{"version":"1.0.0","segments":[{"startTime":0.18,"endTime":4.23,"body":"- Welcome to this Petauri Evidence"},{"startTime":0.18,"endTime":4.23,"body":"webinar."},{"startTime":4.23,"endTime":5.67,"body":"At Petauri Evidence, we"},{"startTime":4.23,"endTime":5.67,"body":"deliver market access"},{"startTime":5.67,"endTime":9.15,"body":"and HEOR support throughout"},{"startTime":5.67,"endTime":9.15,"body":"the product lifecycle"},{"startTime":9.15,"endTime":12.24,"body":"to bring new treatments to"},{"startTime":9.15,"endTime":12.24,"body":"patients across global markets."},{"startTime":13.62,"endTime":18.09,"body":"Follow us on LinkedIn for more"},{"startTime":13.62,"endTime":18.09,"body":"great content from our team."},{"startTime":18.09,"endTime":19.83,"body":"We hope you enjoy the discussion."},{"startTime":20.94,"endTime":24.72,"body":"- Welcome everyone to our"},{"startTime":20.94,"endTime":24.72,"body":"latest global whispers webinar."},{"startTime":24.72,"endTime":27.18,"body":"Please see our YouTube"},{"startTime":24.72,"endTime":27.18,"body":"channel for past webinars"},{"startTime":27.18,"endTime":30.0,"body":"and look out for more content"},{"startTime":27.18,"endTime":30.0,"body":"from us in the future."},{"startTime":31.53,"endTime":35.76,"body":"Topic today is communicating"},{"startTime":31.53,"endTime":35.76,"body":"value to US Payers, insights"},{"startTime":35.76,"endTime":37.59,"body":"for pharma and MedTech."},{"startTime":37.59,"endTime":39.03,"body":"I'm Louise Maddison,"},{"startTime":39.03,"endTime":42.6,"body":"senior consultant at Petauri Evidence"},{"startTime":44.4,"endTime":46.95,"body":"We have a great mix of"},{"startTime":44.4,"endTime":46.95,"body":"audience today across industry"},{"startTime":46.95,"endTime":48.57,"body":"and healthcare systems"},{"startTime":48.57,"endTime":50.94,"body":"and I'd particularly like"},{"startTime":48.57,"endTime":50.94,"body":"to welcome our global affiliate"},{"startTime":50.94,"endTime":53.58,"body":"partners who play a key"},{"startTime":50.94,"endTime":53.58,"body":"role in the work that we do."},{"startTime":55.38,"endTime":57.12,"body":"For those that don't know us well,"},{"startTime":57.12,"endTime":60.48,"body":"Petaur Evidence is a global"},{"startTime":57.12,"endTime":60.48,"body":"specialist health economics"},{"startTime":60.48,"endTime":62.88,"body":"outcomes and market access consultancy."},{"startTime":64.56,"endTime":66.66,"body":"With a track record in expert delivery."},{"startTime":66.66,"endTime":69.15,"body":"We provide specialist"},{"startTime":66.66,"endTime":69.15,"body":"support for pharmaceutical"},{"startTime":69.15,"endTime":71.16,"body":"and MedTech clients"},{"startTime":71.16,"endTime":72.75,"body":"and work as a collaborative partner"},{"startTime":72.75,"endTime":74.52,"body":"to healthcare systems worldwide."},{"startTime":76.68,"endTime":78.24,"body":"In June last year, we joined Petauri."},{"startTime":79.685,"endTime":82.86,"body":"Petauri has brought together"},{"startTime":79.685,"endTime":82.86,"body":"some best in class companies"},{"startTime":82.86,"endTime":85.68,"body":"with recognised experience"},{"startTime":82.86,"endTime":85.68,"body":"in market access,"},{"startTime":85.68,"endTime":88.35,"body":"medical affairs, payer"},{"startTime":85.68,"endTime":88.35,"body":"marketing, and more."},{"startTime":89.46,"endTime":91.83,"body":"In particular, Petauri has connected us"},{"startTime":91.83,"endTime":94.35,"body":"with new colleagues in"},{"startTime":91.83,"endTime":94.35,"body":"the US with a wealth"},{"startTime":94.35,"endTime":96.72,"body":"of US market access experience."},{"startTime":98.07,"endTime":100.32,"body":"Petauri recently launched the ACE team,"},{"startTime":100.32,"endTime":103.95,"body":"which is their Access"},{"startTime":100.32,"endTime":103.95,"body":"Customer Experience team,"},{"startTime":103.95,"endTime":107.73,"body":"an in-house team of former"},{"startTime":103.95,"endTime":107.73,"body":"US access decision makers"},{"startTime":107.73,"endTime":111.51,"body":"with experience across all"},{"startTime":107.73,"endTime":111.51,"body":"areas of US healthcare,"},{"startTime":111.51,"endTime":114.33,"body":"including Medicare,"},{"startTime":111.51,"endTime":114.33,"body":"Medicaid, and commercial."},{"startTime":115.23,"endTime":118.35,"body":"I'm delighted to be joined"},{"startTime":115.23,"endTime":118.35,"body":"by a few members of this team"},{"startTime":118.35,"endTime":119.52,"body":"for this webinar today."},{"startTime":121.2,"endTime":125.22,"body":"Today we focus on communicating"},{"startTime":121.2,"endTime":125.22,"body":"value to US payers, insights"},{"startTime":125.22,"endTime":127.32,"body":"for pharma and MedTech."},{"startTime":127.32,"endTime":130.02,"body":"I'm delighted to welcome our"},{"startTime":127.32,"endTime":130.02,"body":"guests from Petauri Advisors"},{"startTime":130.02,"endTime":132.18,"body":"and the A team, Rory, Dan"},{"startTime":132.18,"endTime":134.19,"body":"and Shana who brings a mix"},{"startTime":134.19,"endTime":138.09,"body":"of experience as former US"},{"startTime":134.19,"endTime":138.09,"body":"access decision makers, as well"},{"startTime":138.09,"endTime":140.46,"body":"as insight from pharma and consultancy."},{"startTime":141.66,"endTime":143.76,"body":"Welcome, all. Pleased"},{"startTime":141.66,"endTime":143.76,"body":"could you take a moment"},{"startTime":143.76,"endTime":146.31,"body":"to introduce yourselves, your backgrounds"},{"startTime":146.31,"endTime":149.25,"body":"and current roles within Petauri Advisors."},{"startTime":149.25,"endTime":150.72,"body":"Dan, I'll let you start first."},{"startTime":151.83,"endTime":154.68,"body":"- Excellent. Thanks"},{"startTime":151.83,"endTime":154.68,"body":"Louise. Hello everybody."},{"startTime":154.68,"endTime":156.15,"body":"My name is Dan Vanderpool."},{"startTime":156.15,"endTime":159.27,"body":"Spent my entire career in"},{"startTime":156.15,"endTime":159.27,"body":"the world of market access"},{"startTime":159.27,"endTime":160.77,"body":"pharmacist by education and then"},{"startTime":160.77,"endTime":163.2,"body":"after graduation, started working for one"},{"startTime":163.2,"endTime":165.63,"body":"of the US payers named Humana."},{"startTime":165.63,"endTime":168.51,"body":"Spent about a decade there,"},{"startTime":165.63,"endTime":168.51,"body":"really focused in the notion"},{"startTime":168.51,"endTime":171.84,"body":"of trade relations, which is"},{"startTime":168.51,"endTime":171.84,"body":"rebate negotiation as well"},{"startTime":171.84,"endTime":173.7,"body":"as formulary development."},{"startTime":173.7,"endTime":175.2,"body":"More recently, over the past decade"},{"startTime":175.2,"endTime":178.08,"body":"or so, I've spent my time"},{"startTime":175.2,"endTime":178.08,"body":"focused on strategic payer"},{"startTime":178.08,"endTime":182.11,"body":"marketing as well as payer"},{"startTime":178.08,"endTime":182.11,"body":"strategy work here in the us. So"},{"startTime":182.11,"endTime":184.39,"body":"- Delighted to be here with everybody."},{"startTime":184.39,"endTime":185.39,"body":"Rory."},{"startTime":187.27,"endTime":190.75,"body":"- Hey Dan, Rory Davies. Also"},{"startTime":187.27,"endTime":190.75,"body":"a pharmacist by training."},{"startTime":190.75,"endTime":192.13,"body":"I've spent my career"},{"startTime":190.75,"endTime":192.13,"body":"doing different things."},{"startTime":192.13,"endTime":193.84,"body":"I've worked in in hospital settings,"},{"startTime":193.84,"endTime":195.64,"body":"I've worked in in retail pharmacies,"},{"startTime":195.64,"endTime":198.46,"body":"but I've spent the bulk of"},{"startTime":195.64,"endTime":198.46,"body":"my career in managed care."},{"startTime":198.46,"endTime":201.76,"body":"So I was the pharmacy director"},{"startTime":198.46,"endTime":201.76,"body":"for a state health plan,"},{"startTime":202.63,"endTime":204.52,"body":"worked at a couple of different PBMs."},{"startTime":204.52,"endTime":208.0,"body":"I was in a leadership role at Cigna, one"},{"startTime":208.0,"endTime":212.08,"body":"of the largest payers in"},{"startTime":208.0,"endTime":212.08,"body":"the United States when,"},{"startTime":212.08,"endTime":213.97,"body":"when Cigna acquired Express Scripts, one"},{"startTime":213.97,"endTime":216.64,"body":"of the largest PBMs in the United States."},{"startTime":216.64,"endTime":218.83,"body":"My team was responsible"},{"startTime":216.64,"endTime":218.83,"body":"for a number of things,"},{"startTime":218.83,"endTime":219.97,"body":"but primarily it was"},{"startTime":219.97,"endTime":223.66,"body":"how do we decrease costs on"},{"startTime":219.97,"endTime":223.66,"body":"prescription drugs within"},{"startTime":223.66,"endTime":225.04,"body":"the United States."