why?
Why
do
we
all
do
it?
Susan
didn't
did
mention
that
I
used
to
serve
in
the
legislature
and
I
was
involved
in
government.
I
got
a
first
row
seat
to
her
as
how
government
could
partner
with
industry
to
try
to
be
more
successful
in
drug
discovery
and
I
learned
that
I
have
a
15
year
old
son
that
has
cystic
fibrosis.
I
didn't
choose
to
learn
about.
C
1.8
billion
patients
around
the
world
are
living
a
better
life
today,
we're
alive
today
because
of
these
therapies,
so
I
think
when
we
all
get
together
and
sit
on
panels
like
this,
we
try
to
think
of
that
common
denominator.
It's
a
sick
person!
It's
someone
like
my
son,
it's
someone
like
your
brother
or
your
aunt
to
your
uncle
or
your
mom
or
dad.
You
know
the
only
is
it
doesn't
pick
and
choose
where
it
goes.
It
hits
all
of
us
and-
and
it
does
certainly
doesn't
discriminate.
C
So
it's
so
important
that
we
think
of
that
and
when
you
think
of
how
Massachusetts
was
able
to
really
head
down
this
direction
in
the
last
decade,
we've
had
strong
colleges
and
universities.
We
had
a
you
know,
a
bustling,
a
growing
biotech
industry,
but
what
the
third
thing
that
really
made
it
work
was
a
true
partnership
with
government,
the
members
of
the
legislature
here,
the
members
of
the
administration
for
that
serving
government.
C
Here
in
Massachusetts,
we
really
look
towards
them
as
partners
to
solve
these
difficult
problems,
one
of
which
is
going
to
be
a
topic
for
today.
We're
working
on
cures
for
drugs
right
now,
we're
working
on
precision,
medicine,
breakthrough,
therapies,
things
that
could
change
the
course
of
disease
or
eradicate
it.
C
It
isn't
it
isn't
cheap,
it
isn't
cheap
and
we
have
to
make
sure
that
we
have
a
payer
system
and
we
work
with
the
Harvard
pilgrims
in
the
world,
the
public
payers
and
the
private
payers
to
develop
a
new
system,
a
system
that
will
enable
patients
to
access
these
new
therapies.
We
don't
want
I,
don't
think,
there's
anyone
in
this
room
or
in
the
world
for
that
matter.
C
That
wants
us
to
not
develop
cures
for
disease,
but
we
all
realize
we
have
to
be
able
to
absorb
the
upfront
costs
and
that's
why
I'm
excited
to
be
here
today.
I'm
always
excited
to
sit
on
panels
with
the
folks
that
we're
here
with
today,
because
we're
trying
we're
having
the
difficult
discussion
and
we're
trying
to
develop
solutions
so
that
these
therapies
will
be
available
for
sick
people.
So
those
are
my
opening
remarks
and
I'm
great
it's
great
to
be
here
with
you
guys
and
thank
you
for
attending.
Thank.
D
You
Bob
and
it's
a
pleasure
for
me
to
sit
here
today.
Ten
years
ago,
I
was
in
the
Senate
and
at
a
time
where,
with
Dave
cells,
who's
out
here
in
the
audience
and
others,
we
were
able
to
work
through
the
Life
Sciences
Center
legislation
which
so
it's
really
kind
of
cool
to
be
here
10
years
later,
and
be
able
to
review
back
and
see
the
what
successes
came
from
the
Life
Sciences
Center
and
what
learnings
also
come
from
the
Life
Sciences
Center.
D
In
the
experience
that
we've
had
there
public-private
partnerships
are
ingrained
in
the
Massachusetts
political
environment
and
makes
it
essential,
I
think
it's
governor
weld
might
may
have
pointed
out
at
the
very
beginning
of
this
conference.
You
never
know
who's
going
to
be
your
next
greatest
stakeholder
and
partner
in
negotiating
something
really
important,
and
we.
E
D
Take
that
very
seriously
it's
Undersecretary
of
health
with
Mary
Lou
Saunders,
the
secretary
with
the
with
Governor
Baker.
It's
been
essential
from
day
one
to
review
what
programs
and
services
are
working
in
Health
and
Human
Services
and
adapt
others
that
might
need
to
change
might
need
to
be
eliminated
and
that's
been
a
real
opportunity,
as
the
OHHS
is
a
purchaser
and
as
eohhs
serves
one
in
four
constituents
in
the
Commonwealth.
D
So
moving
from
the
Life
Sciences
Center
to
the
digital
Health,
Council
understanding
that
at
different
times,
there's
state
funding
available
and
at
other
times,
there's
not
state
funding
available.
There
have
been
different
approaches
to
how
we
can
create
the
environment
here
in
Massachusetts,
for
creativity,
for
innovation,
for
research,
for
breakthrough
inventions
and
use
our
role
as
purchaser
use
our
role
as
policymakers
to
support
that
environment.
D
Fundamentally,
changing
the
way
that
Medicaid
care
delivery
and
payments
are
made
by
creating
and
incentivizing
the
advent
of
a
ce
o--'s,
and
so
as
a
ce
o--'s
are
being
defined
as
as
different
levels
of
healthcare
providers
and
insurers
are
coming
together.
We
are
actually
right
now
in
the
process
of
defining
the
contracting
provisions
for
such
care,
delivery
and
system
payment
reform
very
exciting
time,
lots
in
the
mix,
as
we
know
so
many
of
us
were.
We
were
joking
before
this.
D
We
see
each
other
in
a
variety
of
different
ways,
sometimes
on
a
daily
basis,
whether
we're
talking
about
healthcare,
quality
and
developing
important
quality
standards
as
both
to
assist
mass
health
is
there
developing
and
assessing
value
based
contracts.
We
need
to
be
able
to
figure
out
how
we
are
sharing
the
risk
and
how
we
are
sharing
the
savings
and
in
the
Massachusetts
ACO
program.
It
is
new
that
there
will
be
shared
savings
and
there
will
be
shared
risk,
and
so
we
are
in
the
process
of
really
defining
that
now.
D
D
If
many
of
these
life-saving
therapies
are
the
only
life-saving
therapies,
it
requires
all
the
more
the
public-private
partnership
for
folks
to
come
to
the
table
for
those
who
are
creating
these
therapies
to
really
understand
how
it
is
that
we
can
make
accessible
these
therapies
make
affordable
these
therapies
and
balance
the
business
business
requirements
as
well.
We
have
the
Medicaid
participate
in
the
Medicaid
best
price
rule,
negotiating
supplemental
rebates,
and
we
are
right
now
out
with
for
public
comment
with
1115
demonstration
amendment
that
would
allow
the
Massachusetts
Medicaid
program
to
implement
a
closed
formulary.
