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May 9, 2019

If you don’t know the nuts and bolts of the current Health and Human Services (HHS) proposal to nix Pharma’s ability to pay pharmacy benefit manager (PBM) rebates, then it’s possible you might want to listen to EP216 with Chris Sloan first. In this episode, we don’t talk much about the impact of the HHS proposal on patient premiums or drug costs. That’s EP216. What we do talk about today is the impact on pharmaceutical companies. We also discuss the drug-buying transaction. Kuo Tong is my guest today. Kuo is a managing director in the life sciences practice of Navigant, focusing on how pharma companies interact with insurance companies and get reimbursement for their drugs. And that’s actually the burning question we aim to answer today: Will Pharma’s interactions with and reimbursement from insurance companies change after this proposed HHS rule goes into effect, assuming it goes into effect? We also talk about what Pharma could and should be doing right now to improve the odds of a smooth transition into a new contracting model.


You can learn more at, connect with Kuo on Twitter at @NavigantHealth,
or email him at

Kuo Tong is a managing director in the life sciences practice of Navigant and oversees its US Market Access Center of Excellence. He joined the firm in November 2017 to lead a team focused on health economics, pricing, and market access engagements. Prior to joining Navigant, Kuo was the CEO of Quorum Consulting, headquartered in San Francisco, for 21 years. During that time, Quorum was a leading firm helping clients solving policy and access issues with the Centers for Medicare & Medicaid Services (CMS); Blue Cross Blue Shield, commercial, and managed care plans; and other payers and health care delivery systems. Prior to founding Quorum, Kuo was a senior associate at Health Technology Associates (now known as Covance), located in Washington, DC. Prior to entering the consulting field, Kuo was active in clinical and health services research at the University of Pennsylvania School of Medicine and the University of California, Los Angeles (UCLA) Neuropsychiatric Institute. Kuo holds his master’s degree from Johns Hopkins University and a bachelor’s degree from the University of Pennsylvania.

01:54 HHS and better market results as far as Pharma is concerned.
02:56 “Entitlement benefit.”
03:49 How would justifying pharma prices change company behavior?
05:47 “Get back to the business of innovation.”
06:13 Sacrificing broad indications for narrow ones.
08:14 “Branded Pharma raises the price of their branded product ahead of competition.”
08:44 “We’re playing by the rules of the road.”
09:09 “I think we have to … start thinking about a new world order.”
09:34 High-valuation dropping and other trade-offs for a better business model.
10:23 How do you make life science purchasing a win-win?
12:42 Pay to play, PBMs, and short-term vs long-term pharma solutions.
17:15 Are specialty drugs and rare disease drugs the future of Pharma?
17:58 Medicare Part D and Medicaid benefits.
23:50 “The Part D plan itself … for better or worse, they are not the advocate for the patient.”
25:00 Could other contracting models be on the rise?
29:23 What Navigant Health does and what Kuo does over at Navigant Health.

You can learn more at, connect with Kuo on Twitter at @NavigantHealth,
or email him at