},{"startTime":225.04,"endTime":226.12,"body":"My team also,"},{"startTime":226.12,"endTime":227.83,"body":"because we were really,"},{"startTime":226.12,"endTime":227.83,"body":"really good at that,"},{"startTime":227.83,"endTime":231.1,"body":"we also focused on total"},{"startTime":227.83,"endTime":231.1,"body":"cost of care evaluations,"},{"startTime":231.1,"endTime":232.21,"body":"do medications,"},{"startTime":232.21,"endTime":236.38,"body":"offset medical costs when"},{"startTime":232.21,"endTime":236.38,"body":"given in certain situations."},{"startTime":236.38,"endTime":240.105,"body":"So my, my background's mostly"},{"startTime":236.38,"endTime":240.105,"body":"payer in the commercial space"},{"startTime":240.105,"endTime":241.69,"body":"and and not necessarily Medicare."},{"startTime":241.69,"endTime":243.4,"body":"Sharon?"},{"startTime":243.4,"endTime":244.42,"body":"- Yeah, thanks Rory."},{"startTime":244.42,"endTime":245.77,"body":"So I would say similar to Dan"},{"startTime":245.77,"endTime":248.47,"body":"and Rory, I am also a"},{"startTime":245.77,"endTime":248.47,"body":"pharmacist by background"},{"startTime":248.47,"endTime":251.83,"body":"and also spent quite a time"},{"startTime":248.47,"endTime":251.83,"body":"bit of time in the Medicare"},{"startTime":251.83,"endTime":254.74,"body":"as well as commercial and payer spaces."},{"startTime":254.74,"endTime":257.17,"body":"So I also come from a payer background,"},{"startTime":257.17,"endTime":260.44,"body":"having worked at Cigna,"},{"startTime":257.17,"endTime":260.44,"body":"really supporting some"},{"startTime":260.44,"endTime":262.3,"body":"of the benefit designs, particularly"},{"startTime":262.3,"endTime":265.57,"body":"around complex areas like oncology."},{"startTime":265.57,"endTime":269.44,"body":"Also spent time at Express"},{"startTime":265.57,"endTime":269.44,"body":"Scripts as well and at both Cigna"},{"startTime":269.44,"endTime":271.0,"body":"and Express Scripts was in more"},{"startTime":271.0,"endTime":272.44,"body":"of an industry relations role"},{"startTime":272.44,"endTime":276.1,"body":"where I was negotiating"},{"startTime":272.44,"endTime":276.1,"body":"rebates with drug manufacturers"},{"startTime":276.1,"endTime":277.27,"body":"and really supporting a lot"},{"startTime":277.27,"endTime":280.69,"body":"of the unique medical benefit"},{"startTime":277.27,"endTime":280.69,"body":"products in spaces such"},{"startTime":280.69,"endTime":284.47,"body":"as value-based contracts,"},{"startTime":280.69,"endTime":284.47,"body":"gene therapies, biosimilars."},{"startTime":284.47,"endTime":288.07,"body":"I am coming most recently"},{"startTime":284.47,"endTime":288.07,"body":"from a biopharma perspective"},{"startTime":288.07,"endTime":290.41,"body":"having worked at Genentech"},{"startTime":290.41,"endTime":293.59,"body":"and while I was there I"},{"startTime":290.41,"endTime":293.59,"body":"did support medical affairs"},{"startTime":293.59,"endTime":297.01,"body":"as an executive director"},{"startTime":293.59,"endTime":297.01,"body":"in a cross portfolio role."},{"startTime":297.01,"endTime":301.45,"body":"Really engaging with payers,"},{"startTime":297.01,"endTime":301.45,"body":"PBMs, GPO type entities"},{"startTime":301.45,"endTime":304.0,"body":"around market access conversations,"},{"startTime":304.0,"endTime":307.72,"body":"really supporting the value"},{"startTime":304.0,"endTime":307.72,"body":"that products bring to patients"},{"startTime":307.72,"endTime":309.64,"body":"and optimising outcomes."},{"startTime":309.64,"endTime":313.0,"body":"So most recently I did have"},{"startTime":309.64,"endTime":313.0,"body":"my own consulting business,"},{"startTime":313.0,"endTime":316.39,"body":"really supporting more of the"},{"startTime":313.0,"endTime":316.39,"body":"oncology care delivery side."},{"startTime":316.39,"endTime":317.86,"body":"So certainly looking forward"},{"startTime":317.86,"endTime":321.52,"body":"to sharing some unique"},{"startTime":317.86,"endTime":321.52,"body":"insights today on this call."},{"startTime":321.52,"endTime":322.75,"body":"So Louise, back to you."},{"startTime":323.795,"endTime":326.53,"body":"- Thanks. Sure. So I'd"},{"startTime":323.795,"endTime":326.53,"body":"really like to start"},{"startTime":326.53,"endTime":329.92,"body":"by talking about the US"},{"startTime":326.53,"endTime":329.92,"body":"payer landscape in general."},{"startTime":329.92,"endTime":332.62,"body":"Could you outline what we mean"},{"startTime":329.92,"endTime":332.62,"body":"when we talk about payers in"},{"startTime":332.62,"endTime":333.7,"body":"the us Sam?"},{"startTime":335.8,"endTime":337.21,"body":"- Yeah, happy to Louise"},{"startTime":337.21,"endTime":339.46,"body":"and it's a very"},{"startTime":337.21,"endTime":339.46,"body":"interesting term as we say,"},{"startTime":339.46,"endTime":340.96,"body":"payer in the United States"},{"startTime":340.96,"endTime":343.84,"body":"because I think most commonly"},{"startTime":340.96,"endTime":343.84,"body":"when you hear that term,"},{"startTime":343.84,"endTime":346.24,"body":"especially in webinars like"},{"startTime":343.84,"endTime":346.24,"body":"this, where in the active work"},{"startTime":346.24,"endTime":348.58,"body":"that we're doing with"},{"startTime":346.24,"endTime":348.58,"body":"pharmaceutical companies,"},{"startTime":348.58,"endTime":350.89,"body":"most commonly we will refer to payers"},{"startTime":350.89,"endTime":353.53,"body":"as managed care organisations"},{"startTime":350.89,"endTime":353.53,"body":"in the United States,"},{"startTime":353.53,"endTime":355.87,"body":"largely developed by health plans as well"},{"startTime":355.87,"endTime":358.07,"body":"as pharmacy benefit managers or PBMs."},{"startTime":359.06,"endTime":360.77,"body":"But if we take a step beyond that,"},{"startTime":360.77,"endTime":362.96,"body":"those are typically the administrators"},{"startTime":362.96,"endTime":365.96,"body":"of the payment system"},{"startTime":362.96,"endTime":365.96,"body":"within the United States."},{"startTime":365.96,"endTime":367.64,"body":"I think it's important to acknowledge"},{"startTime":367.64,"endTime":370.16,"body":"that the actual financier of them or"},{"startTime":370.16,"endTime":372.8,"body":"or the person that's actually"},{"startTime":370.16,"endTime":372.8,"body":"paying them most commonly in"},{"startTime":372.8,"endTime":375.41,"body":"the United States are the employer groups"},{"startTime":375.41,"endTime":377.75,"body":"of individuals less than 65 and"},{"startTime":377.75,"endTime":379.82,"body":"or CMS, the centres for Medicare"},{"startTime":379.82,"endTime":382.52,"body":"and Medicaid services for"},{"startTime":379.82,"endTime":382.52,"body":"our seniors as well as"},{"startTime":382.52,"endTime":385.76,"body":"for our Medicaid populations"},{"startTime":382.52,"endTime":385.76,"body":"here in the United States."},{"startTime":385.76,"endTime":388.07,"body":"So important distinction there to say,"},{"startTime":388.07,"endTime":390.23,"body":"are we saying literally who is the payer,"},{"startTime":390.23,"endTime":393.35,"body":"meaning the person funding"},{"startTime":390.23,"endTime":393.35,"body":"it that be CMS and employers"},{"startTime":393.35,"endTime":394.64,"body":"or are we remaining payers"},{"startTime":394.64,"endTime":397.04,"body":"as the people administering"},{"startTime":394.64,"endTime":397.04,"body":"these benefits?"},{"startTime":397.04,"endTime":400.04,"body":"Those being more the"},{"startTime":397.04,"endTime":400.04,"body":"managed care organisations."},{"startTime":402.62,"endTime":404.69,"body":"- Okay, thank you. And"},{"startTime":402.62,"endTime":404.69,"body":"is there common themes"},{"startTime":404.69,"endTime":408.89,"body":"between those two buckets"},{"startTime":404.69,"endTime":408.89,"body":"in terms of specific needs"},{"startTime":408.89,"endTime":411.11,"body":"and requirements when"},{"startTime":408.89,"endTime":411.11,"body":"we're communicating value?"},{"startTime":415.325,"endTime":416.33,"body":"- I, I think when, and"},{"startTime":416.33,"endTime":419.12,"body":"and I just want to add a little"},{"startTime":416.33,"endTime":419.12,"body":"bit to to Dan's comments."},{"startTime":419.12,"endTime":422.84,"body":"So when we, when we think"},{"startTime":419.12,"endTime":422.84,"body":"about payers in the commercial"},{"startTime":422.84,"endTime":426.83,"body":"landscape, so think of"},{"startTime":422.84,"endTime":426.83,"body":"people that are employed"},{"startTime":426.83,"endTime":428.42,"body":"that are getting their health insurance"},{"startTime":428.42,"endTime":432.11,"body":"through their employer, there"},{"startTime":428.42,"endTime":432.11,"body":"are different buckets within"},{"startTime":432.11,"endTime":433.88,"body":"that landscape as well."},{"startTime":433.88,"endTime":438.53,"body":"Does the payer or the"},{"startTime":433.88,"endTime":438.53,"body":"health plan take on risk and"},{"startTime":438.53,"endTime":442.37,"body":"and manage the entire"},{"startTime":438.53,"endTime":442.37,"body":"benefit medical and pharmacy?"