The Inflation Reduction Act has introduced significant pricing pressures on manufacturers, particularly through Medicare drug price negotiations and inflation-based rebates. This project serves as a technical safeguard against these pressures by:
- Protecting Net Price: By utilizing the GTN Waterfall Engine, the project allows for real-time monitoring of margin retention. It identifies exactly where Gross-to-Net erosion is occurring, allowing teams to defend the "Floor Net Price" during federal price ceiling discussions.
- Mitigating Inflation Rebates: The IRA Scenario Model simulates price-increase impacts against CPI-U rates, ensuring that commercial pricing strategies do not inadvertently trigger statutory penalties that wipe out year-over-year gains.
- Leakage Prevention: Every dollar lost to 340B Duplicate Discounts is a dollar that cannot be recovered under IRA-negotiated prices. Our Scrubbing Engine automates the identification of these duplicates to ensure the integrity of every unit sold.
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As Cell & Gene therapies carry high upfront costs, Payers are increasingly demanding Value-Based Contracts—where payment is tied to patient outcomes over time. This project provides the data infrastructure required to support VBC:
- Patient-360 Longitudinal Tracking: By merging genomic data with claims, the system creates a baseline to measure therapy efficacy over a multi-year horizon.
- High-Value Sub-Population Identification: Precision targeting ensures that therapies are administered to patients with the highest probability of clinical success, thereby reducing the financial risk associated with "pay-for-performance" models.
- Predictive ROI Dashboard: For market access teams, the dashboard provides the quantitative evidence needed to convince Payers that the long-term clinical savings of a "one-and-done" gene therapy outweigh the high initial acquisition cost.