The Payer Exchange

In the final episode of Season 3, Omar Ali speaks with Ross Margulies of Manatt Health about the policy and legal changes reshaping US pharmaceutical pricing and their consequences far beyond the United States.
They discuss Most Favoured Nation (MFN) and international reference pricing, GUARD and GLOBE, the legal durability of current reforms, the move to formal CMS rulemaking, Part B medicines and provider incentives. Ross also explains why manufacturers are already rethinking launch sequencing and market access planning across global markets as US policy becomes increasingly connected to international prices.
Share your perspective on The Payer Exchange
We’re always looking to hear from current and former payers, healthcare decision-makers and policy experts from around the world.
If you’d like to take part in a future episode of The Payer Exchange or join Verpora’s global payer network, get in touch with Omar Ali, Verpora’s Head of Payers, by email omar.ali@verpora.com or via DM on Linkedin: https://linkedin.com/in/alipha
About The Payer Exchange
The Payer Exchange is a podcast from Verpora exploring the people, policies and decisions shaping pharmaceutical market access around the world. Hosted by Omar Ali, Verpora’s Head of Payers, each episode features an in-depth one-to-one conversation with payers, policy experts and healthcare leaders, offering direct insight into pricing, reimbursement, access and the practical pressures shaping healthcare systems and pharmaceutical strategy.
At Verpora, we’re all about access strategy, and The Payer Exchange was developed as a way to share discussions Verpora is having every day with payers, policy experts and life science organisations.
Verpora helps pharmaceutical companies bridge the gap between the value of innovation and the realities of healthcare funding. Through our global payer network, evidence, data and strategic market access expertise, we support better decisions, stronger partnerships and, ultimately, better patient access.
If today’s conversation has raised questions about your own challenges in market access, pricing, value-based agreements or innovative contracting, or you’d simply like to continue the discussion, we’d be delighted to hear from you.
Visit verpora.com to connect with our team, discover more episodes of The Payer Exchange and explore more specialist, on-demand content.

Disclaimer
This presentation is for educational and informational purposes only, and is not intended as legal or policy advice. This presentation is based on non-confidential intelligence. Views expressed by the speakers are personal opinions and should not be attributed to anyone else or any organization. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

Continuing the US-focused series, Omar Ali speaks with Matt Harman, VP of Clinical Solutions at Employers Health, bringing an employer-sponsored health plan perspective to questions of affordability, access and benefit sustainability.
They discuss commercial spillover from Medicare reforms, specialty pipeline risk, medical benefit visibility, biosimilars, GLP-1 affordability and the changing role of Pharmacy Benefit Managers (PBM)s. Matt explains how Employers Health works with self-insured employers to balance access to effective medicines with benefit designs that remain financially sustainable over the long term.
Share your perspective on The Payer Exchange
We’re always looking to hear from current and former payers, healthcare decision-makers and policy experts from around the world.
If you’d like to take part in a future episode of The Payer Exchange or join Verpora’s global payer network, get in touch with Omar Ali, Verpora’s Head of Payers, by email omar.ali@verpora.com or via DM on Linkedin: https://linkedin.com/in/alipha
About The Payer Exchange
The Payer Exchange is a podcast from Verpora exploring the people, policies and decisions shaping pharmaceutical market access around the world. Hosted by Omar Ali, Verpora’s Head of Payers, each episode features an in-depth one-to-one conversation with payers, policy experts and healthcare leaders, offering direct insight into pricing, reimbursement, access and the practical pressures shaping healthcare systems and pharmaceutical strategy.
At Verpora, we’re all about access strategy, and The Payer Exchange was developed as a way to share discussions Verpora is having every day with payers, policy experts and life science organisations.
Verpora helps pharmaceutical companies bridge the gap between the value of innovation and the realities of healthcare funding. Through our global payer network, evidence, data and strategic market access expertise, we support better decisions, stronger partnerships and, ultimately, better patient access.
If today’s conversation has raised questions about your own challenges in market access, pricing, value-based agreements or innovative contracting, or you’d simply like to continue the discussion, we’d be delighted to hear from you.
Visit verpora.com to connect with our team, discover more episodes of The Payer Exchange and explore more specialist, on-demand content.
Disclaimer
This presentation is for educational and informational purposes only, and is not intended as legal or policy advice. This presentation is based on non-confidential intelligence. Views expressed by the speakers are personal opinions and should not be attributed to anyone else or any organization. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