},{"startTime":442.37,"endTime":446.57,"body":"Or has the employer decided,"},{"startTime":442.37,"endTime":446.57,"body":"you know what, I'm going to go"},{"startTime":446.57,"endTime":448.91,"body":"with my medical coverage over here,"},{"startTime":448.91,"endTime":451.25,"body":"but I'm going to take all"},{"startTime":448.91,"endTime":451.25,"body":"of my pharmacy coverage"},{"startTime":451.25,"endTime":452.84,"body":"and put it over here"},{"startTime":452.84,"endTime":456.38,"body":"'cause I trust these other"},{"startTime":452.84,"endTime":456.38,"body":"groups to manage it better."},{"startTime":456.38,"endTime":460.73,"body":"And when you think of medical"},{"startTime":456.38,"endTime":460.73,"body":"management within the US"},{"startTime":460.73,"endTime":463.1,"body":"getting your drug at your"},{"startTime":460.73,"endTime":463.1,"body":"doctor's office, going"},{"startTime":463.1,"endTime":465.615,"body":"to see your physician"},{"startTime":463.1,"endTime":465.615,"body":"going to the hospital,"},{"startTime":465.615,"endTime":469.25,"body":"the the management is regional"},{"startTime":465.615,"endTime":469.25,"body":"and national dependent"},{"startTime":469.25,"endTime":471.59,"body":"and there's lots of regional"},{"startTime":469.25,"endTime":471.59,"body":"and national players"},{"startTime":471.59,"endTime":473.93,"body":"and those regional national"},{"startTime":471.59,"endTime":473.93,"body":"players need some different"},{"startTime":473.93,"endTime":476.42,"body":"things than, than you would expect,"},{"startTime":476.42,"endTime":478.28,"body":"but there's lots of them."},{"startTime":478.28,"endTime":480.47,"body":"When you think about the"},{"startTime":478.28,"endTime":480.47,"body":"commercially insured,"},{"startTime":480.47,"endTime":482.42,"body":"I get my insurance through my employer."},{"startTime":482.42,"endTime":485.06,"body":"When you think about the"},{"startTime":482.42,"endTime":485.06,"body":"pharmacy management piece,"},{"startTime":485.06,"endTime":487.67,"body":"there are three really big players."},{"startTime":487.67,"endTime":490.97,"body":"So those big players are"},{"startTime":487.67,"endTime":490.97,"body":"pharmacy benefit managers, Optum,"},{"startTime":490.97,"endTime":493.28,"body":"CVS and ESI."},{"startTime":493.28,"endTime":496.01,"body":"And between the three of those, they, they"},{"startTime":496.01,"endTime":501.01,"body":"generally manage about 80%"},{"startTime":496.01,"endTime":501.01,"body":"of commercial lives in the US"},{"startTime":501.05,"endTime":502.07,"body":"and they tend"},{"startTime":502.07,"endTime":504.41,"body":"to need something a little"},{"startTime":502.07,"endTime":504.41,"body":"bit different than the health"},{"startTime":504.41,"endTime":506.6,"body":"plan and, and those other payers."},{"startTime":506.6,"endTime":509.03,"body":"So it's, it's a really"},{"startTime":506.6,"endTime":509.03,"body":"interesting dynamic within the"},{"startTime":509.03,"endTime":511.94,"body":"commercial landscape of"},{"startTime":509.03,"endTime":511.94,"body":"the options employers"},{"startTime":511.94,"endTime":513.32,"body":"have to choose from."},{"startTime":513.32,"endTime":517.82,"body":"Do I decide to use Cigna or Aetna or"},{"startTime":517.82,"endTime":520.61,"body":"or UnitedHealthcare to manage everything?"},{"startTime":520.61,"endTime":524.45,"body":"Do I just trust them to manage"},{"startTime":520.61,"endTime":524.45,"body":"my medical side of the house"},{"startTime":524.45,"endTime":527.78,"body":"and then I'm going to carve"},{"startTime":524.45,"endTime":527.78,"body":"out my pharmacy side"},{"startTime":527.78,"endTime":529.13,"body":"to somebody else and let them there."},{"startTime":529.13,"endTime":531.68,"body":"So it's really interesting dynamic world"},{"startTime":531.68,"endTime":534.92,"body":"and all of these payers, they"},{"startTime":531.68,"endTime":534.92,"body":"all want something similar"},{"startTime":534.92,"endTime":537.145,"body":"but, but they also want"},{"startTime":534.92,"endTime":537.145,"body":"something different as well."},{"startTime":537.145,"endTime":539.67,"body":"And, and and and that's"},{"startTime":537.145,"endTime":539.67,"body":"just kind of the nature"},{"startTime":539.67,"endTime":543.6,"body":"of the US healthcare system"},{"startTime":539.67,"endTime":543.6,"body":"for employees and employers."},{"startTime":544.92,"endTime":546.06,"body":"- Yeah, I think those distinctions"},{"startTime":546.06,"endTime":548.46,"body":"that Rory mentioned are really important"},{"startTime":548.46,"endTime":550.74,"body":"because it links back"},{"startTime":548.46,"endTime":550.74,"body":"to your question Louisa,"},{"startTime":550.74,"endTime":553.08,"body":"as we think about value communication,"},{"startTime":553.08,"endTime":556.08,"body":"it becomes incredibly"},{"startTime":553.08,"endTime":556.08,"body":"important to understand which"},{"startTime":556.08,"endTime":559.41,"body":"of those facets the US payer"},{"startTime":556.08,"endTime":559.41,"body":"is that you're speaking to."},{"startTime":559.41,"endTime":561.03,"body":"And how do we then change the way"},{"startTime":561.03,"endTime":564.33,"body":"that we're thinking about"},{"startTime":561.03,"endTime":564.33,"body":"value communication to them?"},{"startTime":564.33,"endTime":565.35,"body":"Do they take risk?"},{"startTime":565.35,"endTime":567.69,"body":"Are they simply a third"},{"startTime":565.35,"endTime":567.69,"body":"party administrator?"},{"startTime":567.69,"endTime":570.78,"body":"Are they actually managing"},{"startTime":567.69,"endTime":570.78,"body":"both pharmacy and medical"},{"startTime":570.78,"endTime":573.15,"body":"or is it just one or the other?"},{"startTime":573.15,"endTime":576.03,"body":"Each of those dynamics that"},{"startTime":573.15,"endTime":576.03,"body":"Rory started to walk us through,"},{"startTime":576.03,"endTime":579.12,"body":"Louise do play a fairly"},{"startTime":576.03,"endTime":579.12,"body":"significant role in the way"},{"startTime":579.12,"endTime":581.49,"body":"that we think about communicating value"},{"startTime":581.49,"endTime":582.69,"body":"- To those stakeholders."},{"startTime":584.67,"endTime":588.33,"body":"- Thank you. Shana, did you"},{"startTime":584.67,"endTime":588.33,"body":"want to add anything else in?"},{"startTime":589.83,"endTime":591.84,"body":"- No, I mean I agree with everything Rory"},{"startTime":591.84,"endTime":594.24,"body":"and Dan said just in"},{"startTime":591.84,"endTime":594.24,"body":"terms of understanding"},{"startTime":594.24,"endTime":597.69,"body":"where there is commonality,"},{"startTime":594.24,"endTime":597.69,"body":"just to keep the story simple."},{"startTime":597.69,"endTime":599.88,"body":"I mean at the end of the day"},{"startTime":597.69,"endTime":599.88,"body":"I think everyone's really"},{"startTime":599.88,"endTime":604.08,"body":"aligned around, you know,"},{"startTime":599.88,"endTime":604.08,"body":"safety, efficacy as well"},{"startTime":604.08,"endTime":605.7,"body":"as economics."},{"startTime":605.7,"endTime":608.82,"body":"So really thinking of that"},{"startTime":605.7,"endTime":608.82,"body":"as an overarching story."},{"startTime":608.82,"endTime":610.95,"body":"But I agree in terms"},{"startTime":608.82,"endTime":610.95,"body":"of some of the nuances"},{"startTime":610.95,"endTime":613.86,"body":"that Rory pointed out as well"},{"startTime":610.95,"endTime":613.86,"body":"as Dan in terms of, okay,"},{"startTime":613.86,"endTime":616.38,"body":"which lever is more strong"},{"startTime":616.38,"endTime":619.2,"body":"with which particular"},{"startTime":616.38,"endTime":619.2,"body":"player within the market?"},{"startTime":619.2,"endTime":620.94,"body":"And I think that's where, you know, some"},{"startTime":620.94,"endTime":623.13,"body":"of the fun part comes when it comes"},{"startTime":623.13,"endTime":625.44,"body":"to healthcare is really"},{"startTime":623.13,"endTime":625.44,"body":"thinking about, okay,"},{"startTime":625.44,"endTime":626.97,"body":"how do you craft your messaging"},{"startTime":626.97,"endTime":629.94,"body":"and how do you craft your"},{"startTime":626.97,"endTime":629.94,"body":"evidence in a specific way"},{"startTime":629.94,"endTime":632.67,"body":"that resonates with that"},{"startTime":629.94,"endTime":632.67,"body":"particular stakeholder."},{"startTime":634.65,"endTime":637.44,"body":"- Thank you. And if we"},{"startTime":634.65,"endTime":637.44,"body":"just take a step back"},{"startTime":637.44,"endTime":640.17,"body":"because some of our listeners"},{"startTime":637.44,"endTime":640.17,"body":"today will be more familiar"},{"startTime":640.17,"endTime":642.15,"body":"with the payer landscape in Europe"},{"startTime":642.15,"endTime":644.49,"body":"and the bodies there that"},{"startTime":642.15,"endTime":644.49,"body":"conduct health technology"},{"startTime":644.49,"endTime":645.9,"body":"assessment such as NICE"},{"startTime":645.9,"endTime":648.45,"body":"and the GBA as about additional hurdle"},{"startTime":648.45,"endTime":650.88,"body":"after regulatory submission."