D
Looking
for
some
flexibility
to
assess
clinical
efficacy,
which
you
know
we
guarantee,
are
clients
access
through
clinically
proven
efficacious
drugs
at
the
same
time,
maintaining
access
to
drugs
and
not
limiting
access
for
life-saving
drugs.
For
the
folks
that
we
serve
through
the
MassHealth
program
at
eohhs,
we
view
our
rural,
broadly
and
I
could
be,
I
could
go
on
and
on
and
won't
about
creating
connections
and
I.
D
Guess
I
would
just
highlight
that
although
healthcare
costs
in
Massachusetts
are
high,
they
are
not
growing
at
the
pace
that
they
had
been
growing
and
we
believe
that
that's
really
critical.
The
other
piece
of
this
is
through
the
connections
that
we
are
making
and
we
are
making
connections
every
day.
D
So
all
of
those
things
are
very
exciting
and
I
think
are
very
important
to
connecting
research
and
academics,
innovation,
Public
Health,
Initiatives
programs
and
services,
and
fundamentally
also
sharing
information
data
data
information
that
we
have
at
you,
HHS
through
public
health
reporting
and
others.
So
we
look
forward
to
the
dialogue
here
today
and
and
thank
you
all
and
I'm
gonna
turn
it
over
to
Michael.
F
We
want
our
our
stakeholders,
our
members,
to
have
access
to
the
drugs
that
they
need
and
I'll
share,
that
when
we
do
get
appeals
or
looking
at
policies.
First
thing
I
remind
my
pharmacist
when
they're
scratching
their
head,
trying
to
ferret
what
to
do
is
to
remind
them.
What
would
you
do
if
it
were
a
member
of
your
family
who
have
the
disease?
What's
what's
the
right
thing
to
do?
F
Let's
start
with
that
and
then
figure
out
how
to
deal
with
the
payment
and
the
other
issues,
and
that's
a
pretty
good
moral
compass
that
we
deal
with
now.
The
fact
is,
we
spend
about
three
billion
dollars
a
year
on
health
care
and
we're
not
for
profit
but
would
like
to
break
even
we
haven't
been
successful
in
the
last
couple
years,
but
we're
trying
and
the
reason
I
mention
that
is.
F
It
means
that
when
we
see
new
expensive
drugs
at
the
market-
and
let's
assume
that
they're
good
drugs
that
we
want
to
make
available,
we're
all
paying
for
them.
If
you
think
about
it,
the
ability
to
take
the
cost
share
for
these
expensive
drugs
and
passed
on
between
individuals
very
limited
or
they
won't
fill
a
prescription
which
means
by
and
large,
these
are
feeding
into
premiums
over
the
past
five
years.
F
Actually,
the
cost
year,
the
percentage
paid
by
the
individual
has
gone
from
thirty
four
cents
of
what
is
spent
on
on
drugs
to
21
and
a
half
cents,
and
that
represents
I
would
argue
the
fact
that
costs
are
going
up
and
that
we're
trying
to
protect
the
individual
so
that
they
they
do
get
the
drugs.
They
need.
The
other
couple
of
other
numbers
we
know
and
went
out
of
every
four
dollars
on
drugs
and
for
the
specialty
pharmacy
portion
of
that
which
is
the
fastest
growing
in
high
cost
and
complex
biologics,
etc.
F
That
grew
at
20%
year
over
year
and
I
monitor
this
on
a
monthly
basis
or
very
current
numbers
and
I'd
argue
know
that
some
people
might
find
that
contentious.
I.
Don't
think
my
colleagues
here
I
do
it
because
I'd
also
say
that
those
are
numbers,
those
aren't
good
or
bad
they're
numbers,
and
it
may
be
that,
as
we
see
some
of
the
great
blockbuster
drugs
coming
out,
that
the
right
number
is
30%
or
more,
particularly.
F
If
we
see
that
we're
getting
value
through
the
drugs
that
people
are
living
longer
are
living
high
quality
lives
kept
out
of
the
hospital,
etc.
So
it's
really
not
about
the
numbers
themselves.
It's
about.
What's
underlying
them
now,
I'll
share
that
we
do
worry
about
affordability,
as
I
mentioned
when
we
see
Costco
by
that
amount.
It's
convenient
premiums.
People
do
want
to
the
drugs
Aeneid.
They
don't
actually
get
very
excited
about
higher
premiums.
So
we
need
to
work
together
to
balance
to
do,
and
you
know
there
are
many
approaches.
F
Life
sciences,
industry
on
board
with
the
same
model
and
that's
very
exciting
and
I
think
is
an
opportunity
for
them
not
only
to
align
with
the
rest
of
the
system
but
actually
to
align
with
the
providers,
the
physicians
and
others
who
writing
prescriptions,
whom
they
spend
a
lot
of
time.
Energy
and
money
trying
to
market
you
and,
and
one
great
way
to
do,
that
is
to
show
that
they're
actually
aligned
with
how
the
providers
are
being
compensated
more
and
more.
So
it
is
certainly
the
right
thing
to
do.
But
it's
also
hard
briefly.
F
F
So
we
do
have
a
dozen
agreements.
Many
of
them
are
relatively
modest
in
terms
of
the
degree
of
risk,
but
they're
showing
that
we
can
do
this
and
I.
Think
part
of
this
is
proof
of
concept.
I'd
also
point
to
our
agreement
with
Amgen
for
path
as
being
a
terrific
opportunity
for
both
of
us
and
for
doing
the
right
thing
and
that
agreement
we
do
cover
their
drugs,
their
pcsk9,
which
is
a
higher
cost
alternative
to
statins
that
can
help
prevent
cardiovascular
events
and
people
who
have
risk
factors
and
high
cholesterol,
etc.
F
Now,
as
we
move
forward,
there's
many
many
high
cost
therapies
on
the
market
and
generally
I'm
excited
about
them
and
their
type
of
therapies.
I
lined
for
a
member
of
my
family
if
they
have
that
type
of
condition,
whether
their
gene
therapies
that
are
brand
new,
the
Karki
therapies
or
cancer
that
are
expected
to
the
market
and
both
of
those
within
the
next
year.
They're
important
advances,
but
they're
also
likely
to
be
very
expensive.
And
so,
if
we're
trying
to
figure
out,
how
do
we
actually
balance
access
and
affordability?
F
G
So
we're
just
a
few
minutes
away
from
the
robust
discussion,
so
I'll
try
and
keep
an
eye
keep
my
comments
short,
because
I
am
I'm.
