MFN, no more secret deals. We'll be unpacking that and looking at the wider implications for the industry. Now, I think it's fair to say that the world is changing for the pharmaceutical industry right now. It is. I mean, MFN has become like a whole global issue. Let's just look really what is happening with MFN. What is the philosophy and why is it having the impact? I use this phrase, no more secret deals. What do I mean by that? The idea behind MFN, the US administration is saying we are paying too heavy prices for medicines in the US, and the rest of the world European markets are not paying enough. So they're trying to get the balance equity, I. E. Reduce the price of medicines in the US, have other countries increase what they pay for medicines. I'll go into later why I don't think that's going to work. But what it effectively means is there is a significant pressure right now to lower the price of medicines in many European markets, particularly when you look at the basket. We know that from the nineteen or so that was originally has been whittered down to eight, and it's the second lowest price of those eight nations. That's where the first issue we talk about the secret deals is going to have an impact and we'll come to that. The question is how are manufacturers going to increase the price of medicines in those markets where there's going to be resistance? And actually, will it at all result in lowering of medicines prices in the US, which is going to be opposed by the manufacturers. So let's have a look at the implications for life sciences pharmaceutical industry. Usually what has happened in the past, and we know this, the European markets and wider often have lower prices. The only way they really achieve that is usually by some secret or confidential discount. The issue what MFN has done has made those secret discounts no longer viable. Why? Because pre MFN, you could have a secret deal, or you could go to, say, a HTA body like NICE or PBAC or ZYN and have a discount that no one was going to reveal. So you could still launch a very high price in the U. S, and no one knows what the true net price is in European markets. MFN has turned that on its head. Now manufacturers are not going to be able to do a secret deal, Adam, because it's not a secret anymore. And the issue with the secret deal is that a lot of these prices are going to be reported back to the U. S, and that will affect the U. S. Price. So what we are seeing is manufacturers are no longer willing to do these confidential discounts. They're pushing for prices to be increased. That is never going to happen. Now, I don't want to say binary never going to happen. What I'm going to say is the markets are pushing back. And we have seen that both from the work we've done at Vipora, but also from the wide publicly available information. And we'll come to a couple of the quotes, whereby manufacturers are struggling to achieve the high price that was initially planned through MFN. The markets are pushing back. And by that, I mean, most of the payers in these markets don't really care for MFN. They have their own methodology for setting prices, and no MFN is going to make them want to pay double or anywhere near US drug pricing. Many of these markets have budgetary concerns themselves around health care as well. So the idea of increasing budget and spend on medicines when they're already quite under pressure is another issue. Health care has become a zero sum game. We know that. Many new drugs are coming, asking for increasing prices. And many markets and governments, due to financial and economic global scenarios, are constricting. They're not expanding. There's not many markets today reporting economic growth. They're all showing fiscal constraint. So we've got the meeting here of a very bad situation, Adam. We've got companies being asked to increase their prices in European and around the world markets, MFN baskets. And we've got those markets constricting and saying they are budget impacted, they're financially constrained, and they're not going to pay for these medicines. So think about the implications of that. And we've seen actually many pharmaceutical companies that we've been supporting almost putting their foot on the brake. Yes. I mean, we know that there's been some very difficult confidential negotiations going on. We're seeing I've never seen this before whereby manufacturers are actually showing their cards. They're saying to payers in the MFN baskets, look, I'm really sorry to do this to you, but I have to launch at this price. Those payer bodies are saying no chance. You're never going to get that price. And so companies we are seeing sadly are walking away. This means and we discuss what the implications are delayed launch, even not launching and maybe pulling out new innovative medicines, particularly from MFN or MFN related baskets. And Adam, I know that whilst a lot of this is confidential, some