Course Title: U.S. Healthcare/Pharma Reimbursement Market
Instructor: Saumil Pandya, SPH '99 (MHS)
Brought to you by Odyssey
June 10, 2024 - July 15, 2024 (6 Sessions)
Monday, 6 PM ET
Virtual via Zoom
Course Description: The U.S. healthcare reimbursement system consists of a mix of public and private third-party coverage, in which employers, individuals and the government all contribute to the costs related to healthcare. The financial dynamics of our healthcare system make it an extremely interesting topic of discussion regardless of whether you work in healthcare or not. Although healthcare has traditionally been the domain of payers and providers, every practicing healthcare administrator and supporting industries should understand the basic principles of the administration and financing of healthcare delivery. The pharmaceutical industry is no exception. Over the past few years, increased media and policymaker focus on the price of medicines has led to anger and frustration targeted at pharmaceutical manufacturers, pharmacy benefit managers (PBMs), and health plans. Drug pricing is a complex and often confusing issue, shaped by a pharmaceutical distribution and payment methodologies that involves multiple transactions among numerous stakeholders.
The U.S. healthcare reimbursement system is diverse and complex, but in this course, we will focus on developing an understanding of the evolving U.S. healthcare landscape and the role of the pharmaceutical industry. Participants will gain a better understanding of the structure of the public and private players that comprise the U.S. healthcare reimbursement system with an emphasis on the pharmaceutical market. They will learn about the funding mechanisms behind our current reimbursement system, many of the misaligned financial incentives that exist. We will explore public/private sector roles, the impact of managed care and insurance, and the positive points and unintended consequences of the drug provisions in the Inflation Reduction Act, along with drug pricing/PBM reform policy proposals that are being considered to make our system function more efficiently.
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