Actually
gonna
echo
some
of
the
things
other
panelists
have
said,
but
perhaps
add
a
couple
of
observations.
So
you
know
one
observation
you
know
potentially
for
discussion.
I
think
we've
heard
it
in
the
panelists
is
that
there's
always
a
tension
between
kind
of
and
a
consumption
and
when
I
say
consumption,
I
mean
kind
of
the
things
we
think
about
in
health
care,
they're
keeping
the
lights
on
colonoscopies
dispensing.
G
You
know:
generic
medicines
delivering
babies
right,
Manning,
ers.
You
know
staffing,
hospitals,
all
the
things
that
actually
haven't
changed
that
much
since
I
was
a
physician.
It's
funny
for
me
to
think
back.
I
trained
at
Stanford,
and
many
of
the
things
that
are
being
done
now
are
being
done
almost
exactly
the
same
way
as
they
were
30
years
ago.
So
I
call
that
you
know
sort
of
the
present,
but
there's
always
a
tension
with
the
future,
with
future
investment
with
the
promise
of
technology
that
perhaps
hasn't
delivered
this
day.
G
But
has
huge
promise
for
the
future,
and
we've
heard
some
of
that
today,
right
Boston's,
obviously
a
center,
a
very
future
focused
Center
for
Biotechnology
and
I'm
privileged
to
work
for
a
company
that
is
both
present
in
Boston
and
has
also
grown
over
the
years
when
I
joined
Amgen
in
2005.
We
had
about
six
products.
Now
we've
got
about
20,
so
hopefully
we
work
in
that
tally
of
500
plus
products
that
have
been
added.
G
You
know,
I
think
that
when
new
technologies
introduced
it
always
looks
a
bit
more
expensive
than
the
present
day.
Consumption
I
remember
again
went
to
Stanford
I'm
dating
myself
now
so
I
was
training
in
the
80s
and
one
of
the
few
diseases
in
the
oncology
area
that
we
can
actually
cure
at
that
time
was
Hodgkin's
disease
right.
That
was
the
miracle
right
of
the
80s
right
and
essentially,
some
some
incredibly
dedicated
and
and
sort
of
forward-thinking
oncologists
figured
out
how
to
use
four
different
drugs
for
drugs
right
together.
G
That
was
the
chopper
regimen
right
to
take
the
cure
rate
from
Hodgkin's
disease
from
about
10
percent
to
I
think
it
was
80
to
90
percent
of
the
more
favorable
variance
and
I.
Remember
sitting
in
my
lecture
hall
was
thinking
how
amazing
that
was.
But
even
then
it
was
very
expensive
right.
These
were
largely
still
patent
protected
medicines
and
you
had
to
use
essentially
four
of
them
together
right
to
cure
disease
right.
So
I
think
these
are
not
new
problems.
G
This
tension
between
consumption
and
investment
I
think
what
does
the
English
today
from
say
30
years
ago,
is
and
I
think
Michael.
You
alluded
to
this.
Just
the
amazing
progress
we've
made
the
the
basis
for
a
lot
of
the
medicines
we
see.
Now
is
the
genetic
revolution
so
again
going
back
to
my
Stanford
days
hate
to
over
leverage
those
experiences,
but
back
then
you
could
win
a
Nobel
Prize
for
sequencing.
One
gene
I.
Remember
that
that's,
but
that
was
the
big
thing
right
in
the
80s
was
wow.
G
So
I
think
biotechnology
is
a
place
where
actually
Moore's
laws
and
Moore's
laws,
the
technology
law
that
basically
computing
power
doubles.
You
know
I
think
every
you
know,
18
months,
that's
actually
at
play
in
biotechnology,
because
these
products
that
used
to
be
expensive
are
now
generic,
but
the
future
has
not.
You
know,
played
out
yet
as
its
introduced
and
and
as
Alice
has
alluded
to
right.
There
are
thousands
of
compounds
now
in
development,
so
I
think
you
know
one
of
the
challenges
for
discussion
and
I
think
this
is
where
value-based
partnerships
are
important.
G
Is
balancing
this
tension
between
present-day
consumption
because
that's
important
right
taking
delivering
your
children
managing
your
high
blood
pressure?
Doing
your
colonoscopies,
that's
important,
but
I
think
these
other
things
are
important
too,
because
ultimately,
it's
things
like
Alzheimer's
disease,
which
currently
now
have
no
effective
treatment.
That's
projected
to
cost
I
think
nearly
a
trillion
dollars
by
2050.
We
need
drugs
to
treat
that,
and
that
is
a
notoriously
difficult
area
to
treat
and
we
need
to
continue
to
invest.
G
Heart
disease
kills
hundreds
of
thousands
of
people
a
year
or
making
progress
with
drugs
like
like
Michael
mentioned
by
path
of
ours
at
Amgen,
but
we
need
progress
in
that
area
because
that
disease
is
costing
us
six
hundred
billion
dollars
a
year
in
kind
of
present-day
dollars.
So
the
value
to
me
of
the
value-based
partnership
is
to
the
point
getting
people
together.
We
need
to
talk
about
value
we
need
to.
G
Actually
we
have
to
get
value
right
before
we
can
get
prices
right
and
there's
a
lot
of
kind
of,
let's
say
frameworks
for
value
out
there.
That
I,
don't
think,
are
getting
value
right.
I
think
it
allows
us
to
focus
on
the
methods
to
collect
the
data.
We
need
to
actually
inform
the
value
decision.
I.
G
Let
you
focus
on
the
things
that
matter
most
to
patients
and
I,
think
that's
the
spirit
of
sort
of
unearthing,
these
mutual
goals
that
we
share
and
putting
in
interactions
and
partnerships
that
can
allow
us
to
make
progress
at
the
level
of
where
care
is
provided
like
by
Fort
Michael
like
where
Michael
was
talking
about
just
a
few
minutes
ago.
So
I
will
now
turn
it
back
over
to
Susan
and
thank
you
all
and
again,
look
forward
to
a
great
discussion,
great.
B
Thank
you
to
all
of
you
and
let's
just
reflect
for
a
moment
on
what
we
heard.
First
of
all,
as
you
heard
again,
underscoring
the
dramatic
growth
in
the
bio
technology
life
sciences
sector
here
in
Massachusetts
Bob
started
a
soft
pointing
out,
in
addition
to
some
of
the
statistics,
I
mentioned
a
37%
growth
in
employment
in
that
sector
Bob,
as
you
said,
within
a
decade,
and
not
just
in
the
science
side,
but
also
in
manufacturing.