companies have come out publicly, haven't they? Amgen, Novartis, I think Lilly, to name a few, have actually come out publicly and made statements about some of these pressures and the potential impact. Amgen have come out and they've said that they are delaying entry in lower priced markets until that US anchor is firmly established. Novartis have come out and they've said that actually the MFN basket makes it dangerous to launch in smaller EU nations, because of the wider implications and it's circling back to affect US prices like you've outlined. And finally, Lilly have come out and they've said that they're concerned that the MFN policies are going to force reallocation of investment away from EU countries. And that's only going to impact on access of these innovative medicines to the patients there. Well, one of the things I really want to explain to our viewers is we're not just reporting what's happening. The poorer are in the room, Adam. We're in the room for these difficult MFN negotiations. We're in the room seeing how the life science industry and the payers are behaving in real time. What are we seeing when we're in that room? Well, I mean, you're right. Difficult negotiations is a good way of summarising it, because we are seeing that companies are pushing for higher prices, knowing that it's going to affect the price in the US. And the markets are digging their heels in saying this is how we assess medicines and these are our cost effectiveness thresholds, etc. We talk about ZOPA, zone of possible agreement in negotiations. We're seeing that there's no ZOPA in some of these negotiations. They are wider part. And companies are trying to negotiate. As you said earlier, they are being open about the problems and the pressures and the feedback to the US pricing. But they're so far apart that many of them are walking away from the table. I agree. You can't do the secret deal anymore because that net price will track back to the US. You're trying to say to European payers, I'm really sorry my drug is overpriced. I'm doing it so I can get a good price for the U. S. European payers don't care about that. They just want to get a cost effectiveness and budget impact thresholds right for the value of the medicine in their market. So you're right, we're having a look at a walk away situation. Now let's flip this. What if we say, okay, Adam, so Amgen walk away, so Lilly's product doesn't get launched. So what? Well, the world will go on. There's loads of medicines coming. So what does it matter if we miss one or two products? Well, I think, you know, yes, patients will care about that individual product, but on a more macro level. You know, it is one product that may not be a huge issue, it's unlikely to be a huge issue. But one year, two year down the line, maybe there's five, ten, fifteen, twenty products or more that haven't been able to gain access in these European markets and these others in the MFN basket. And that becomes a problem. That becomes a problem because no longer is that market able to access innovative medicines. They're falling behind. And that's going to create a lot of political pressure to try and resolve that issue. Yeah. So MFN was originally started to increase price in other European and other markets. That's not happening. It was aimed to reduce the price in the US. Companies not letting that happen. So how are companies playing the game? What are they doing on the chessboard then? Well, we're seeing probably three different things. One is that companies are saying, let's launch in the US. And then we'll kind of try and work out the rest. That's probably a pause on those that are in the basket. But the main thing is let's get a good price in the US first. So there's no MFN to reference to because the drug is not available in those other markets. Eight, potentially nineteen countries. Correct. But again, that's probably not sustainable, and we'll come on to that. The next is that they are launching in the US, and then maybe some of the other markets that are not in that reference basket are becoming even more important. Like, don't forget, some of these markets have huge populations. Talking like Brazil, two hundred odd million people there, like China, they're not in the reference basket. And so companies are going to look more and more to those to really make sure that they get decent price there and it doesn't affect the US. I mean, that's a really interesting take. We've seen that in the room, Adam, haven't we? When I say seen that in the room, what I mean is clients coming to us looking for opportunities in the non MFN countries, which may not be traditional countries they've sold in. They may not have a sales force or vendors even in those areas or even the infrastructure, but they're now looking to think how can we get a product launch in markets in a non MFN basket? Well, that's potentially a new opportunity. Correct. And, you know, the third thing