The Payer Exchange

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.

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 where Omar Ali , Head of Payers at Verpora, sits down with payers from around the world to talk candidly about what’s shaping access, value, and decision-making in their markets. 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. Disclaimer This podcast is for educational and informational purposes only, and is not intended as legal or policy advice. All content 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 Omar Ali, Verpora Limited.

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 where Omar Ali , Head of Payers at Verpora, sits down with payers from around the world to talk candidly about what’s shaping access, value, and decision-making in their markets. 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. Disclaimer This podcast is for educational and informational purposes only, and is not intended as legal or policy advice. All content 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 Omar Ali, Verpora Limited.

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 CADTH’s evolving role and MFN impact About The Payer Exchange The Payer Exchange is a podcast where Omar Ali , Head of Payers at Verpora, sits down with payers from around the world to talk candidly about what’s shaping access, value, and decision-making in their markets. 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. Disclaimer This podcast is for educational and informational purposes only, and is not intended as legal or policy advice. All content 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 Omar Ali, Verpora Limited.

Omar speaks with Dr Krzysztof Łanda, 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 where Omar Ali , Head of Payers at Verpora, sits down with payers from around the world to talk candidly about what’s shaping access, value, and decision-making in their markets. 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. Disclaimer This podcast is for educational and informational purposes only, and is not intended as legal or policy advice. All content 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 Omar Ali, Verpora Limited.

In this opening episode, 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 where Omar Ali , Head of Payers at Verpora, sits down with payers from around the world to talk candidly about what’s shaping access, value, and decision-making in their markets. 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. Disclaimer This podcast is for educational and informational purposes only, and is not intended as legal or policy advice. All content 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 Omar Ali, Verpora Limited.

What happens when the world’s pricing pressures start reshaping national systems from the inside? In Season 2 of The Payer Exchange, we speak to former payers and policy leaders from five different countries—each responding to the same global trends in very different ways. From MFN spillover to combination oncology, from HTA reform to value-based agreements, we look at how systems are adapting, what’s working, and where the pressure is still building. Guests this season include: 🇬🇧 Yousaf Ahmed (UK) 🇵🇱 Krzysztof Łanda (Poland) 🇨🇦 Don Husereau (Canada) 🇧🇪 Lieven Annemans (Belgium) 🇸🇦 Abdulrazag Aljazairi (Saudi Arabia) Each episode is a one-to-one conversation with someone who has made the difficult decisions on pricing, access, and funding. These are unfiltered discussions based on real experience inside the system. Global voices. Local insight. Clear thinking on the future of market access. Disclaimer: This podcast is for educational and informational purposes only, and is not intended as legal or policy advice. All content 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 Omar Ali, Verpora Limited.

In this final episode of our first series, I speak with Jaime Espín—health economist, former adviser to the Spanish Ministry of Health, and one of the country’s most recognised payer voices. We explore the latest regulatory reforms reshaping access in Spain, a move toward greater transparency in payer decision-making, and the country’s experimentation with outcomes-based and staged payment models for innovative medicines. It’s a compelling look at a system in transition—and a fitting close to a series that’s revealed how differently payers around the world are grappling with shared challenges. About The Payer Exchange The Payer Exchange is a podcast where Omar Ali , Head of Payers at Verpora, sits down with payers from around the world to talk candidly about what’s shaping access, value, and decision-making in their markets. 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. Disclaimer This podcast is for educational and informational purposes only, and is not intended as legal or policy advice. All content 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 Omar Ali, Verpora Limited.

In this episode, I speak with Hans Severens, former Vice Chair of the Dutch Health Council and a key figure in health technology assessment at ZIN in the Netherlands. We dig into how the Netherlands is advancing value-based pricing frameworks, why severity of disease may outweigh rarity in reimbursement discussions, and the pressures of sustaining a publicly funded system in the face of high-cost therapies. Hans brings a considered and critical lens to how access decisions are made, and offers a Dutch perspective on balancing economic realism with equity and innovation. About The Payer Exchange The Payer Exchange is a podcast where Omar Ali , Head of Payers at Verpora, sits down with payers from around the world to talk candidly about what’s shaping access, value, and decision-making in their markets. 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. Disclaimer This podcast is for educational and informational purposes only, and is not intended as legal or policy advice. All content 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 Omar Ali, Verpora Limited.

In this episode, I’m joined by Professor Fabrizio Gianfrate, a voting member of AIFA—the Italian Medicines Agency—and a long-time figure in European health economics. We explore why Italy is viewed as a strong market for rare disease access, the growing friction between good patient access and lower pricing, and how delayed payment and instalment models are creating challenges for innovative contracting in Italy’s system. It’s a fascinating look at a market that often flies under the radar, with real-world insights from someone deeply embedded in both policy and practice. About The Payer Exchange The Payer Exchange is a podcast where Omar Ali , Head of Payers at Verpora, sits down with payers from around the world to talk candidly about what’s shaping access, value, and decision-making in their markets. 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. Disclaimer This podcast is for educational and informational purposes only, and is not intended as legal or policy advice. All content 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 Omar Ali, Verpora Limited.

In this episode, I speak with Detlev Parow, a former payer from one of Germany’s largest statutory health insurance funds. We unpack how German systems are managing access and affordability—sometimes in surprising ways. Detlev shares why, in Germany, obesity drugs might not be the budgetary problem everyone assumes, why multiple indications don’t always mean lower prices, and how gene therapies are being handled through outcomes-based guarantees. Along the way, we hear what it’s like to negotiate from “the dark side” and get a glimpse into a payer mindset shaped by pragmatism, experience, and a few unexpected views. About The Payer Exchange The Payer Exchange is a podcast where Omar Ali , Head of Payers at Verpora, sits down with payers from around the world to talk candidly about what’s shaping access, value, and decision-making in their markets. 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. Disclaimer This podcast is for educational and informational purposes only, and is not intended as legal or policy advice. All content 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 Omar Ali, Verpora Limited.

In our first episode, I’m joined by Jean Claude Castanier, a former CEPS member and leading voice in France’s pricing and reimbursement landscape. We talk about the ongoing challenge of preserving net price across multiple indications, the payer’s role as a public communicator, and what long-term sustainability really means for healthcare systems under pressure. From confidential discounts to transparency, and the tension between innovation and affordability—this is a grounded look at one of Europe’s most closely watched pricing systems. About The Payer Exchange The Payer Exchange is a podcast where Omar Ali , Head of Payers at Verpora, sits down with payers from around the world to talk candidly about what’s shaping access, value, and decision-making in their markets. 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. Disclaimer This podcast is for educational and informational purposes only, and is not intended as legal or policy advice. All content 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 Omar Ali, Verpora Limited.

What really shapes access decisions in healthcare? Beyond the policy documents and headlines—it’s the people. The payers making the calls. I’m Omar Ali , and The Payer Exchange is a podcast where I sit down with payers from around the world for honest, unscripted conversations about what’s really driving decisions on drug pricing, access, and reimbursement. Each episode, I speak to someone working at the heart of healthcare funding in their country. We talk about the local challenges, global trends, and how payer thinking is evolving—from horizon scanning to contracting, regulatory reform to real-world evidence. This isn’t a panel. It’s not a pitch. It’s a chance to hear what’s really happening—straight from the people who live it. Subscribe now to join me for global voices, local insights, and real talk on the future of access. Disclaimer: This podcast is for educational and informational purposes only, and is not intended as legal or policy advice. All content 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 Omar Ali, Verpora Limited.