B
Thirty,
four
percent
increase
in
bio
manufacturing
over
the
decade
alone,
so
again,
really
dramatic
growth
in
that
sector
and
Alice
also
mentioned
as
I
did
earlier.
The
hope
now
that
the
similar
process
can
happen
in
the
digital
health
sector,
with
the
state,
investments
and
others
being
brought
to
bear
in
that
area
as
well,
several
of
our
panelists
under
for
the
importance
of
public
and
private
partnerships
in
creating
the
environment
that
has
been
conducive
to
this
major
investment
in
biotechnology
and
life
sciences,
as
well
as
increasingly
in
digital
health.
B
They
have
noted
that
costs
in
the
state
have
moderated
over
what
was
the
case
a
decade
ago.
Nonetheless,
again
they're
still
rising
faster
than
the
desired
state
benchmark
and,
in
particular,
we're
seeing
growth,
as
Michael
mentioned,
in
spending
on
biopharmaceuticals
and
especially
in
the
so-called
specialty
area
of
drugs.
These
new,
very
innovative
new
therapies
that
we've
also
been
discussing
and,
as
Michael
said,
that
now
I'm
mounting
to
20%
rate
of
growth
in
specialty
farmer/year.
B
One
of
the
major
initial
efforts
in
the
private
commercial
ACO
space
that's
been
complemented
as
you're
heard
from
Alice
now
with
through
this
1115
waiver,
signed
with
CMS,
which
will
create
under
the
aegis
of
MassHealth,
the
combined
Medicaid
and
CHIP
program
here
in
the
state
new,
a
COS
in
the
medicaid
space,
with
the
hope
that
again,
more
alignment
can
take
place
between
the
dollars
expended
on
healthcare
and
the
value
obtained
for
it.
And,
as
you
heard,
Alice
say,
these
are
going
to
entail
shared
risk
and
share
gains
with
the
state.
B
The
question
now
is
as
martin
TWP
for
us
as
we
bring
on
more
expensive
medications,
which
surely
will
go
through
the
life
cycle
of
all
drugs
in
this
country.
Eventually,
they
too
will
become
generic
and
lower-cost
in
the
meantime.
There's
this
issue
about
how
do
we
balance
the
tension
between
these
extremely
high
cost
medications?
The
fact
that
we
need
$2
today
to
spend
on
many
other
needs,
as
well
as
on
healthcare.
How
do
we
balance
that
tension?
So
thank
you
all
of
you
for
teeing
up
these
very
important
issues
for
a
discussion.
B
So,
let's
go
back
if
we
could,
for
a
moment
to
the
value-based
contracting
Michael
I
want
to
ask
you
more
about
this
because,
as
you
know,
there
is
skepticism
around
about
whether
value-based
contracting
is
going
to
be
a
real
path
to
resolving
these
tensions
between
high
cost
drugs
and
in
our
current
needs
and
Harvard
Pilgrim
really
has
been
a
leader
candidly.
Not
all
the
Massachusetts
insurers
are
on
the
same
page
around
this
strategy.
F
Great
question,
and
that
is
what
we
spend
a
lot
of
our
time.
Thinking
about
and
and
I'd
remind
everyone
that
we
spend
quite
a
bit
of
time
out
there
trying
to
sell
this
concept
to
pharma
companies.
Our
oldest
agreement
of
our
dozen
is
only
about
two
years
old,
so
we
really
are
in
the
early
innings
and
just
starting
to
collect
data.
F
In
order
to
be
successful
and
I
agree,
the
jury
is
that
we
need
to
show
what
we
can
do
together
and
I
think
that
many
stakeholders
have
reasons
for
wanting
to
work
and
again
I'm
encouraged,
even
by
some
of
the
pharma
companies
and
biotechs
that
are
coming
to
us
very
early
where
their
drug
maybe
a
year
way
for
from
approval,
and
they
are
high
cause
specialty
drugs
and
they're.
Starting
to
talk
to
us
about
what
kind
of
endpoints
do,
you
think
are
amenable
for
these
type
of
agreements.
F
If,
if
we
put
the
patient
on
a
drug
and
we
fail
to
avoid
a
liver
transplant,
if
we
take
risk
for
that
and
that
needs
to
refund
a
payment
would
that
be
of
interest,
though
there's
a
lot
of
dialogue
underway?
There
is
more
life
sciences,
companies
going
proactively
new
organizations
like
I
serve,
which,
as
I
mentioned,
is
one
of
a
number
of
entities
that
come.
That
has
value
frameworks
and
essentially
comes
up
with
what
you
might
think.
It
was
a
fair
market
value
and
I'll.
F
Add
that
when
they're
priced
similar
to
what
I
sir
comes
up
was
there's
a
grand
bargain
emerging
where
payers
and
to
say
yes,
we
want
to
promote
use
of
that
drug.
So
it's
again
a
win-win
and
we
see,
for
example,
sanity
regenerative
their
atopic
dermatitis
drug.
Do
I,
sir
said
it
should
be
in
the
$30,000
range.
It
was
priced,
pretty
close
that
and
saying
gee
that's
fair
value.
We
should.
We
should
encourage
that
drug
and
we
see
some
of
the
car
key
companies
and
gene
therapies.
Therapy
companies
have
gone
to
icer
and
said.
F
Essentially
we
want
you
to
evaluate
our
drug,
not
we're
afraid
you'll
evaluated.
We
want
you
to
do
and
because
they're
anticipating
in
the
need
for
value
based
agreements
and
knowing
that
a
value
based
agreement
in
itself
is
not
sufficient.
You
need
some
sort
of
benchmark
to
tell
you
that,
with
that
agreement,
you're
at
a
price,
that's
reasonable
and
fair
for
all
stakeholders
and
I
do
mean
for
all
stakeholders.
Again
we
have
a
vibrant
life
sciences.
F
Industry
in
the
state
and
elsewhere,
and
understanding
that
R&D
is
risky
should
be
a
fair
rate
of
return
to
investors
and
other
stakeholders
to
incentivize
allocation
of
capital.
To
that,
so
we
really
need
to
think
about
what
works
for
all
parties
where
I
see
us
heading
in
it
where
I
hope
we're
heading,
though,
is
toward
more
agreements
for
some
of
these
high
cost
drugs,
whether
for
some
of
these
rare
diseases
for
oncology
for
gene
therapy,
we're,
assuming
that
the
value
frameworks
may
show
that
a
high
cost
is
reasonable.
We
still
need
to
figure
out.
F
How
do
we
afford
that
in
part
through
paying
maybe
90%
less
in
those
cases
where
it
doesn't
work
enough
to
cover
the
cost
of
manufacturing
other
costs,
but
not
to
provide
that
kind
of
profit
that
will
allow
us
to
pay
those
large
amounts
where
it
is
successful,
we're
having
discussions
about?