},{"startTime":650.88,"endTime":653.46,"body":"Can we make a similar comparison in the US"},{"startTime":653.46,"endTime":657.75,"body":"and could you talk a"},{"startTime":653.46,"endTime":657.75,"body":"little bit more about isa?"},{"startTime":660.15,"endTime":661.71,"body":"- Yeah, I'll, I'll jump in first"},{"startTime":661.71,"endTime":664.02,"body":"and then I'll, I'll"},{"startTime":661.71,"endTime":664.02,"body":"pivot to Rory and Shana."},{"startTime":664.02,"endTime":666.72,"body":"So there are definitely"},{"startTime":664.02,"endTime":666.72,"body":"similarities, Louise,"},{"startTime":666.72,"endTime":668.61,"body":"but also distinct differences."},{"startTime":668.61,"endTime":670.29,"body":"If we think about the similarities, each"},{"startTime":670.29,"endTime":671.67,"body":"of those managed care organisations"},{"startTime":671.67,"endTime":673.95,"body":"that we had just"},{"startTime":671.67,"endTime":673.95,"body":"mentioned do have pharmacy"},{"startTime":673.95,"endTime":677.07,"body":"and the therapeutics committees"},{"startTime":673.95,"endTime":677.07,"body":"as new products are coming"},{"startTime":677.07,"endTime":679.89,"body":"to market and as new devices"},{"startTime":677.07,"endTime":679.89,"body":"are coming to market,"},{"startTime":679.89,"endTime":683.4,"body":"individuals that sit within"},{"startTime":679.89,"endTime":683.4,"body":"p\u0026t committees are reviewing"},{"startTime":683.4,"endTime":684.81,"body":"them, we're looking at the safety,"},{"startTime":684.81,"endTime":686.01,"body":"we're looking at the efficacy,"},{"startTime":686.01,"endTime":688.74,"body":"we're looking at the economics"},{"startTime":686.01,"endTime":688.74,"body":"that Shana had just mentioned"},{"startTime":688.74,"endTime":690.81,"body":"to do some of that cursory review."},{"startTime":690.81,"endTime":694.62,"body":"So everybody from a US standpoint"},{"startTime":690.81,"endTime":694.62,"body":"is looking at that then,"},{"startTime":694.62,"endTime":698.4,"body":"which in some ways is the"},{"startTime":694.62,"endTime":698.4,"body":"basis of formulary access"},{"startTime":698.4,"endTime":699.87,"body":"of those medications."},{"startTime":699.87,"endTime":702.12,"body":"However, as you mentioned,"},{"startTime":699.87,"endTime":702.12,"body":"there's a different dynamic"},{"startTime":702.12,"endTime":704.31,"body":"of organisations like ICER that do tend"},{"startTime":704.31,"endTime":708.12,"body":"to function a bit more"},{"startTime":704.31,"endTime":708.12,"body":"like some of the, some"},{"startTime":708.12,"endTime":710.73,"body":"of the European bodies"},{"startTime":708.12,"endTime":710.73,"body":"that you had mentioned"},{"startTime":710.73,"endTime":713.23,"body":"where they're taking a bit"},{"startTime":710.73,"endTime":713.23,"body":"of a different approach,"},{"startTime":713.23,"endTime":715.87,"body":"more economically faced approach."},{"startTime":715.87,"endTime":718.93,"body":"I do feel like there's"},{"startTime":715.87,"endTime":718.93,"body":"varying degrees of interest,"},{"startTime":718.93,"endTime":721.93,"body":"shall I say, from a US"},{"startTime":718.93,"endTime":721.93,"body":"payer coverage standpoint"},{"startTime":721.93,"endTime":724.24,"body":"with respect to the output that they have."},{"startTime":724.24,"endTime":726.4,"body":"I think there's very"},{"startTime":724.24,"endTime":726.4,"body":"interesting work going on"},{"startTime":726.4,"endTime":727.72,"body":"by those organisations."},{"startTime":727.72,"endTime":729.58,"body":"I think the biggest downfall"},{"startTime":729.58,"endTime":733.0,"body":"that I see from a US payer"},{"startTime":729.58,"endTime":733.0,"body":"standpoint is typically those"},{"startTime":733.0,"endTime":734.83,"body":"analyses that they're running tend"},{"startTime":734.83,"endTime":738.07,"body":"to be fairly far in nature"},{"startTime":734.83,"endTime":738.07,"body":"from when those products have"},{"startTime":738.07,"endTime":740.92,"body":"been approved and launched"},{"startTime":738.07,"endTime":740.92,"body":"onto the US market."},{"startTime":740.92,"endTime":744.52,"body":"So that gap between when product"},{"startTime":740.92,"endTime":744.52,"body":"availability happens versus"},{"startTime":744.52,"endTime":748.24,"body":"when something like an ICER"},{"startTime":744.52,"endTime":748.24,"body":"economic analysis comes out is,"},{"startTime":748.24,"endTime":752.17,"body":"is so differentiated in timeline"},{"startTime":748.24,"endTime":752.17,"body":"that it somewhat negates"},{"startTime":752.17,"endTime":754.9,"body":"as much utility as we would"},{"startTime":752.17,"endTime":754.9,"body":"like to see otherwise."},{"startTime":754.9,"endTime":758.35,"body":"But that, that said Shana,"},{"startTime":754.9,"endTime":758.35,"body":"Rory feel free to agree"},{"startTime":758.35,"endTime":760.63,"body":"or disagree with kind"},{"startTime":758.35,"endTime":760.63,"body":"of that point of kind"},{"startTime":760.63,"endTime":763.18,"body":"how ICER plays into sort of"},{"startTime":760.63,"endTime":763.18,"body":"coverage policies in the us."},{"startTime":764.53,"endTime":766.375,"body":"- Yeah, I agree with, go ahead."},{"startTime":768.16,"endTime":770.41,"body":"I no go point Dan."},{"startTime":770.41,"endTime":773.68,"body":"I would say as well as the"},{"startTime":770.41,"endTime":773.68,"body":"other limitation I've seen is"},{"startTime":773.68,"endTime":775.42,"body":"that ICER just really isn't able"},{"startTime":775.42,"endTime":777.25,"body":"to review everything, right?"},{"startTime":777.25,"endTime":780.58,"body":"So in the key categories"},{"startTime":777.25,"endTime":780.58,"body":"that ICER is reviewing,"},{"startTime":780.58,"endTime":783.82,"body":"ICER does become important and we see that"},{"startTime":783.82,"endTime":787.24,"body":"because payers are starting to"},{"startTime":783.82,"endTime":787.24,"body":"use that information in terms"},{"startTime":787.24,"endTime":788.95,"body":"of negotiation leverage,"},{"startTime":788.95,"endTime":792.61,"body":"we also see biopharma companies"},{"startTime":788.95,"endTime":792.61,"body":"engaging even early, even"},{"startTime":792.61,"endTime":795.28,"body":"before ICER releases the report just"},{"startTime":795.28,"endTime":797.65,"body":"to provide some background"},{"startTime":795.28,"endTime":797.65,"body":"information, you know,"},{"startTime":797.65,"endTime":798.7,"body":"where they can,"},{"startTime":799.6,"endTime":801.13,"body":"but I still believe at the end of the day"},{"startTime":801.13,"endTime":802.84,"body":"that there is some gaps there"},{"startTime":802.84,"endTime":807.46,"body":"and so different companies"},{"startTime":802.84,"endTime":807.46,"body":"look at other avenues in"},{"startTime":807.46,"endTime":808.87,"body":"addition to ICER"},{"startTime":808.87,"endTime":812.89,"body":"to really provide some solid"},{"startTime":808.87,"endTime":812.89,"body":"pharmacoeconomic information."},{"startTime":814.0,"endTime":815.11,"body":"And Roy please feel free to add,"},{"startTime":817.36,"endTime":819.815,"body":"- I'm going to counter just"},{"startTime":817.36,"endTime":819.815,"body":"for fun, I'm going to counter"},{"startTime":821.285,"endTime":823.84,"body":"ICER does some really interesting things."},{"startTime":823.84,"endTime":826.99,"body":"So the FDA in the United"},{"startTime":823.84,"endTime":826.99,"body":"States, the FDA (Food"},{"startTime":826.99,"endTime":830.29,"body":"and Drug Administration, this"},{"startTime":826.99,"endTime":830.29,"body":"is a safety efficacy body"},{"startTime":830.29,"endTime":832.5,"body":"drug is safe and effective then and,"},{"startTime":832.5,"endTime":835.54,"body":"and it gets approved, it gets"},{"startTime":832.5,"endTime":835.54,"body":"an indication it is not a cost"},{"startTime":835.54,"endTime":839.56,"body":"effectiveness body ICER does"},{"startTime":835.54,"endTime":839.56,"body":"cost effective research in"},{"startTime":839.56,"endTime":840.97,"body":"the United States."},{"startTime":840.97,"endTime":843.49,"body":"As a payer, I've used ICER"},{"startTime":843.49,"endTime":847.3,"body":"to help negotiate additional"},{"startTime":843.49,"endTime":847.3,"body":"value for manufacturers."},{"startTime":847.3,"endTime":850.84,"body":"I don't generally use ICER for formulary"},{"startTime":850.84,"endTime":852.465,"body":"or management decisions."},{"startTime":852.465,"endTime":854.29,"body":"It it, it just doesn't happen."},{"startTime":854.29,"endTime":858.58,"body":"So within a payer, I've"},{"startTime":854.29,"endTime":858.58,"body":"got two, two bodies."},{"startTime":858.58,"endTime":860.08,"body":"I've got a clinical body"},{"startTime":860.08,"endTime":862.36,"body":"and I've got a cost effectiveness body."},{"startTime":862.36,"endTime":863.89,"body":"My clinical body sits over here"},{"startTime":863.89,"endTime":865.99,"body":"and as Dan mentioned, this"},{"startTime":863.89,"endTime":865.99,"body":"is a p and t committee."},{"startTime":865.99,"endTime":868.03,"body":"This is a group of independent physicians"},{"startTime":868.03,"endTime":870.34,"body":"that make decisions on the drug."