that we are seeing and it's good for us because this is our North Star as a company is an uptake in value based agreements and innovative contracting. Because what that can do, some of these agreements, they can mask that net price. And it's that net price, as you mentioned, that goes back to the US, gets declared, and then it's the second lowest price from those. Yes, totally. I mean, we have clients coming to us increasing VBA and innovative contracting to master that price, increasing VBA, innovative contracting to get their net price. Like the market would never do it without, say, a reassurance of an outcome base. And you know what, Adam? I really think what this has caused the access triangle is broken. We always refer to the access triangle. I mean, being a government payer for ten years, you have your access population, you have time to reimbursement, and you have your price. A lot of companies' strategy thinks they'll get all three of those. They think they'll get the best price. They believe they'll get the widest population, and they think they'll get it immediately. And there's often a dance in the negotiation. If you want the best price, you might get small population. If you want the widest population, I might reduce your price. If you're not willing to budge on those, I use time to delay your launch, and now you're losing dollars or euros or whatever you're translating in. The reason why I think that's broken is, and to your point, they're now walking away. They're now walking away. Those confidential net price agreements that gained access in many of these difficult markets, those confidential net prices aren't really confidential anymore. Or in one way or another, will track back to the US, which means they're walking away. So the access triangle, I think now is broken. Yeah, they're certainly willing to give on time and potentially access to keep that price We've seen companies, I think, even the ones you mentioned, there are others that have even put their launch on pause. They're using that phrase. Are you bringing it to market or not? They're not saying yes or no. They're just saying, we're waiting. We're waiting because of all the uncertainty. And they're waiting because of the unsustainable situation we find ourselves with MFN. So, Omar, where is this going? Well, where is this going? Firstly, I think and I've said this, it's not really going to work. Are we going to lower U. S. Drug pricing? Companies are not going let that happen. They're doing everything to stop that from happening. Are we going to raise the prices in European other baskets? Very unlikely. They're not showing any appetite to provide a high price to help the US price come down. For me, I think what's gone wrong is MFN is copying other global payer systems and adopting it into the US. That doesn't work. And there's a couple of reasons why it doesn't work. Probably the main one is, in the US, health care is a business. If you look at other, say, typical European markets, health care is like a cost. It's a taxpayer investment. It's a societal taxpayer burden. The US, health care, you follow the dollar. And everyone wants some of that dollar. If you look at the whole rebate mechanism that is resulting in the high prices of medicines, there's far too many vertically integrated health care organisations that feed off those rebates. And they all still want those rebates. So the paradox is this is not really going to work. The truth is the US really needs its own value framework. We can see the way in which US administration is going, that there is a formulaic approach becoming to be born that looks HTA like, trying to look at medicines and the value they deliver instead of and we historically have said the price of a drug in Europe is what the HDA value delivers. The price of a medicine in the U. S. Is what the market will bear, I. E. How high can you go before you break it? And that's your price. That does need fixing. But just to adopt and copy MFN countries is not going to be the solution, Adam. And for one thing, there's a number of markets in there, for example, that use the quali. Well, we know right now that the US doesn't really use the QALY at all. It's actually anti statute for some of the CMS and government pricing, and we've seen in CMS drug price negotiations. It's actually against a statute to use a QALY. So why would you try and base your US prices on elements of markets that use systems like the quali base? It's just not going to work, and it's going to be problematic. So that brings us really to an interesting point. What do we do now, Adam? There's companies watching, seeing this problem. What should they be doing? Omar, we've got great experience here. We're living this every day. If you are a company trying to get access in an MFN market or looking to launch in international markets or wanting to design value based agreements or innovative contracts, get in contact, drop us a line.