In Episode 12, Omar Ali speaks with Drake Reiter, Director of Pharmacy Operations at Priority Health, about how a regional US health plan is thinking about the next phase of pricing and contracting reform.
They discuss Most Favoured Nation (MFN), the Inflation Reduction Act (IRA) and Pharmacy Benefit Manager (PBM) reform, the gradual erosion of rebate-led contracting, commercial spillover from Medicare Most Fair Pricing (MFPs), transparency, formulary leverage and whether a different definition of value could open the door to more outcomes-based and value-based agreements. The conversation also considers the consequences for manufacturers managing launch and pricing strategy across global markets.
Share your perspective on The Payer Exchange
We’re always looking to hear from current and former payers, healthcare decision-makers and policy experts from around the world.
If you’d like to take part in a future episode of The Payer Exchange or join Verpora’s global payer network, get in touch with Omar Ali, Verpora’s Head of Payers, by email omar.ali@verpora.com or via DM on Linkedin: https://linkedin.com/in/alipha
About The Payer Exchange
The Payer Exchange is a podcast from Verpora exploring the people, policies and decisions shaping pharmaceutical market access around the world. Hosted by Omar Ali, Verpora’s Head of Payers, each episode features an in-depth one-to-one conversation with payers, policy experts and healthcare leaders, offering direct insight into pricing, reimbursement, access and the practical pressures shaping healthcare systems and pharmaceutical strategy.
At Verpora, we’re all about access strategy, and The Payer Exchange was developed as a way to share discussions Verpora is having every day with payers, policy experts and life science organisations.
Verpora helps pharmaceutical companies bridge the gap between the value of innovation and the realities of healthcare funding. Through our global payer network, evidence, data and strategic market access expertise, we support better decisions, stronger partnerships and, ultimately, better patient access.
If today’s conversation has raised questions about your own challenges in market access, pricing, value-based agreements or innovative contracting, or you’d simply like to continue the discussion, we’d be delighted to hear from you.
Visit verpora.com to connect with our team, discover more episodes of The Payer Exchange and explore more specialist, on-demand content.
Disclaimer
This presentation is for educational and informational purposes only, and is not intended as legal or policy advice. This presentation is based on non-confidential intelligence. Views expressed by the speakers are personal opinions and should not be attributed to anyone else or any organization. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

Launching Series 3 of The Payer Exchange’s special US focus, Omar Ali speaks with Jill Hanson, VP of Regional Pharmacy at Centene Pharmacy Services, who brings a specialty pharmacy perspective to changes in drug pricing, contracting and medical benefit management, from one of the largest Medicaid managed care organisations in the US. 

The conversation covers MFN, GUARD and GLOBE, the shift away from rebate maximisation, high-cost therapy forecasting, Part B pricing and site-of-care optimisation. Jill also shares a practical IVIG case study showing how a change in care setting improved the patient experience while reducing both co-pays and overall plan costs.
Share your perspective on The Payer Exchange
We’re always looking to hear from current and former payers, healthcare decision-makers and policy experts from around the world.
If you’d like to take part in a future episode of The Payer Exchange or join Verpora’s global payer network, get in touch with Omar Ali, Verpora’s Head of Payers, by email omar.ali@verpora.com or via DM on Linkedin: https://linkedin.com/in/alipha
About The Payer Exchange
The Payer Exchange is a podcast from Verpora exploring the people, policies and decisions shaping pharmaceutical market access around the world. Hosted by Omar Ali, Verpora’s Head of Payers, each episode features an in-depth one-to-one conversation with payers, policy experts and healthcare leaders, offering direct insight into pricing, reimbursement, access and the practical pressures shaping healthcare systems and pharmaceutical strategy.
At Verpora, we’re all about access strategy, and The Payer Exchange was developed as a way to share discussions Verpora is having every day with payers, policy experts and life science organisations.
Verpora helps pharmaceutical companies bridge the gap between the value of innovation and the realities of healthcare funding. Through our global payer network, evidence, data and strategic market access expertise, we support better decisions, stronger partnerships and, ultimately, better patient access.
If today’s conversation has raised questions about your own challenges in market access, pricing, value-based agreements or innovative contracting, or you’d simply like to continue the discussion, we’d be delighted to hear from you.
Visit verpora.com to connect with our team, discover more episodes of The Payer Exchange and explore more specialist, on-demand content.
Disclaimer
This presentation is for educational and informational purposes only, and is not intended as legal or policy advice. This presentation is based on non-confidential intelligence. Views expressed by the speakers are personal opinions and should not be attributed to anyone else or any organization. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

What happens when the world’s largest pharmaceutical market fundamentally changes the way it pays for medicines?
As US policy evolves around Most Favoured Nation pricing, the Inflation Reduction Act, CMS drug price negotiations and international reference pricing, the consequences could influence launch sequencing, commercial strategy and patient access around the world.
Season 3 of The Payer Exchange has a special US focus, bringing together complementary perspectives from specialty pharmacy, regional health plans, employer-sponsored healthcare and health policy. Combined, they build a broader picture of what’s happening on the ground in the US, where the market could be heading, and what that could mean for global healthcare systems.
Guests this series include:
🇺🇸 Jill Hanson, Centene Pharmacy Services – bringing a specialty pharmacy perspective from one of the largest Medicaid managed care organisations in the US, including how contracting could shift away from rebate maximisation and towards value-based agreements.
🇺🇸 Drake Reiter, Priority Health – exploring what happens next if pricing reforms begin to reshape the commercial market and challenge established thinking around value.
🇺🇸 Matt Harman, Employers Health – bringing the employer-sponsored health plan perspective, including the challenge of building financing and access models that make high-cost innovation sustainable for patients and purchasers.
🇺🇸 Ross Margulies, Manatt Health – examining the policy and legal landscape, and what MFN, the IRA, CMS drug price negotiations and international reference pricing could mean for global launch and market access strategy.
For anyone working in pricing, market access, HEOR or commercial strategy, these conversations offer direct insight into how different parts of the US healthcare system are responding to a period of significant change, and why manufacturers around the world are paying attention.
Four perspectives. One changing market. Global consequences.
Disclaimer: This podcast is for educational and informational purposes only, and is not intended as legal or policy advice. Views expressed by the speakers are personal opinions and should not be attributed to anyone else or any organization. No part of this presentation may be reproduced for commercial purposes without the express permission of Omar Ali, Verpora Limited.