},{"startTime":870.34,"endTime":874.06,"body":"If the drug is it, it should"},{"startTime":870.34,"endTime":874.06,"body":"be added to the formulary and"},{"startTime":874.06,"endTime":877.33,"body":"and most drugs are, are"},{"startTime":874.06,"endTime":877.33,"body":"what we consider a may add."},{"startTime":877.33,"endTime":880.27,"body":"You don't have to add it,"},{"startTime":877.33,"endTime":880.27,"body":"you could potentially add it."},{"startTime":880.27,"endTime":884.83,"body":"The, the cost effectiveness"},{"startTime":880.27,"endTime":884.83,"body":"committee takes that information"},{"startTime":884.83,"endTime":887.08,"body":"and this committee has a group of actuary"},{"startTime":887.08,"endTime":889.3,"body":"and underwriters that"},{"startTime":887.08,"endTime":889.3,"body":"take that in information"},{"startTime":889.3,"endTime":891.8,"body":"and then determine formulary coverage."},{"startTime":891.8,"endTime":895.76,"body":"But at the end of the day"},{"startTime":891.8,"endTime":895.76,"body":"they're not always the payer,"},{"startTime":895.76,"endTime":897.86,"body":"it's the employer that's the payer."},{"startTime":897.86,"endTime":899.69,"body":"So when we think about the, the quality"},{"startTime":899.69,"endTime":902.63,"body":"of justice life here, the ICER"},{"startTime":899.69,"endTime":902.63,"body":"cost effectiveness research"},{"startTime":902.63,"endTime":905.81,"body":"and who the end payer is"},{"startTime":902.63,"endTime":905.81,"body":"is generally the employer."},{"startTime":905.81,"endTime":907.1,"body":"And there has been there,"},{"startTime":907.1,"endTime":909.77,"body":"there has been some payers"},{"startTime":907.1,"endTime":909.77,"body":"in the US that say, you know"},{"startTime":909.77,"endTime":912.74,"body":"what, we're going to use the"},{"startTime":909.77,"endTime":912.74,"body":"cost effectiveness threshold"},{"startTime":912.74,"endTime":915.32,"body":"and we're going to say"},{"startTime":912.74,"endTime":915.32,"body":"no when it goes above"},{"startTime":915.32,"endTime":916.88,"body":"that cost effectiveness threshold."},{"startTime":916.88,"endTime":917.93,"body":"So these were some programmes"},{"startTime":917.93,"endTime":920.39,"body":"that were rolled out 5, 6, 7 years ago"},{"startTime":920.39,"endTime":922.67,"body":"and they just haven't"},{"startTime":920.39,"endTime":922.67,"body":"gained as much traction."},{"startTime":922.67,"endTime":925.88,"body":"So I would say ICER is"},{"startTime":922.67,"endTime":925.88,"body":"important, it's used"},{"startTime":925.88,"endTime":927.08,"body":"as a a bargaining chip"},{"startTime":927.08,"endTime":929.54,"body":"and used as leverage to have"},{"startTime":927.08,"endTime":929.54,"body":"additional conversations"},{"startTime":929.54,"endTime":930.8,"body":"with manufacturers"},{"startTime":930.8,"endTime":933.11,"body":"and sometimes there's been cases"},{"startTime":933.11,"endTime":936.98,"body":"where the price actually comes"},{"startTime":933.11,"endTime":936.98,"body":"down for the drug as a result"},{"startTime":936.98,"endTime":938.78,"body":"of those ICER thresholds."},{"startTime":938.78,"endTime":941.09,"body":"So I would say yes, absolutely use it."},{"startTime":941.09,"endTime":943.46,"body":"It's generally not used for"},{"startTime":941.09,"endTime":943.46,"body":"formulary decision making."},{"startTime":946.285,"endTime":948.56,"body":"- Thank you all for that,"},{"startTime":946.285,"endTime":948.56,"body":"that's really helpful."},{"startTime":948.56,"endTime":950.09,"body":"Dan did you have anything else to add?"},{"startTime":951.65,"endTime":952.88,"body":"- No, I think we already hit it spot on."},{"startTime":953.72,"endTime":955.85,"body":"- Perfect. Okay,"},{"startTime":955.85,"endTime":957.86,"body":"let's talk a little bit"},{"startTime":955.85,"endTime":957.86,"body":"more about the evidence"},{"startTime":957.86,"endTime":960.17,"body":"requirements, both clinical and economics."},{"startTime":960.17,"endTime":962.57,"body":"So could you give an overview of the type"},{"startTime":962.57,"endTime":966.59,"body":"of evidence required by the"},{"startTime":962.57,"endTime":966.59,"body":"key payers in the US Shana?"},{"startTime":968.06,"endTime":971.66,"body":"- Yeah, that's great. So I"},{"startTime":968.06,"endTime":971.66,"body":"mean generally speaking the FDA"},{"startTime":971.66,"endTime":974.9,"body":"is a regulated process"},{"startTime":971.66,"endTime":974.9,"body":"when it is approving drugs"},{"startTime":974.9,"endTime":978.59,"body":"and typically they're"},{"startTime":974.9,"endTime":978.59,"body":"focused on the clinical"},{"startTime":978.59,"endTime":979.97,"body":"and safety elements."},{"startTime":979.97,"endTime":982.73,"body":"And typically what they're"},{"startTime":979.97,"endTime":982.73,"body":"looking at then is randomised"},{"startTime":982.73,"endTime":985.16,"body":"controls, clinical trials, really looking"},{"startTime":985.16,"endTime":988.73,"body":"for statistically significant"},{"startTime":985.16,"endTime":988.73,"body":"improvements in clinical"},{"startTime":988.73,"endTime":992.24,"body":"endpoints with acceptable safety payers."},{"startTime":992.24,"endTime":994.76,"body":"On the other hand,"},{"startTime":992.24,"endTime":994.76,"body":"while they are not going"},{"startTime":994.76,"endTime":997.16,"body":"to consider a product"},{"startTime":994.76,"endTime":997.16,"body":"for formulary adoption"},{"startTime":997.16,"endTime":999.44,"body":"unless it has FDA approval,"},{"startTime":999.44,"endTime":1001.93,"body":"I think they go a little"},{"startTime":999.44,"endTime":1001.93,"body":"deeper from the standpoint"},{"startTime":1001.93,"endTime":1003.22,"body":"that they're going to think about, okay,"},{"startTime":1003.22,"endTime":1006.22,"body":"how was the product actually FDA approved?"},{"startTime":1006.22,"endTime":1009.97,"body":"So as an example, was it"},{"startTime":1006.22,"endTime":1009.97,"body":"under an accelerated approval?"},{"startTime":1009.97,"endTime":1011.8,"body":"Was it with surrogate endpoints?"},{"startTime":1011.8,"endTime":1013.99,"body":"And I think a notable"},{"startTime":1011.8,"endTime":1013.99,"body":"example of that, many"},{"startTime":1013.99,"endTime":1017.74,"body":"of us remember a few years ago"},{"startTime":1013.99,"endTime":1017.74,"body":"from the Alzheimer's space,"},{"startTime":1017.74,"endTime":1020.56,"body":"but I would say more"},{"startTime":1017.74,"endTime":1020.56,"body":"importantly in addition to that,"},{"startTime":1020.56,"endTime":1024.43,"body":"payers are really going to focus"},{"startTime":1020.56,"endTime":1024.43,"body":"more on the economic story."},{"startTime":1024.43,"endTime":1027.04,"body":"So they're going to think about"},{"startTime":1024.43,"endTime":1027.04,"body":"comparative effectiveness."},{"startTime":1027.04,"endTime":1030.34,"body":"Okay, so is the new treatment"},{"startTime":1027.04,"endTime":1030.34,"body":"better than those treatments"},{"startTime":1030.34,"endTime":1031.87,"body":"that are already on the market today?"},{"startTime":1032.77,"endTime":1034.18,"body":"Is it worth the cost?"},{"startTime":1034.18,"endTime":1036.64,"body":"And of course what is the"},{"startTime":1034.18,"endTime":1036.64,"body":"real world performance?"},{"startTime":1036.64,"endTime":1039.1,"body":"Meaning do the clinical trials"},{"startTime":1039.1,"endTime":1041.23,"body":"and those endpoints,"},{"startTime":1039.1,"endTime":1041.23,"body":"are they going to translate"},{"startTime":1041.23,"endTime":1043.15,"body":"to my actual population?"},{"startTime":1047.59,"endTime":1050.95,"body":"- Can you explain a little bit"},{"startTime":1047.59,"endTime":1050.95,"body":"more about the pre-approval"},{"startTime":1050.95,"endTime":1053.11,"body":"information exchange as well?"},{"startTime":1053.11,"endTime":1057.73,"body":"That's quite important I"},{"startTime":1053.11,"endTime":1057.73,"body":"understand in the payer aspect."},{"startTime":1058.96,"endTime":1061.9,"body":"- Yes, thanks Louise. It certainly is."},{"startTime":1061.9,"endTime":1065.53,"body":"So I would say back in about"},{"startTime":1061.9,"endTime":1065.53,"body":"2018 there was certainly a"},{"startTime":1065.53,"endTime":1068.35,"body":"framework that really helped"},{"startTime":1065.53,"endTime":1068.35,"body":"provide some additional"},{"startTime":1068.35,"endTime":1070.37,"body":"guidance around, okay, what type"},{"startTime":1070.37,"endTime":1072.89,"body":"of information exchange can take place"},{"startTime":1072.89,"endTime":1076.79,"body":"between a biopharma company and a payer."