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In this longer-format special feature, Omar Ali and Adam Buckler step back from the usual case-study format to unpack the wider implications of MFN for global pharma.

Most Favoured Nation pricing sounds straightforward on paper.

In reality, it’s starting to change how global pricing actually works.

If a lower price in one market can affect what happens elsewhere — particularly in the US — then the old model of confidential discounting starts to fall apart. And once that happens, everything from launch strategy to negotiation dynamics shifts with it.

Across four sections, Verpora’s Access Strategy leads examine what MFN is changing, why negotiations are becoming harder, what companies are doing in response, and where the market may move next.

1) Introduction to MFN

The discussion starts with the underlying shift in pricing logic. MFN is not just another policy headline. It changes the negotiation dynamic by making it far harder to discount quietly in one market without risking wider consequences.

2) Implications for the life sciences industry

Payers in international markets are not suddenly willing to absorb higher prices just to help protect US pricing. At the same time, manufacturers are becoming less willing to offer the confidential discounts that historically helped close difficult deals. The result is a more rigid, more confrontational negotiation environment, with fewer workable zones of agreement.

3) How MFN is playing out today

Omar and Adam discuss the patterns emerging in real time: delayed launches, pauses in market entry, greater focus on non-MFN markets, and renewed interest in innovative contracting as a way to manage net price exposure more carefully.

4) Our opinion: where is this going?

Finally, we ask where this leads. If the old negotiation playbook is no longer reliable, what replaces it? The discussion points to a market where launch sequencing, subgroup strategy, value-based agreements, and stronger evidence packages are no longer optional extras.

This episode will be especially useful for:

• global pricing and market access leaders managing cross-market price risk

• regional and country teams navigating difficult payer negotiations

• launch strategy teams thinking about sequencing, basket exposure, and access timing

• anyone working in innovative contracting, value-based agreements, or reimbursement strategy

If MFN is changing how your business thinks about launch order, discounting, access, or negotiation flexibility, this special feature is worth your time.

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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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

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With CMS now releasing MFPs for IPAY 2027 and preparations already underway for IPAY 2028, the landscape continues to shift. This focused 1-hour webinar brings together advisors from Verpora and Manatt Health — joined for the first time by a US payer perspective — to examine what’s changing and how manufacturers should respond.

Unlike our previous IPAY webinars, which focused on lessons from previous cycles, this session looks ahead — addressing early strategy for selected products, the inclusion of Part B medicines, and the impact of broader political and regulatory developments.

In this session:

• How CMS’s approach has evolved between IPAY 2026 and 2027 — and what that signals for IPAY 2028

• The new complexity introduced by Part B inclusion in IPAY 2028

• Manufacturer strategy: how early preparation shapes outcomes

• Most Favored Nation (MFN) pricing pressures and negotiation dynamics

• The payer response: formulary strategy, unintended consequences, and future readiness

Thinking ahead to IPAY 2028 or preparing for possible selection?

Use Verpora’s insight to sharpen your early strategy and better understand what’s coming.

Email wanda.lesowiec@verpora.com to start the conversation.

Webinar Disclaimer: This presentation is for discussion purposes only. No part of this presentation is intended as legal advice. This presentation is based on non-confidential, publicly sourced intelligence. Views expressed by the speakers are personal opinion and should not be attributed to anyone else. No part of this webinar may be reproduced for commercial purposes without the express permission of Verpora and Manatt Health.

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Speakers

Adam Buckler
VP Innovative Contracting
LinkedIn

Omar Ali
Head of Payers, Verpora
LinkedIn

Chris Webber
Head of Negotiation, Verpora
LinkedIn

Ross Margulies
Partner,
Manatt Health
LinkedIn

Drake Reiter
Director, Pharmcy Operations, Priority Health
LinkedIn

In the final episode of the series, Omar speaks with Dr Abdulrazag Al-Jazairi, Advisor to the Saudi Food and Drug Authority, about the rapidly evolving payer and HTA environment in Saudi Arabia.

They discuss what it means to develop payer infrastructure from the ground up, the influence of international frameworks on domestic decision-making, and how value-based agreements are beginning to play a role in national pricing strategy.

Key themes:

• HTA system development in Saudi Arabia

• Local adaptation of international pricing logic

• Role of VBAs in emerging access models

About The Payer Exchange

The Payer Exchange is a podcast from Verpora that explores how payers around the world are navigating complex pricing and access decisions. Hosted by Omar Ali, Verpora’s Head of Payers, each episode features a one-to-one conversation with a payer from a different healthcare system—offering direct insight into the practical realities of drug funding, reimbursement, and health system sustainability.