How
do
we
pay
for
some
of
these
over
multiple
years
again
to
help
bridge
affordability,
so
that
the
budget
impact
doesn't
become
a
reason
not
to
cover
drugs
when
it's
the
right
thing
to
do?
F
Skeptical
of
the
initial
holder
that
comes
out
and
again
agreeing
essentially
you
the
warrant.
The
data
that
you
use
to
get
the
drug
approved
seems
both
fair
and
there's
a
way
to
bridge
that
divide
and
then
finally,
the
other
opportunity
here
is
that
we're
seeing
more
and
more
drugs
approved
with
what
historically
would
have
been
viewed
as
limited
data.
If
you
think
that
exists-
or
you
know,
it's
been
rasa
ready
kava,
these
are
very
expensive
drugs
that
were
approved
with
very,
very
limited
evidence.
Now.
F
The
fact
is
just
to
be
there
for
some
of
these
conditions
and
for
others
that
may
be
ultra
rare.
It
may
be
hard,
if
not
impossible,
to
do
what
would
be
considered
or
well
controlled
clinical
trial
because
there's
not
enough
patients
out
there.
So
the
question
becomes:
how
do
you
provide
access
to
these
drugs
for
these
patients
and
absence
of
really
good
data
at
a
high
cost
without
being
overly
limiting
and
spending
money?
F
That
really
is
being
wasted
and
I
think
that's
another
perfect
example
for
us
to
have
agreements
where,
if
the
FDA
wants
to
accelerate
the
approval
of
some
of
these
drugs
and
the
interests
that
make
them
available-
and
let's
agree
do
that,
but
you
know
if
it's
not
effective,
just
please
don't
send
us
a
bill,
so
I
think
that
there's
a
lot
of
opportunity
and
I
think
there's
a
lot
of
reason
for
all
the
stakeholders
at
the
table
to
want
to
make
this
work.
I
can
think
about
Bob.
B
Ironically,
there
was
a
lot
of
belief
that
these
were
gonna
be
blockbuster,
very
expensive
drugs.
It
looks
like
the
and
they
are
expensive,
but
the
volume
of
sales
has
turned
out
to
be
much
less
than
was
predicted,
and
it
might
be
that
these
value-based
contracts
played
a
role
in
that
by
containing
the
group
of
patients
who
on
whom
these
drugs
were
used.
So
I
guess
the
question
is
in
the
long
run,
or
does
this
form
of
contracting
get
a
workout
for
the
life
sciences
sector?
So.
G
I
you
I
would
separate
so
two
issues,
one
maybe
relating
specifically
to
therapies
and
their
uptake
rates.
And
second,
you
know
our
value
based
partnerships.
You
know
a
tool
for
getting
the
right
patient
the
right
medicine
at
the
right
time,
which
is
I,
think
we
can
agree
what
we
all
want
right.
We
develop
these
this
therapeutic
armamentarium
for
patients,
they're,
usually
patients
these
days
and
because
of
the
genetic
revolution
that
are
sometimes
highly
specialized
hard
to
find
Michael.
You
already
alluded
to
it.
G
Sometimes
it's
even
difficult
to
do
a
trial
for
some
of
these
patients
in
it
in
a
regular
sense
and
we'll
value-based
partnerships
help
that.
So
on
the
first
issue
in
terms
of
uptake,
you
know,
I
think
that
we
are
thinking
carefully
in
a
in
a
constrained
environment
about
who
gets
which
drug
I
think.
G
They
get
used
a
lot
more
thoughtfully
than
that
they
get
taken
up
and
they
get
applied.
Physicians
have
to
get
experience
with
them
and
so
I
think
what
we're
actually
seeing
is
a
measured
uptake,
which
is
what
we
want
right.
I
mean
we
want
measured,
thoughtful
uptake
of
products,
but
I
think
there's
actually
been
some
overshoot
because
of
the
bad
math
that
was
basically
circulated
and
I.
Don't
think
anyone
is
no
surprised.
You
know
three
four
years
ago
right
there
were
some
major
cost
struggles
with
affording
sovaldi
right
and
sovaldi
I
think
that.
G
You
know
with
a
lot
of
the
payers.
How
do
we
come
back
a
little
bit
and
get
the
right
medicine
to
the
right
patient
at
the
right
time
and
I
would
also
argue
at
the
right
price
right
and
that's
the
bridge
to
value
right.
It's
right
right
time.
Right
price
is
a
value
bridge.
So
will
they
work
out
for
us
I?
Think
Michael
says
something
very
important.
G
These
things
are
barely
a
couple
years
old,
I,
I.
Think
the
worst
thing
that's
gonna
happen,
or
that
could
happen
is
that
we
oversell
how
quickly
they
change
human
behavior
and
we
undersell
how
hard
they
may
be
to
do
so.
Let
me
talk
first
about
overselling.
It's
easy
to
oversell
how
quick
it
is
to
change
human
behavior
because,
let's
face
it,
the
fastest
easiest
and
surest
thing
to
do
in
terms
of
drug
contracting
is
the
old
way
where
we
just
a
Guillou
ver
discounts
right.
G
We
had
we
get
to
a
number,
and
then
everyone
knows
what
that
number
is
right.
That's
easy
and
people
are
used
to
it's,
not
easy,
but
it's
basically
it's.
It
creates
a
lot
less
uncertainty.
You
alluded
to
value-based
contracts,
create
more
uncertainty
right.
We
have
to
actually
put
something
on
the
line.
G
Both
the
payer,
as
well
as
the
pharma
company,
are
actually
entering
into
an
area
that
is
more
risky
for
both
sides
right,
because
we
we
actually
neither
side,
has
the
data
to
be
able
to
play
out
into
the
future
exactly
how
these
contracts
may
pay
off
for
one
side
or
the
other,
but
I
think
that's
actually
a
good
sign.
The
fact
that
each
side
is
willing
to
come
to
the
table,
you
know
put
something
at
risk,
but
I
think
again.
G
The
most
important
thing
is
that
when
you
come
together
and
haggle
over
a
price
that
doesn't
require
you
to
do
anything
that
gets
you
to
the
level
of
the
patient
doesn't
require
you
to
measure
outcomes.
It
doesn't
keep
anyone
accountable
for
drugs,
actually
working.
So
to
me,
the
most
important
thing
about
the
value-based
partnerships
is
we're.
Gonna
have
to
give
them
time.
We're
gonna,
have
to
devote
some
resource
into
them,
to
measure
outcomes,
to
collect
data
and
I.