},{"startTime":1076.79,"endTime":1080.18,"body":"And so with that framework,"},{"startTime":1076.79,"endTime":1080.18,"body":"what was outlined"},{"startTime":1080.18,"endTime":1081.92,"body":"and what really helped open the door"},{"startTime":1081.92,"endTime":1085.58,"body":"for more conversations was really"},{"startTime":1085.58,"endTime":1089.45,"body":"around areas such as"},{"startTime":1085.58,"endTime":1089.45,"body":"important facets around"},{"startTime":1089.45,"endTime":1093.32,"body":"how manufacturers can share"},{"startTime":1089.45,"endTime":1093.32,"body":"in advance some endpoints"},{"startTime":1093.32,"endTime":1095.72,"body":"around clinical trial design,"},{"startTime":1095.72,"endTime":1099.77,"body":"what could be expected in"},{"startTime":1095.72,"endTime":1099.77,"body":"terms of the population"},{"startTime":1099.77,"endTime":1104.03,"body":"and any information"},{"startTime":1099.77,"endTime":1104.03,"body":"around the patient journey"},{"startTime":1104.03,"endTime":1105.47,"body":"as an example."},{"startTime":1105.47,"endTime":1107.54,"body":"And then on the other side, the guardrails"},{"startTime":1107.54,"endTime":1110.03,"body":"that were spelled out"},{"startTime":1107.54,"endTime":1110.03,"body":"through this were things"},{"startTime":1110.03,"endTime":1111.53,"body":"that cannot be shared."},{"startTime":1111.53,"endTime":1113.96,"body":"So as an example, what"},{"startTime":1111.53,"endTime":1113.96,"body":"can't be shared in some"},{"startTime":1113.96,"endTime":1117.02,"body":"of these pre-approval"},{"startTime":1113.96,"endTime":1117.02,"body":"conversations certainly aren't"},{"startTime":1117.02,"endTime":1119.57,"body":"definitive claims around"},{"startTime":1117.02,"endTime":1119.57,"body":"safety and efficacy"},{"startTime":1119.57,"endTime":1122.18,"body":"because the product"},{"startTime":1119.57,"endTime":1122.18,"body":"hasn't been approved yet,"},{"startTime":1122.18,"endTime":1124.04,"body":"there can't be any promotional claims."},{"startTime":1124.04,"endTime":1126.98,"body":"And then typically there"},{"startTime":1124.04,"endTime":1126.98,"body":"is an absolute information"},{"startTime":1126.98,"endTime":1130.37,"body":"with regards to the"},{"startTime":1126.98,"endTime":1130.37,"body":"financial element in terms"},{"startTime":1130.37,"endTime":1132.32,"body":"of the drug cost itself."},{"startTime":1132.32,"endTime":1137.18,"body":"But ultimately what these,"},{"startTime":1132.32,"endTime":1137.18,"body":"this framework allowed for is"},{"startTime":1137.18,"endTime":1140.48,"body":"further engagement that"},{"startTime":1137.18,"endTime":1140.48,"body":"can take place again"},{"startTime":1140.48,"endTime":1143.0,"body":"before products FDA approved."},{"startTime":1143.0,"endTime":1146.48,"body":"And really the goal here is"},{"startTime":1143.0,"endTime":1146.48,"body":"to balance providing the payer"},{"startTime":1146.48,"endTime":1148.49,"body":"with enough information"},{"startTime":1148.49,"endTime":1151.73,"body":"that they can start planning"},{"startTime":1148.49,"endTime":1151.73,"body":"from a budgetary process while"},{"startTime":1151.73,"endTime":1156.38,"body":"still keeping the conversation,"},{"startTime":1151.73,"endTime":1156.38,"body":"you know, clinically robust."},{"startTime":1156.38,"endTime":1159.26,"body":"So in terms of that overarching theme"},{"startTime":1159.26,"endTime":1162.8,"body":"and it being a successful"},{"startTime":1159.26,"endTime":1162.8,"body":"pre-engagement conversation,"},{"startTime":1162.8,"endTime":1165.26,"body":"of course the conversation is intended not"},{"startTime":1165.26,"endTime":1166.43,"body":"to be a one and done."},{"startTime":1166.43,"endTime":1168.92,"body":"You just don't deliver,"},{"startTime":1166.43,"endTime":1168.92,"body":"for example, you know,"},{"startTime":1168.92,"endTime":1170.69,"body":"a pie presentation,"},{"startTime":1170.69,"endTime":1173.21,"body":"but it's intended to be"},{"startTime":1170.69,"endTime":1173.21,"body":"an ongoing conversation"},{"startTime":1173.21,"endTime":1175.28,"body":"that can take place"},{"startTime":1173.21,"endTime":1175.28,"body":"between the manufacturer"},{"startTime":1175.28,"endTime":1177.44,"body":"and the payer to really help prepare for"},{"startTime":1177.44,"endTime":1178.76,"body":"that particular launch"},{"startTime":1181.25,"endTime":1184.46,"body":"- Drawing Sheena's"},{"startTime":1181.25,"endTime":1184.46,"body":"- Last last point was, I'm sorry Louise,"},{"startTime":1184.46,"endTime":1187.43,"body":"I was just going to expand"},{"startTime":1184.46,"endTime":1187.43,"body":"upon Shana's last point."},{"startTime":1187.43,"endTime":1190.37,"body":"It becomes really important"},{"startTime":1187.43,"endTime":1190.37,"body":"to think that PI is not a one"},{"startTime":1190.37,"endTime":1192.68,"body":"and done conversation"},{"startTime":1190.37,"endTime":1192.68,"body":"typically with payers."},{"startTime":1192.68,"endTime":1195.14,"body":"In fact, if we look at the actual guidance"},{"startTime":1195.14,"endTime":1196.7,"body":"that exists from the FDA,"},{"startTime":1196.7,"endTime":1198.92,"body":"basically if we're"},{"startTime":1196.7,"endTime":1198.92,"body":"communicating any information"},{"startTime":1198.92,"endTime":1200.9,"body":"that has significant"},{"startTime":1198.92,"endTime":1200.9,"body":"or substantial change,"},{"startTime":1200.9,"endTime":1203.12,"body":"it's the obligation of the"},{"startTime":1200.9,"endTime":1203.12,"body":"biopharmaceutical company"},{"startTime":1203.12,"endTime":1207.11,"body":"to go back and further have"},{"startTime":1203.12,"endTime":1207.11,"body":"dialogue with those US payers"},{"startTime":1207.11,"endTime":1209.39,"body":"to talk about any of the"},{"startTime":1207.11,"endTime":1209.39,"body":"change in the information"},{"startTime":1209.39,"endTime":1210.68,"body":"that they may have provided."},{"startTime":1210.68,"endTime":1213.71,"body":"So it's a really important"},{"startTime":1210.68,"endTime":1213.71,"body":"aspect to think about this"},{"startTime":1213.71,"endTime":1215.81,"body":"as a opportunity to continue"},{"startTime":1215.81,"endTime":1217.85,"body":"to engage US payers all the way up"},{"startTime":1217.85,"endTime":1219.95,"body":"until approval from the FDA."},{"startTime":1219.95,"endTime":1223.31,"body":"The one other thing that I was"},{"startTime":1219.95,"endTime":1223.31,"body":"going to mention is if I go back"},{"startTime":1223.31,"endTime":1225.14,"body":"to Shana's first part of her answer,"},{"startTime":1225.14,"endTime":1226.67,"body":"I think she did a wonderful job of kind"},{"startTime":1226.67,"endTime":1229.55,"body":"of describing the importance"},{"startTime":1226.67,"endTime":1229.55,"body":"of efficacy, safety"},{"startTime":1229.55,"endTime":1232.04,"body":"and the overall economic"},{"startTime":1229.55,"endTime":1232.04,"body":"value of products."},{"startTime":1232.04,"endTime":1233.48,"body":"I think the one other aspect"},{"startTime":1233.48,"endTime":1236.36,"body":"that we see US payers taking"},{"startTime":1233.48,"endTime":1236.36,"body":"into consideration pretty"},{"startTime":1236.36,"endTime":1238.88,"body":"heavily is also the demand aspect."},{"startTime":1238.88,"endTime":1241.49,"body":"As we see a product come"},{"startTime":1238.88,"endTime":1241.49,"body":"to market, understanding"},{"startTime":1241.49,"endTime":1242.87,"body":"what demand looks like,"},{"startTime":1242.87,"endTime":1245.33,"body":"it really does play a"},{"startTime":1242.87,"endTime":1245.33,"body":"strong factor in some"},{"startTime":1245.33,"endTime":1247.56,"body":"of the decision making that they make"},{"startTime":1247.56,"endTime":1248.64,"body":"on both sides of the fence."},{"startTime":1248.64,"endTime":1250.32,"body":"As cor as Rory described,"},{"startTime":1250.32,"endTime":1253.09,"body":"we have more the clinically"},{"startTime":1250.32,"endTime":1253.09,"body":"leaning element of p\u0026t"},{"startTime":1253.09,"endTime":1256.02,"body":"and we have the more economically"},{"startTime":1253.09,"endTime":1256.02,"body":"leaning element products"},{"startTime":1256.02,"endTime":1257.28,"body":"that are used heavily"},{"startTime":1257.28,"endTime":1258.69,"body":"or demanded heavily"},{"startTime":1258.69,"endTime":1262.53,"body":"by HCPs in the US are looked"},{"startTime":1258.69,"endTime":1262.53,"body":"upon somewhat differentiated"},{"startTime":1262.53,"endTime":1264.57,"body":"versus products that"},{"startTime":1262.53,"endTime":1264.57,"body":"simply are not moving,"},{"startTime":1264.57,"endTime":1266.25,"body":"that are not gaining market share."},{"startTime":1266.25,"endTime":1269.01,"body":"So I would just add that as an"},{"startTime":1266.25,"endTime":1269.01,"body":"additional piece of evidence"},{"startTime":1269.01,"endTime":1272.46,"body":"that at times becomes a really"},{"startTime":1269.01,"endTime":1272.46,"body":"important factor from the"},{"startTime":1272.46,"endTime":1275.04,"body":"overall decision making"},{"startTime":1272.46,"endTime":1275.04,"body":"that occurs from a US payer"},{"startTime":1275.04,"endTime":1276.04,"body":"- Standpoint."},{"startTime":1276.875,"endTime":1280.125,"body":"Yeah, and go ahead Rory."},{"startTime":1280.125,"endTime":1282.81,"body":"- I I just want to"},{"startTime":1280.125,"endTime":1282.81,"body":"expand on on on just the,"},{"startTime":1282.81,"endTime":1284.43,"body":"this this idea of cost, right?"