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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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

Omar is joined by Professor Lieven Annemans, former chair of Belgium’s health economics advisory committee, to explore the complexities of European HTA policy.

They talk about the role of Joint Clinical Assessment (JCA), the risk of over-assessment in policy design, and the challenge of maintaining local relevance within a harmonised EU framework. Lieven brings perspective on how the purpose of assessment is sometimes lost in the process of implementation.

Key themes:

• Joint Clinical Assessment (JCA) readiness and implications

• Local vs EU-level HTA alignment

• Over-assessment, duplication, and unintended bureaucracy

About The Payer Exchange

The Payer Exchange is a podcast from Verpora that explores how payers around the world are navigating complex pricing and access decisions. Hosted by Omar Ali, Verpora’s Head of Payers, each episode features a one-to-one conversation with a payer from a different healthcare system—offering direct insight into the practical realities of drug funding, reimbursement, and health system sustainability.

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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

In this episode, Omar speaks with Canadian health economist and policy advisor Don Husereau about Canada’s unique payer landscape. Don isn’t your typical policy analyst. He’s worked in HTA, advised governments, and written widely about the gaps, flaws, and hidden logic in pricing systems like Canada’s.

They discuss the decentralised nature of decision-making, the gap between evidence generation and clinical practice, and the disconnect between how healthcare science is developed versus how healthcare systems operate. Don shares his perspective on the pressures facing CADTH and how Canadian policy reflects a deeper tension between idealism and pragmatism.

Key themes:

• Decentralised payer environment in Canada

• Evidence generation vs clinical practice

About The Payer Exchange

The Payer Exchange is a podcast from Verpora that explores how payers around the world are navigating complex pricing and access decisions. Hosted by Omar Ali, Verpora’s Head of Payers, each episode features a one-to-one conversation with a payer from a different healthcare system—offering direct insight into the practical realities of drug funding, reimbursement, and health system sustainability.

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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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

Omar speaks with Dr Krzysztof Landa, former Deputy Minister of Health, health economist, and someone who’s helped shape the pricing and HTA landscape in Poland over the past two decades.

They examine the influence of external pricing references, the practical realities of MFN implementation, and the state of HTA reform. The discussion also covers the potential role of JCA and how manufacturers can adapt to a system that combines political oversight with economic rigor.

Key themes:

• External reference pricing and its impact in Poland

• MFN price pressure and response

• HTA reform and the readiness for JCA

About The Payer Exchange

The Payer Exchange is a podcast from Verpora that explores how payers around the world are navigating complex pricing and access decisions. Hosted by Omar Ali, Verpora’s Head of Payers, each episode features a one-to-one conversation with a payer from a different healthcare system—offering direct insight into the practical realities of drug funding, reimbursement, and health system sustainability.

Listen and subscribe

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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

In the opening episode of series two of The Payer Exchange, Omar Ali is joined by Dr Yousaf Ahmad, Chief Pharmacist and Director of Medicines Optimisation at a NHS Integrated Care System.

They explore the practical trade-offs being made inside the NHS today: the pressure to find efficiency without losing sight of quality, the reality of navigating oncology value frameworks, and the challenge of ensuring that VBAs work for both payers and manufacturers. The conversation also touches on the UK’s evolving approach to MFN spillover and combination treatments.

Key themes:

• NHS cost-effectiveness thresholds and their evolution

• Practical implementation of VBAs in the NHS

• Oncology access and MFN pricing ripple effects

About The Payer Exchange

The Payer Exchange is a podcast from Verpora that explores how payers around the world are navigating complex pricing and access decisions. Hosted by Omar Ali, Verpora’s Head of Payers, each episode features a one-to-one conversation with a payer from a different healthcare system—offering direct insight into the practical realities of drug funding, reimbursement, and health system sustainability.

Listen and subscribe

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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

Access to this masterclass is by request only. Click here to arrange access

Global pricing pressures are reshaping how market access teams operate — not just in the US, but across every major region. As the balance of pricing power shifts and expectations rise in emerging markets, companies face a new imperative: to defend value globally, while operating with fewer resources and faster timelines.