Think
we're
also
gonna
have
to
be
willing
to
be
a
bit
more
transparent.
G
I
actually
believe
that
biotechnology
is
creating
so
much
value
that,
in
the
end,
that
transparency,
that
measurement
and
that
agreement
on
value
is
only
going
to
help
our
industry.
You
know
over
time,
and
so
I
actually
I'm
excited
at
the
infancy
of
these
things,
because
I
think
that
when
the
more
people
know
about
what
our
medicines
do
and
and
how
they
can
basically
change
healthcare,
the
more
people
I
think
will
be
willing
to
again
pay
for
didn't,
innovate
for
the
future.
Let.
F
Me
just
add
that,
and
again
I
would
agree
with
everything
that
Martin
said.
I'd
add
that
I
actually
think
these
agreements
will
facilitate
market
access.
If
you
think
about
the
things
that
people
in
my
position
worry
about
its
spending
money
on
something
that
doesn't
work,
if
you
remove
that
as
a
barrier,
so
the
new
drug
comes
to
market,
it's
expensive,
we
can
always
say
gee,
we're
not
sure
how
long
that
kardi
therapy
will
be
effective
for
the
gene
therapy
and
it's
really
expensive.
F
Let's
wait
a
year
or
two
or
let's
limit
it
to
this
sub
segment,
where
the
data
was
really
good,
which
may
be
good
from
a
cost
perspective,
but
kind
of
bad.
If
you're
one
of
the
people
who
would
benefit
from
that
drug
and
if
that
allows
us,
it
creates
an
environment
where
we
can
say
fine,
we're
not
going
to
restrict
it
for
that
group
in
return,
you
agree
not
to
charge
us
if
it
doesn't
have
the
effect.
That's
going
to
expand
access
and
again
do
so
in
a
way
that
doesn't
lead
to
waste.
C
But
I
just
want
to
add
to
that
from
industry
standpoint.
These
two
companies
should
truly
be
commended
because
they're
trying
to
do
something
new
they're
trying
to
solve
the
problem.
It's
a
market-based
solution
and
what
we
try
to
talk
to
our
elected
officials
and
leadership
here
in
Massachusetts
is
give
us
some
trying
to
try
to
work
this
out.
We
know
there's
a
problem.
My
advice
to
other
state
legislators
would
be
to
you
know,
encourage
this
type
of
dialogue.
C
So
as
government
there's
things,
we
can
do
to
get
out
of
the
way
to
encourage
this
and
make
it
happen,
and
that's
what
government
should
be
doing
because,
like
you
said
and
think
about,
what's
happened
around
hepatitis
C
with
the
increase
of
competition,
the
pricing
is
coming
way
down.
That's
a
huge
value,
drug
and
I
couldn't
agree
more
Martin
that
we're
in
the
business
of
inventing
new
therapies
that
change
the
course
of
disease
that
keeps
people
healthy.
It
keeps
them
working.
C
B
In
a
moment,
we're
going
to
go
to
questions
from
all
of
you
and
mics
will
be
available.
So
when
you
do
have
a
question,
if
you
would
raise
your
hand
we'll
get
a
mic
over
to
you
before
we
go
to
mic,
though
I
want
to
bring
one
question
back
to
Alice,
which
is
just
on
the
point
that
Bob
made
and
that
Martin
made
earlier.
B
A
great
hope
is
that
investments
in
biotechnology
will
result
in
the
kinds
of
therapies
that
will
produce
these
important
breakthroughs
and
cures
and
displace
a
lot
of
other
healthcare
expenditures
that
we're
making
now,
but
there's
no
guarantee
that
that's
going
to
happen
as
often
as
observed
a
dollar
of
somebody's
healthcare
expenses,
a
dollar
or
somebody
else's
healthcare
income.
We
can
imagine
entities
in
the
system
that
will
fight
long
and
hard
to
give
keep
from
giving
up
that
dollar
of
income.
B
D
You
need
to
we're
going
to
need
to
adapt
as
things
change
as
new
therapies
are
introduced
and
I.
You
know,
I
would
distinguish
between
those
curative
therapies,
those
those
therapies
that
cure
the
ailment
versus
those
therapies
that
treat
the
ailment
and
I.
Think
that's
where
the
value
based
approach
gets
to
be
a
challenge,
but
in
the
ACO
model
that
we're
designing
through
the
Medicaid
program,
there's
their
shared
savings
and
shared
risk,
but
with
the
you
know,
apply
to
the
total
care
of
the
patient
of
the
client.
D
So
it's
it's
getting
at
Martin's
point
about
right
care
right
time,
right,
right,
treatment,
right
place
it
it
all.
You
can't
just
look
at
one
piece
of
it
and
and
look
at
the
farm
a
piece
of
it
from
our
perspective.
We
really
need
to
be
looking
at
all
of
it
and
developing
quality
and
value
measurements
and
requiring
performance
and
assessing
outcomes
to
be
able
to
be
in
a
position
to
change
and
assess.
What's
working
and
what's
not
and
so
I
I,
don't
think
health
care
will
be
ever
static
from
here.
D
B
Right,
we
are
officially
open
for
questions
or
comments
or
short
speeches
masquerading
as
questions
from
the
audience.
So
if
you
do
have
a
question
raise
your
hand
and
we
will
get
a
mic
over
to
you
and,
of
course,
I'm
sure
this
panel
would
benefit
from
knowing
what
other
states
are
doing
and
whether
there
are
lessons
to
be
learned
here
in
Massachusetts
from
those
other
parts
of
the
country.
If
you
would
identify
yourself
also
by
name
and
affiliation,
that
would
be
very
helpful.
H
Great
good
afternoon,
I'm
David
salts
from
Massachusetts
health
policy
Commission.
Thank
you
for
this
great
panel.
One
of
the
themes
from
this
conference
has
been
finding
bipartisan
solutions,
and
one
of
the
issues
that
I've
seen
in
polling
that
has
overwhelmingly
bipartisan
support
is
increasing
the
transparency
of
pharmaceutical
pricing
and
spending
trends,
and
so
my
question
really
is
for
Bob.
Is
the
industry
willing
to
step
up
and
partner
with
States
in
increasing
transparency
in
this
industry?
Just
as
hospitals
and
health
plans
already
have
done
that
the.
C
Answer
is
absolutely
David,
however,
you
know
and
I've
said
this
before
on
other
panels.
What
is
transparency?
We've
got
transparency
legislation
in
Massachusetts
that
is
horrible.
It
doesn't
do
anything
to
lower
the
cost
of
inventing
a
drug.