},{"startTime":1284.43,"endTime":1286.17,"body":"New medication comes out."},{"startTime":1286.17,"endTime":1290.13,"body":"So when, when I was at Cigna"},{"startTime":1286.17,"endTime":1290.13,"body":"I had a team of actuaries that"},{"startTime":1290.13,"endTime":1291.585,"body":"that's just how we operated."},{"startTime":1291.585,"endTime":1295.65,"body":"We, we had a, a forecasting"},{"startTime":1291.585,"endTime":1295.65,"body":"group that we called the Oracles"},{"startTime":1295.65,"endTime":1297.66,"body":"that are looking at drugs that are going"},{"startTime":1297.66,"endTime":1299.88,"body":"to get FDA approved over"},{"startTime":1297.66,"endTime":1299.88,"body":"the next five years."},{"startTime":1299.88,"endTime":1302.31,"body":"Over the next year, over the"},{"startTime":1299.88,"endTime":1302.31,"body":"next two years we had some"},{"startTime":1302.31,"endTime":1304.41,"body":"assumptions that we built"},{"startTime":1302.31,"endTime":1304.41,"body":"in that we used to work"},{"startTime":1304.41,"endTime":1306.69,"body":"with manufacturers on"},{"startTime":1304.41,"endTime":1306.69,"body":"is this close to what,"},{"startTime":1306.69,"endTime":1310.74,"body":"what your data says as well,"},{"startTime":1306.69,"endTime":1310.74,"body":"how much cost can we anticipate"},{"startTime":1310.74,"endTime":1313.59,"body":"and then when the drug gets"},{"startTime":1310.74,"endTime":1313.59,"body":"approved, like we, we know"},{"startTime":1313.59,"endTime":1315.63,"body":"what our spends going to be"},{"startTime":1313.59,"endTime":1315.63,"body":"over the next three years,"},{"startTime":1315.63,"endTime":1318.33,"body":"we can anticipate it, we"},{"startTime":1315.63,"endTime":1318.33,"body":"can make changes to that"},{"startTime":1318.33,"endTime":1320.34,"body":"that's not the same everywhere"},{"startTime":1320.34,"endTime":1322.71,"body":"and that's not the same for a lot of PDMs"},{"startTime":1322.71,"endTime":1325.68,"body":"and that's not the same for"},{"startTime":1322.71,"endTime":1325.68,"body":"a lot of regional plans."},{"startTime":1325.68,"endTime":1330.0,"body":"And so providing some some"},{"startTime":1325.68,"endTime":1330.0,"body":"cost forecasting is going"},{"startTime":1330.0,"endTime":1332.64,"body":"to be important 'cause they're"},{"startTime":1330.0,"endTime":1332.64,"body":"going to ingest that information"},{"startTime":1332.64,"endTime":1334.38,"body":"and make some small tweaks to it"},{"startTime":1334.38,"endTime":1336.6,"body":"because they're not going to"},{"startTime":1334.38,"endTime":1336.6,"body":"have the resources that a,"},{"startTime":1336.6,"endTime":1339.045,"body":"that a Cigna Aetna or"},{"startTime":1336.6,"endTime":1339.045,"body":"UnitedHealthcare does."},{"startTime":1340.53,"endTime":1342.69,"body":"- Yeah and I love that point too that you"},{"startTime":1342.69,"endTime":1344.13,"body":"and Dan have made just in terms"},{"startTime":1344.13,"endTime":1347.37,"body":"of once the product is"},{"startTime":1344.13,"endTime":1347.37,"body":"approved, I think that's really"},{"startTime":1347.37,"endTime":1350.73,"body":"where the economic story can"},{"startTime":1347.37,"endTime":1350.73,"body":"really come into play most"},{"startTime":1350.73,"endTime":1353.94,"body":"concretely where drug price can be shared"},{"startTime":1353.94,"endTime":1357.39,"body":"and often, you know what"},{"startTime":1353.94,"endTime":1357.39,"body":"manufacturers do try to do"},{"startTime":1357.39,"endTime":1360.27,"body":"and I know I've had the"},{"startTime":1357.39,"endTime":1360.27,"body":"opportunity to deliver these tools,"},{"startTime":1360.27,"endTime":1363.33,"body":"they're called bims or"},{"startTime":1360.27,"endTime":1363.33,"body":"business impact models."},{"startTime":1363.33,"endTime":1366.36,"body":"And really what it is designed"},{"startTime":1363.33,"endTime":1366.36,"body":"to do is to really help"},{"startTime":1366.36,"endTime":1369.63,"body":"that payer or PBM forecast,"},{"startTime":1366.36,"endTime":1369.63,"body":"okay based on the launch"},{"startTime":1369.63,"endTime":1373.53,"body":"of this product, how is it"},{"startTime":1369.63,"endTime":1373.53,"body":"going to impact my population?"},{"startTime":1373.53,"endTime":1377.61,"body":"And a good BIM when it's"},{"startTime":1373.53,"endTime":1377.61,"body":"designed well has the flexibility"},{"startTime":1377.61,"endTime":1380.55,"body":"to accommodate that"},{"startTime":1377.61,"endTime":1380.55,"body":"particular stakeholder."},{"startTime":1380.55,"endTime":1382.56,"body":"So as an example, is it a population"},{"startTime":1382.56,"endTime":1386.13,"body":"that skews heavy Medicare"},{"startTime":1382.56,"endTime":1386.13,"body":"as an example or commercial?"},{"startTime":1387.18,"endTime":1390.78,"body":"But by having those conversations"},{"startTime":1387.18,"endTime":1390.78,"body":"it not only helps then the"},{"startTime":1390.78,"endTime":1393.48,"body":"PBM as well as the payer kind of plan"},{"startTime":1393.48,"endTime":1396.63,"body":"and anticipate maybe one,"},{"startTime":1393.48,"endTime":1396.63,"body":"two and three years out."},{"startTime":1396.63,"endTime":1399.42,"body":"Sometimes it gets used even after well"},{"startTime":1399.42,"endTime":1401.49,"body":"after launch just to do a little bit"},{"startTime":1401.49,"endTime":1403.44,"body":"of a check based on what Rory said."},{"startTime":1403.44,"endTime":1406.08,"body":"'cause we know forecasting"},{"startTime":1403.44,"endTime":1406.08,"body":"isn't always important"},{"startTime":1406.08,"endTime":1408.33,"body":"and it really does allow"},{"startTime":1406.08,"endTime":1408.33,"body":"that manufacturer in"},{"startTime":1408.33,"endTime":1411.99,"body":"that payer slash PBM entity"},{"startTime":1408.33,"endTime":1411.99,"body":"to have the conversations"},{"startTime":1411.99,"endTime":1414.12,"body":"around why the numbers look like they look"},{"startTime":1414.12,"endTime":1417.12,"body":"and then how maybe those"},{"startTime":1414.12,"endTime":1417.12,"body":"two could come together"},{"startTime":1417.12,"endTime":1419.1,"body":"and potentially think through strategies"},{"startTime":1419.1,"endTime":1421.86,"body":"and solutions to either"},{"startTime":1419.1,"endTime":1421.86,"body":"optimise outcomes for patients"},{"startTime":1421.86,"endTime":1424.62,"body":"or start talking more around"},{"startTime":1421.86,"endTime":1424.62,"body":"areas of affordability."},{"startTime":1428.17,"endTime":1432.34,"body":"- Thank you. So what would"},{"startTime":1428.17,"endTime":1432.34,"body":"you say would be the things"},{"startTime":1432.34,"endTime":1436.36,"body":"that a company could do in terms"},{"startTime":1432.34,"endTime":1436.36,"body":"of optimising their chances"},{"startTime":1436.36,"endTime":1439.09,"body":"of market access in us"},{"startTime":1436.36,"endTime":1439.09,"body":"with the right evidence?"},{"startTime":1442.39,"endTime":1445.51,"body":"- Yeah, so one area we've"},{"startTime":1442.39,"endTime":1445.51,"body":"already highlighted a bit when we"},{"startTime":1445.51,"endTime":1448.15,"body":"talked about the business impact models,"},{"startTime":1448.15,"endTime":1450.28,"body":"but I do think there's"},{"startTime":1448.15,"endTime":1450.28,"body":"some other great areas"},{"startTime":1450.28,"endTime":1451.66,"body":"to partner around."},{"startTime":1451.66,"endTime":1454.78,"body":"I think real world evidence"},{"startTime":1451.66,"endTime":1454.78,"body":"is one of those areas."},{"startTime":1454.78,"endTime":1457.66,"body":"So for example, we know"},{"startTime":1454.78,"endTime":1457.66,"body":"clinical trials are designed,"},{"startTime":1457.66,"endTime":1460.42,"body":"patients are in somewhat"},{"startTime":1457.66,"endTime":1460.42,"body":"of an artificial setting."},{"startTime":1460.42,"endTime":1461.92,"body":"We know there's inclusion"},{"startTime":1461.92,"endTime":1464.62,"body":"and exclusion criteria for example."},{"startTime":1464.62,"endTime":1468.34,"body":"And so the we, I think real"},{"startTime":1464.62,"endTime":1468.34,"body":"world evidence really comes"},{"startTime":1468.34,"endTime":1469.9,"body":"to the table is it's able"},{"startTime":1469.9,"endTime":1473.26,"body":"to take a look at a broader population use"},{"startTime":1473.26,"endTime":1475.45,"body":"that may be more reflective of what"},{"startTime":1475.45,"endTime":1477.43,"body":"that population truly looks like with"},{"startTime":1477.43,"endTime":1479.23,"body":"that particular disease state."},{"startTime":1479.23,"endTime":1481.27,"body":"So as an example, if you have a disease"},{"startTime":1481.27,"endTime":1483.82,"body":"where the average age is of a patient 70"},{"startTime":1483.82,"endTime":1486.88,"body":"and African Americans are"},{"startTime":1483.82,"endTime":1486.88,"body":"disproportionately impacted"},{"startTime":1486.88,"endTime":1490.21,"body":"and their clinical trial is"},{"startTime":1486.88,"endTime":1490.21,"body":"heavy with Caucasian patients,"},{"startTime":1490.21,"endTime":1492.1,"body":"you recognise then that"},{"startTime":1490.21,"endTime":1492.1,"body":"that you may have a bit"},{"startTime":1492.1,"endTime":1493.72,"body":"of a data gap there."