For senior access leaders, this isn’t just about reallocating budgets — it’s about reshaping how capability is structured and delivered across international markets. Where do you invest? How do you scale strategy and execution when local needs differ so widely? And what kind of system supports agility without losing consistency?

If your remit includes international access strategy or capability development, this session offers grounded perspective on what’s working — and where it’s heading next:

• Key tips on how to scale and adapt access capabilities across diverse markets without losing local relevance

• Ways to strengthen payer engagement under resource and pricing pressure

• Strategies to align global & regional intent with local execution

• Insights into the practical barriers holding back implementation — and proven strategies to fix it

• The unique perspective of pharma leaders tackling current real world challenges, as told live and in-person

Real-world insights
on how to:

Partner with INSPIRE! to scale international access

Arrange a time to discuss your greatest challenges with the INSPIRE! expert team…

Email wanda.lesowiec@verpora.com

Speakers

Adam Buckler
VP Innovative Contracting
Verpora
LinkedIn

Omar Ali
Head of Payers,
Verpora
LinkedIn

Chris Webber
Head of Negotiation, Verpora
LinkedIn

Paola Valinotti
Founder,
Access2Health
LinkedIn

Webinar Disclaimer: This presentation is for discussion purposes only. No part of this presentation is intended as legal advice. This presentation is based on non-confidential, publicly sourced intelligence. Views expressed by the speakers are personal opinion and should not be attributed to anyone else. No part of this webinar may be reproduced for commercial purposes without the express permission of Verpora and Manatt Health.

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What happens when a one-time therapy offers a lifetime of benefit — but payers still expect year-by-year value?

Hemgenix’s 10-year agreement in Europe shows how VBAs are evolving to meet the needs of high-cost, high-impact treatments. Omar and Adam unpack how this deal was structured, why such long-term agreements are gaining traction, and what this means for pipeline therapies in cell and gene.

Covered:

• The economics of curative therapies

• What makes long-term VBAs viable for both sides

• Early signals on payer thinking across the EU

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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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

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Rare diseases face a paradox: the need for urgent access meets a limited evidence base.

In this episode, Omar and Adam unpack what makes value alignment so tough in rare conditions, where uncertainty is high and endpoints are often unconventional. Through case examples, they explore how to shift payer conversations beyond “how much?” to “what value really means.”

Themes include:

• Why rare disease deals stall at the value stage

• Approaches for agreement under clinical and financial uncertainty

• Making space for risk-sharing, not just risk-avoidance

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Receive a single email each week with a direct link to the latest IC Fireside Chat— no spam, just the latest episode, straight to your inbox.

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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

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Even with good data and a well-reasoned value proposition, misalignment between manufacturers and payers is common. This episode explores what causes value mismatches — from how data is interpreted, to what decision-makers are actually incentivised to consider. Omar and Adam discuss how to identify the root of disconnects, and what manufacturers can do to rebuild common ground.

We explore:

• Strategic and operational blind spots in payer engagement

• When cost-effectiveness models aren’t the problem, but the mindset is

• How to navigate value communication in fragmented systems

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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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

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Not all patients benefit equally. So what happens when a drug performs better in one subpopulation than another? Denmark’s SMA pricing model shows how tiered approaches can make pricing fair — aligning with outcomes and satisfying payer expectations. In this episode, we discuss how different evidence sets, real-world performance, and evolving patient stratification are reshaping price-per-value thinking.

Covered:

• Denmark’s model for Spinal Muscular Atrophy (SMA)

• The problem of uniform pricing across uneven efficacy

• Designing contracting mechanisms that flex with data

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Receive a single email each week with a direct link to the latest IC Fireside Chat— no spam, just the latest episode, straight to your inbox.

