CareSet Advantage: Pharmaceutical Industry Regulatory Overhaul

Ashish Patel

March 7, 2024

CareSet Advantage: Pharmaceutical Industry Regulatory Overhaul

Pharmaceutical executives are navigating through an increasingly complex regulatory landscape due to the Inflation Reduction Act (IRA).  It introduced substantial drug cost shifting and now impacts strategic and analytical planning for insurance carriers and drug manufacturers alike. This pivotal legislation brings transparency, and Medicare negotiation to drug pricing, through measures like the 2024 Catastrophic Coverage Cap and a comprehensive overhaul in 2025.

Enter CareSet — the industry leader in Medicare analysis for the drug market access landscape. With its innovative approach, CareSet is far ahead in delivering insights to the industry through actionable reports that the industry direly needs. How can pharmaceutical teams harness CareSet's expertise to not just adapt, but thrive, in this evolving landscape?

The IRA and Pharma: New Affordability for Patients

The IRA's impact on drug pricing is substantial. By capping out-of-pocket costs at $8,000 in 2024 and furthering changes in 2025 that include new discounts, higher payor cost shares, and the removal of the coverage gap, the bill requires extensive recalibration of existing financial models. Insurers and pharmaceutical companies alike need to be prepared to adapt to these shifts with plan and parent payor-level analysis.

CareSet's LIS Exposure Impact Report is a critical element of the industry’s strategic recalibration. By harnessing the power of the Master Beneficiary Summary File, which offers clear segmentation between LIS and non-LIS patients, and coupling it with precise categorization and segmentation methodologies to assess benefit phases, CareSet catalyzes the changes to pharma financial forecasting and impact assessment. Moreover, CareSet's comprehensive coverage status information for Part D Events allows for the precise categorization and segmentation of total spending based on benefit phases, such as Catastrophic coverage. This is particularly crucial at year-end, as it empowers drug access teams to evaluate potential accruals for the upcoming January more effectively.

The Role of Customized Reporting

Pharmaceutical companies have long relied on CMS Spending Dashboards for financial guidance, but with CareSet's entry, the industry can leverage monthly timeliness and unlimited customizations. CareSet stands apart by reconstructing these Medicare B/D claims dashboards with monthly updates with a few weeks lag, providing industry best analysis that equips pharmaceutical teams with nuanced insights into national, payor, and market behavior.

Leadership in Transparency and Collaboration

Transparency and collaboration are cornerstones of CareSet's approach, and this philosophy has established the company as a leader within the competitive landscape. Through past and present engagement with CMS, ONC, and the Whitehouse, CareSet ensures that its reporting solutions are informed by the very regulations they seek to illuminate. Recently, we partnered with ProPublica to investigate when a vascular procedure is overdone on Medicare patients, which can result in severe complications. Our investigation with ProPublica led to an article that uncovered that some doctors earn millions from procedures with questionable necessity, spotlighting the influence of financial incentives in healthcare decisions. In tandem with its commitment to the pharmaceutical industry, CareSet's partnership with CMS fuels a check-and-balance system that maintains data integrity and relevance. By participating in policy-focused task forces, the company paves the way for a shared future of accountability and innovation. 

Conclusion: A New Day in Pharmaceutical Reporting

The pharmaceutical industry is at a crossroads, and the choices made today will determine the successes of tomorrow. With the implementation of the IRA and the forthcoming direct pricing negotiations, accurate and dynamic reporting has never been more critical. CareSet stands ready to support the industry in adapting to the regulatory climate and complexity with its robust library of decision tools and expertise.

The CareSet advantage is more than just about data — it's about empowerment. In the face of change, the most powerful asset a company can possess is insight, and this is exactly what CareSet offers. With a focus on transparency, collaboration, and innovation, CareSet is not just a name in the industry; it's a catalyst for change that positions the entire pharmaceutical landscape for a future of greater resilience and success.

Ashish Patel

An accomplished analyst, data scientist and journalist before co-founding CareSet, Ashish is the visionary leader and healthcare data transparency advocate with a mission of fostering a healthcare system where data benefits patients.

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