It
doesn't
do
anything
to
help
a
patient.
It
doesn't
do
anything
to
change
how
we
do
business.
If
we're
gonna
have
transparency
legislation,
I
couldn't
agree
with
Martin
more,
let's
have
transparency
out
there
from
the
beginning
to
what
a
patient
takes
drugs.
So,
let's
look
at
really
how
much
money
does
a
company
put
towards
R&D?
C
That's
easy
to
come
up
with
the
transparency
legislation
that
sticks
out
along
with
the
minute
something
becomes
NIH
funding
to
becoming
something
that's
patented
to
a
beedi
deal
with
a
or
an
investment
from
a
VC.
Then
a
partnership
with
a
large
pharma
coming.
That's
just
silly
trying
to
figure
all
that
out
all
right,
let's
figure
out
what
transparency
really
means.
Let's
talk
about
transparency
as
it
relates
to
the
payers
and
formularies
and
whatnot.
Let's
talk
about
transparency
with
PBMs,
and
where
does
that
fit
in
my
goodness?
C
F
Know
again
won't
claim
to
be
an
expert
on
all
of
the
bills
that
are
out
there,
but
I
mean
the
reason
we're
having
this
dialogue
is.
People
are
questioning
the
value
of
the
medications
and
the
pricing,
so
you
know
I,
you
know,
I
I,
don't
know
whether
a
transparency
bill
is
the
best
way
to
get
there.
I
hope
if
there's
something
for
the
sake
of
the
life
sciences,
companies
that
if
they
were
to
do
something
it's
at
least
standardized
across
the
50
states-
yeah.
My
sympathy
on
that,
but
again
that
the
issue
is.
F
There
are
a
lot
of
questions
out
there
and,
for
example,
insurers
are
required
to
share
the
MLR
the
medical
loss
ratio,
in
other
words
the
percentage
of
the
dollar.
That's
spent
on
care
around
that
versus
marketing
and
profit
in
executive
salaries.
So
I
could
see
something
analogous
again:
I'm,
not
smart.
How
do
you
actually
define
it?
I
could
see
something
analogous
that
would
provide
some
comfort
to
you
know
to
the
population,
to
all
the
stakeholders
and
again
I
I
think
it's
also
fair
to
say,
there's
a
large
discrepancy
among
pharma
companies.
F
There's
also
some
bad
actors
out
there,
which
I
think
my
colleagues
would
agree
on
so
I
I
could
see
something
like
that.
Quite
frankly,
if
I
had
my
wish,
there'd
be
a
opportunity
to
price
in
a
way
that
aligns
with
an
entity
like
I
serve,
and
if
you
show
your
again
that's
another
way
to
answer
the
question.
F
I
mean
again,
we
can
debate
whether
that's
the
right
framework
and
whether
it
needs
to
be
adjusted
but
conceptually
with
an
independent
framework
that
says
this
is
fair
market
value
in
a
way
that
we
as
a
society,
you
think
we
can
afford
and
if
you
are
priced
that
way,
terrific,
if
not
perhaps
you're,
subject
to
additional
state
reporting
burden,
so
maybe
there's
a
way
to
create
an
incentive
to
cooperate
in
some
other
methodology.
Okay,
great.
J
My
question
is:
what
in
your
work,
would
that
also
be
the
same
score
in
the
formulary
for
Medicare,
and
would
it
also
be
on
the
formularies
for
all
the
rest
of
the
insurance
companies
I'm,
looking
a
consistency
across
the
way?
Why
one
and
not
the
other,
that's
the
challenge
we
always
face
in
the
legislation
that
we
have
yeah.
D
Agreed
we
have
to
start
somewhere
a
cos,
are
not
a
new
concept
and
we're
slow
to
start
here
so,
to
the
extent
that
we
are
innovating
in
that
space.
I
think
it's
important
that
we
balance
and
always
take
into
account
the
Medicare
requirements.
But
sometimes
you
know
sometimes
Massachusetts
needs
to
experiment
and
that's
what
this
is.
D
But
we
are
always
guided
by
other
standards,
for
example
in
the
quality
measurements
that
we
are
reviewing
now
we're
very
cognizant
of
the
multiple
sets
of
quality
measurements
that
exist
on
the
federal
side,
as
well
as
the
quality
measurements
that
exist
in
the
commercial
insurance
world
and
really
trying
to
bring
constituencies
along
to
agree
on
what
the
next
set
of
quality
measurement
should
be.
But
we
exist
in
this
health
care
world
with
multiple
regulators
and
so
coexisting.
D
B
F
Really
really
hard
to
align
for
a
whole
variety
of
reasons,
so
and
and
whether
it's
because
we're
competing
and
negotiating
individually
with
pharma
companies
or
sometimes
we
read
the
data
differently.
So
I'll
give
you
an
example.
When
the
second
company
came
out
with
a
Hep
C
drug
IV,
they
came
out
with
a
drug
via
Kara.
Some
of
our
competitors
preferred
that
drug
we
preferred
the
Gilead
drugs
ability
and
then
harvoni.
F
The
reason
for
that
is
that
the
other
drug
required
a
pill
burden
of
as
many
ten
pills
a
day
and
the
Gilead
drug
was
one
pill
a
day.
I
can't
enforce
our
competitors
to
agree
with
our
assessment,
which
is
to
prefer
the
guilty
a
drug,
because
we
thought,
with
one
pill
a
day:
the
chances
of
someone
being
adherent
and
taking
the
drug
correctly
and
getting
a
cure
was
better
again.
F
F
In
other
words,
if
patient
leaving
Harvard
Feldman
going
to
a
competitor
or
going
for
MassHealth
to
us,
etcetera,
if
that
that
ongoing
payment
mechanism
doesn't
flow
with
them,
it's
very
hard
to
do
that.
It's
not
impossible
or
exploring
it,
but
it's
very
hard,
so
I
think
I
think
there's
a
need
here
for
some
common
policies
around
some
of
these
high
cost
drugs,
but
given
the
legal
requirements
and
etc.
It's
it's
hard
to
do.
B
F
Generally,
the
the
discussions
that
I
that
I
see
are
looking
anywhere
from
one
to
two
million
dollars.
That's
what
most
people
think
this
will
be
per
treatment
and
again
they
may
be
one-time
and
curative,
but
you
still
have
the
question:
how
do
you
pay
for
them
upfront
and
particularly
with
unknowns
around
their
durability,
etc?
So
again,
we
don't
want
that
cost
burden
to
be
a
reason
to
keep
them
from
the
people
who
need
them,
which
is
why
we
need
those
kind
of
understandings
and
common
policies
to
enable
these
kind
of
and.