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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

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The strategy behind combination therapy launch sequencing isn’t just about timing — it can dramatically reshape your pricing outcomes. In this second episode on oncology combinations, we dig into launch scenarios, evidence generation timelines, and why some deals end up hurting the value of later products. Adam and Omar unpack the tension between short-term wins and long-term market shaping.

Key themes:

• How pricing is influenced by which product launches first

• Real-world missteps and their consequences

• The fine line between data readiness and market readiness

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Receive a single email each week with a direct link to the latest IC Fireside Chat— no spam, just the latest episode, straight to your inbox.

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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

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Combination therapies in oncology are changing the game, but the challenge is real: how do you price a drug that only adds incremental benefit when used with another?

In this episode, we explore how payers assess these add-ons and why clinical benefit must be separated from commercial strategy. Omar and Adam walk through real-world examples and ask: What kind of evidence is persuasive when your therapy isn’t the main event, but still adds value?

Topics covered:

• How frameworks struggle with incremental benefit

• Why oncology poses specific IC challenges

• What happens when combination therapies hit misaligned HTA processes

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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

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Receive a single email each week with a direct link to the latest IC Fireside Chat— no spam, just the latest episode, straight to your inbox.

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In this final episode of Series 1, Omar Ali speaks with Jaime Espín, health economist, former advisor to the Spanish Ministry of Health, and one of Spain’s most well-known payer figures.

Jaime discusses the ongoing regulatory reforms reshaping the Spanish access environment, including efforts to modernise outdated decision-making processes. The conversation also explores moves toward greater pricing transparency and Spain’s experience with outcome-based payment models—including the practical and economic barriers to implementing staged payments in a system under pressure.

This episode brings the series to a close with a clear-eyed look at how one of Europe’s most complex markets is evolving in response to innovation, cost, and political scrutiny.

About The Payer Exchange

The Payer Exchange is a podcast from Verpora that explores how payers around the world are navigating complex pricing and access decisions. Hosted by Omar Ali, Verpora’s Head of Payers, each episode features a one-to-one conversation with a payer from a different healthcare system—offering direct insight into the practical realities of drug funding, reimbursement, and health system sustainability.

Listen and subscribe

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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

In this episode, Omar Ali speaks with Hans Severens, a respected academic and former Vice Chair of the Dutch Health Council, who brings deep insight into the work of ZIN and the Netherlands’ evolving HTA framework.

Hans shares how the Dutch approach to value-based pricing is becoming increasingly sophisticated—and why severity of disease may carry more weight than rarity in reimbursement decisions. The conversation also explores the feasibility of sustaining the healthcare system amid rising costs, and the importance of honest trade-offs in payer decision-making.

This episode offers a sharp, system-level view of Dutch payer logic, and raises essential questions for manufacturers working with high-cost therapies and real-world evidence.

About The Payer Exchange

The Payer Exchange is a podcast from Verpora that explores how payers around the world are navigating complex pricing and access decisions. Hosted by Omar Ali, Verpora’s Head of Payers, each episode features a one-to-one conversation with a payer from a different healthcare system—offering direct insight into the practical realities of drug funding, reimbursement, and health system sustainability.

Listen and subscribe

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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

In this episode, Omar Ali speaks with Professor Fabrizio Gianfrate, a voting member of AIFA (the Italian Medicines Agency) and a long-standing voice in European health economics and policy.

The discussion highlights Italy’s relatively positive access environment for rare disease treatments—contrasted with the pricing trade-offs manufacturers may need to accept. Fabrizio also addresses the structural limitations of Italy’s financial governance, and how this affects the country’s ability to implement payment-over-time models or innovative contracting.

It’s a nuanced conversation that sheds light on a market often perceived as opaque, but which offers valuable lessons on access strategy, fiscal policy, and real-world system constraints.

About The Payer Exchange

The Payer Exchange is a podcast from Verpora that explores how payers around the world are navigating complex pricing and access decisions. Hosted by Omar Ali, Verpora’s Head of Payers, each episode features a one-to-one conversation with a payer from a different healthcare system—offering direct insight into the practical realities of drug funding, reimbursement, and health system sustainability.