B
I
You
delegate
Louis
young
from
Maryland
and
I'd
like
to
follow
up
on
that
transparency
question
because
Maryland
successfully
passed
price,
gouging
legislation
that
basically
said
that,
if
the
cost
of
a
drug
increased
by
a
certain
amount
of
money
or
a
percentage,
it
would
trigger
an
Ag
investigation.
So
about
two
to
three
months.
After
the
legislation
passed,
we
were
informed
that
there's
a
lawsuit
from
some
pharmaceutical
companies,
so
I'm
just
curious.
If
any
of
you
might
want
to
comment
given
that
is
legislation
that
was
designed
to
protect
consumer
accessibility
and
affordability,
why?
B
And
it's
my
understanding,
those
that
legislation
was
particularly
directed
at
the
bad
actor
phenomenon
that
Michael
referenced,
that
Martin
shkreli
being
an
example
who
was
just
just
found
guilty
on
several
charges?
Essentially
not
not
unrelated
charges,
I
should
say,
but
nonetheless
came
in,
bought
a
pharmaceutical
company
like
the
price
up
dramatically
no
relationship
to
the
underlying
cause
of
producing
the
drug
and
obviously
harmed
a
number
of
people
with
HIV.
C
Added
that
it
really
shined
the
spotlight
on
issues
in
the
generic
industry.
If
you
look
at
what
Martin
shkreli
did
that's
unconscionable
and
it's
because
there's
not
enough
competition
in
the
generic
space
the
whole.
The
pharma
industry
is
the
only
component
of
the
healthcare
industry
that
has
built-in
cost
reductions.
We
have
a
data
exclusivity
data
exclusivity
period
for
small
molecule,
drugs,
large
medical
drugs
and
then
the
fact
that
they
go
to
generic
it's
supposed
to
be
cheap,
to
create
headspace
for
new
drugs
to
come
into
the
system.
C
So
when
people
behave
like
Martin's
Corelli,
because
there
was
no
competition,
it
upsets
the
whole
apple
cart.
It
drives
me,
nuts,
it's
so
upsetting,
and
if
you
look
at
the
whole
EpiPen
situation
and
what's
happened
there,
that
has
nothing
to
do
with
the
companies
that
are
actually
innovating
new
therapies.
So
what
is
the
FDA
doing
now?
They're
increasing
the
resources,
so
generic
manufacturers
can
come
online
quicker.
C
The
FDA
is
also
identifying
now
I'm
publishing
a
list
of
drugs
that
are
off-label
off
exclusivity
that
don't
have
competition,
and
hopefully
you
can
get
more
market-based
solutions
around
competition
there
to
solve
that
problem.
But
it's
so
difficult
to
explain
to
people
the
difference
between
branded
Pharma
new
drugs
in
the
generic
industry,
because
we're
just
not
familiar
with
the
industry.
It's
confusing!
Thank
you.
We.
E
I'd
like
to
follow
up
on
the
generic
question,
Kathy
Keller
from
Montana
what
we
have
discovered
and
I'm
glad
you're
angry
is
that
there
are
very
few
companies
that
are
interested
in
producing
the
generic
drugs
and
the
generic
drugs
that
are
available,
at
least
for
us,
where
I
live
outweigh
out
there
in
the
mountains.
I
tend
to
be
just
a
price
just
a
little
bit
under
the
drugs
that
are
still
under
patent,
and
is
there
something
anything
that
you
can
do
in
this
partnership?
E
State-Level
stuff?
That
would
you
know
we're
a
small
population
state
they're
not
going
to
do
something
special
for
Montana.
Is
there?
Are
there
that
we
could
have
on
you
know?
Let's
have
those
generic
drugs
manufactured,
there
need
there
needed
and
it
costs
so
much
less
for
our
people.
What
can
we
do
like.
B
F
Was
actually
hoping,
somebody
else
would
answer
the
question
because
I
don't
know
that
I
have
a
good
answer.
I
was
very
Montana,
would
I
mean
tax
breaks
to
bring
generic
companies
to
Montana,
perhaps
I
know,
but
the
the
issue
it
notes
seriously.
The
issue
is:
there's
a
number
of
generics
that
have
seen
unconscionable
price
hikes
as
a
percentage
and
the
the
issue
is
in
many
of
these
cases
the
number
of
competitors
is
shrunk
to
one
or
two
and,
and
the
truth
is
there's
very
little
we
can
do
the
companies
are.
F
You
know
their
strategy
is
predicated
on
our
need
to
make
the
drugs
available
to
our
insured
members,
and
doctors
need
to
prescribe
them
and
with
a
lack
of
competition.
And,
frankly
again,
unless
there's
you
know
the
you
know,
state
or
other
actions
again
based
on
these
kind
of
egregious
hikes,
there's
very
little.
We
can
do
what
we
won't
do
is
put
our
patients
in
so
I.
Don't.
B
H
G
Right
seems
to
have
embraced
this
idea
that,
and
we
completely
agree
with
this-
we
watch
the
generic
space
very
carefully
because,
as
I
alluded
to
in
my
introductory
comments,
a
vibrant
generic
space
that
provides
society
access
to
these
medicines
once
their
patents
have
expired,
is
absolutely
essential
to
an
innovative
space
to
continue
to
bring
medicines
to
the
market.
So
if
you
have
a
failure
in
the
generic
marketplace,
even
though
I
actually
the
generic
marketplace
just
to
be
very
clear,
the
generic
marketplace
as
a
whole,
thousands
and
thousands
of
medicines-
is
actually
working
quite
well.
G
Those
medicines
on
the
whole
continue
to
decrease
an
average
price
and
provide
more
access
to
more
patients
than
ever
before.
However,
the
headline-grabbing
stories
right
are
those
you
know,
handful
of
medicines
that
do
experiences.
These
price
increases
because
of
market
failures.
Basically
lack
of
competition
and
I
think
the
new
FDA
Commissioner
has
basically
suggested
that
you
know
for
those
areas
that
are
that
are
basically
in
jeopardy
of
not
having
enough
competition
of
experiencing
these
sorts
of
market
distortions.
G
They
will
fast-track
applications
to
provide
medicines
in
these
areas
and
I,
don't
think
you
have
to
make
it
instantaneous
I
think,
once
you
cut
that
interval
down
from
two
and
a
half
years
to
maybe
four
months
right,
that
will
actually
prevent
the
type
of
arbitrage
activity
that
we
saw
in
the
most
egregious
cases
of
generic
price
distortions.
So
I
think
there
actually
is
is
some
mindfulness
of
that
of
that
that
area.