Listen and subscribe

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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

In this episode of The Payer Exchange, Omar Ali speaks with Detlev Parow, former Head of Pharmaceutical Services at one of Germany’s largest statutory health insurance funds.

The conversation explores how Germany is responding to rising pressures on access and affordability—often in ways that differ from other major markets. From a pragmatic stance on obesity drugs to counterintuitive pricing dynamics for multi-indication products, Detlev offers sharp insights grounded in payer practice.

They also discuss the growing role of outcomes-based guarantees, especially for high-cost therapies like gene treatments, and reflect on how payer mindsets are adapting to evolving innovation and fiscal pressure.

About The Payer Exchange

The Payer Exchange is a podcast from Verpora that explores how payers around the world are navigating complex pricing and access decisions. Hosted by Omar Ali, Verpora’s Head of Payers, each episode features a one-to-one conversation with a payer from a different healthcare system—offering direct insight into the practical realities of drug funding, reimbursement, and health system sustainability.

Listen and subscribe

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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

In the opening episode of The Payer Exchange, Verpora’s Head of Payers, Omar Ali, speaks with Jean Claude Castanier, a former member of CEPS, the French Economic Committee for Health Products.

The conversation explores France’s approach to managing drug pricing and reimbursement in an increasingly complex therapeutic landscape. Jean Claude shares his perspective on the long-running challenges of preserving net price across multiple indications, the evolving role of payers as public communicators, and the importance of maintaining long-term healthcare system sustainability.

This episode offers rare, candid insight into the thinking behind one of Europe’s most influential pricing bodies—and sets the tone for a global series of honest conversations with payers on the front lines.

About The Payer Exchange

The Payer Exchange is a podcast series that offers a candid and unfiltered look at how real-world decisions on drug pricing, access, and reimbursement are being made by payers across different healthcare systems.

Hosted by Omar Ali, Verpora’s Head of Payers, each episode features a one-to-one conversation with a payer from a different country in Verpora’s payer network. These are not panel discussions or scripted interviews—they are direct, unscripted dialogues that explore the practical realities of funding decisions from those who have been directly involved in them.

The series covers a range of consistent themes across markets—such as horizon scanning, indication-based pricing, rare diseases, and system sustainability—while also highlighting country-specific dynamics. By asking the same core questions in each conversation, the podcast reveals both common pressures and contrasting approaches across healthcare systems.

The Payer Exchange is designed for professionals working in market access, pricing, policy, and strategy who want a deeper understanding of how payers are approaching the increasingly complex landscape of pharmaceutical innovation.

Listen and subscribe

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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

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This episode digs into a story where patient perspectives changed everything. Omar Ali and Adam Buckler discuss how Botox, as a treatment for migraine, didn’t initially look promising:

• It was an injectable therapy in a space dominated by cheaper oral medicines.

• The clinical data didn’t show a clear reduction in migraine frequency.

• The cost and delivery challenges made it even tougher to justify to payers.

Who could help you with your next move in this position?

This is where the patient voice proved critical, giving real-world evidence that challenged conclusions of the original PREEMPT study — demonstrating how the treatment genuinely improved patients’ daily lives, work, and wellbeing in ways the data didn’t fully capture, which was that while the frequency of migraines didn’t change with the treatment, it caused patients to experience less severe attacks.

This feedback reframed the conversation, showing that effectiveness isn’t just about numbers — it’s about lived experience and the outcomes that matter most to those who rely on the treatment.

The takeaway is clear: patients are a crucial voice in shaping what access and value truly mean. When their perspectives are heard, they can transform how treatments are understood, evaluated, and brought to the people who need them most.

If you’re interested in how other stakeholders shape access and value, check out our earlier episode on stakeholder engagement, particularly empowering physicians — another key voice in making market access decisions work.

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. No part of this presentation may be reproduced for commercial purposes without the express permission of Verpora.

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