},{"startTime":1493.72,"endTime":1496.45,"body":"Likewise, where real world"},{"startTime":1493.72,"endTime":1496.45,"body":"evidence can really come into"},{"startTime":1496.45,"endTime":1500.08,"body":"play is really looking at some"},{"startTime":1496.45,"endTime":1500.08,"body":"of those long-term outcomes"},{"startTime":1500.08,"endTime":1503.8,"body":"and really helping to west"},{"startTime":1500.08,"endTime":1503.8,"body":"test, okay, what was predicted"},{"startTime":1503.8,"endTime":1505.6,"body":"or expected from the clinical trial?"},{"startTime":1505.6,"endTime":1509.77,"body":"Is that truly reflected then"},{"startTime":1505.6,"endTime":1509.77,"body":"in the real world evidence?"},{"startTime":1509.77,"endTime":1513.22,"body":"So I think that becomes"},{"startTime":1509.77,"endTime":1513.22,"body":"critically important."},{"startTime":1513.22,"endTime":1516.76,"body":"I also think that there is"},{"startTime":1513.22,"endTime":1516.76,"body":"becoming a heavier emphasis on"},{"startTime":1516.76,"endTime":1519.28,"body":"patient reported outcomes as well."},{"startTime":1519.28,"endTime":1520.39,"body":"And I think the reason for"},{"startTime":1520.39,"endTime":1524.2,"body":"that is people are really"},{"startTime":1520.39,"endTime":1524.2,"body":"starting to appreciate that"},{"startTime":1524.2,"endTime":1525.82,"body":"aspects of quality of life,"},{"startTime":1525.82,"endTime":1529.39,"body":"particularly in disease"},{"startTime":1525.82,"endTime":1529.39,"body":"states like maybe depression"},{"startTime":1529.39,"endTime":1531.76,"body":"or migraines for example."},{"startTime":1531.76,"endTime":1534.31,"body":"That quality of life"},{"startTime":1531.76,"endTime":1534.31,"body":"element can actually impact"},{"startTime":1534.31,"endTime":1538.27,"body":"productivity and that actually"},{"startTime":1534.31,"endTime":1538.27,"body":"has cost implications,"},{"startTime":1538.27,"endTime":1541.33,"body":"particularly if you're thinking"},{"startTime":1538.27,"endTime":1541.33,"body":"about an employed population"},{"startTime":1541.33,"endTime":1542.95,"body":"or a commercial book of business."},{"startTime":1545.53,"endTime":1547.99,"body":"- Louise, if, if I can, I think"},{"startTime":1545.53,"endTime":1547.99,"body":"Shana said that wonderfully,"},{"startTime":1547.99,"endTime":1551.41,"body":"I would simply add one other"},{"startTime":1547.99,"endTime":1551.41,"body":"element that we're seeing more"},{"startTime":1551.41,"endTime":1553.15,"body":"and more growing in importance"},{"startTime":1553.15,"endTime":1556.06,"body":"and that's the whole notion of"},{"startTime":1553.15,"endTime":1556.06,"body":"evidence generation planning"},{"startTime":1556.06,"endTime":1559.39,"body":"pretty early on in the clinical"},{"startTime":1556.06,"endTime":1559.39,"body":"development life cycle."},{"startTime":1559.39,"endTime":1561.55,"body":"I feel like oftentimes"},{"startTime":1559.39,"endTime":1561.55,"body":"if we go back a decade"},{"startTime":1561.55,"endTime":1563.77,"body":"or so, there was very much only a focus on"},{"startTime":1563.77,"endTime":1565.78,"body":"what are the clinical"},{"startTime":1563.77,"endTime":1565.78,"body":"endpoints, what is sort of"},{"startTime":1565.78,"endTime":1568.78,"body":"that requirement to get a"},{"startTime":1565.78,"endTime":1568.78,"body":"product approved And I feel like"},{"startTime":1568.78,"endTime":1570.79,"body":"we're doing a better job, but"},{"startTime":1568.78,"endTime":1570.79,"body":"I still think there's more"},{"startTime":1570.79,"endTime":1572.26,"body":"that we should be doing"},{"startTime":1572.26,"endTime":1575.53,"body":"of thinking about evidence"},{"startTime":1572.26,"endTime":1575.53,"body":"generation opportunities in"},{"startTime":1575.53,"endTime":1578.59,"body":"that development cycle"},{"startTime":1575.53,"endTime":1578.59,"body":"to think about US payers"},{"startTime":1578.59,"endTime":1580.45,"body":"and to think about some"},{"startTime":1578.59,"endTime":1580.45,"body":"of the economic values"},{"startTime":1580.45,"endTime":1581.86,"body":"or some of that data"},{"startTime":1581.86,"endTime":1585.04,"body":"that they would find most"},{"startTime":1581.86,"endTime":1585.04,"body":"useful at product approval."},{"startTime":1585.04,"endTime":1588.55,"body":"So the more that we could do"},{"startTime":1585.04,"endTime":1588.55,"body":"there in that upfront part,"},{"startTime":1588.55,"endTime":1590.38,"body":"thinking about some of the criteria"},{"startTime":1590.38,"endTime":1593.8,"body":"that US payers find most"},{"startTime":1590.38,"endTime":1593.8,"body":"valuable I think would be a huge,"},{"startTime":1593.8,"endTime":1595.75,"body":"huge benefit as we start to think about"},{"startTime":1595.75,"endTime":1597.49,"body":"how are we developing products in the us."},{"startTime":1599.56,"endTime":1601.69,"body":"- Uri did you have anything to add?"},{"startTime":1601.69,"endTime":1603.62,"body":"- Yeah, I'd like to, I'd like"},{"startTime":1601.69,"endTime":1603.62,"body":"to think about real world"},{"startTime":1603.62,"endTime":1605.09,"body":"evidence in kind of two buckets."},{"startTime":1605.09,"endTime":1607.555,"body":"So I've got external real world evidence"},{"startTime":1607.555,"endTime":1608.75,"body":"that that gets published."},{"startTime":1608.75,"endTime":1610.85,"body":"We we're, we're looking at PubMed,"},{"startTime":1610.85,"endTime":1612.62,"body":"we're finding these journals, articles,"},{"startTime":1612.62,"endTime":1614.03,"body":"you guys are bringing us information,"},{"startTime":1614.03,"endTime":1615.65,"body":"farmers bringing us information"},{"startTime":1615.65,"endTime":1617.87,"body":"and then the real world evidence that me"},{"startTime":1617.87,"endTime":1619.82,"body":"as a payer I can generate."},{"startTime":1619.82,"endTime":1622.79,"body":"So at Cigna we have 15"},{"startTime":1619.82,"endTime":1622.79,"body":"million medical rides"},{"startTime":1622.79,"endTime":1625.91,"body":"and so what often was the case"},{"startTime":1622.79,"endTime":1625.91,"body":"is I can't make a formulary"},{"startTime":1625.91,"endTime":1628.28,"body":"decision generally on real world evidence."},{"startTime":1628.28,"endTime":1630.92,"body":"What I can do is I can"},{"startTime":1628.28,"endTime":1630.92,"body":"take that information"},{"startTime":1630.92,"endTime":1634.16,"body":"and then go look at my data,"},{"startTime":1630.92,"endTime":1634.16,"body":"what do we find out in my data?"},{"startTime":1634.16,"endTime":1637.13,"body":"We actually built programmes"},{"startTime":1634.16,"endTime":1637.13,"body":"at Cigna because of this."},{"startTime":1637.13,"endTime":1638.78,"body":"There was an interesting tidbit"},{"startTime":1638.78,"endTime":1641.87,"body":"that came from a"},{"startTime":1638.78,"endTime":1641.87,"body":"manufacturer that said X, Y"},{"startTime":1641.87,"endTime":1644.81,"body":"or Z is happening within"},{"startTime":1641.87,"endTime":1644.81,"body":"the US population."},{"startTime":1644.81,"endTime":1646.4,"body":"And we would say, oh that's interesting."},{"startTime":1646.4,"endTime":1648.65,"body":"Let us go confirm it. Let us go take"},{"startTime":1648.65,"endTime":1651.47,"body":"that information internally,"},{"startTime":1648.65,"endTime":1651.47,"body":"let's validate it"},{"startTime":1651.47,"endTime":1653.48,"body":"and let's see if there's"},{"startTime":1651.47,"endTime":1653.48,"body":"cost savings there."},{"startTime":1653.48,"endTime":1656.96,"body":"If there's cost savings or"},{"startTime":1653.48,"endTime":1656.96,"body":"outcomes generated within this"},{"startTime":1656.96,"endTime":1660.53,"body":"intervention, we can then"},{"startTime":1656.96,"endTime":1660.53,"body":"capture that as affordability"},{"startTime":1660.53,"endTime":1662.72,"body":"and we can actually take"},{"startTime":1660.53,"endTime":1662.72,"body":"it back to the marketplace"},{"startTime":1662.72,"endTime":1665.99,"body":"and we can say we're going to"},{"startTime":1662.72,"endTime":1665.99,"body":"spend less because of this."},{"startTime":1665.99,"endTime":1669.26,"body":"And it starts with real"},{"startTime":1665.99,"endTime":1669.26,"body":"world evidence over that that"},{"startTime":1669.26,"endTime":1672.14,"body":"that the manufacturer brings"},{"startTime":1669.26,"endTime":1672.14,"body":"that we validate internally."},{"startTime":1676.04,"endTime":1680.87,"body":"- Thank you. So if we think"},{"startTime":1676.04,"endTime":1680.87,"body":"about other factors aside"},{"startTime":1680.87,"endTime":1684.83,"body":"from efficacy, safety, cost effectiveness,"},{"startTime":1684.83,"endTime":1687.41,"body":"what else is impactful"},{"startTime":1684.83,"endTime":1687.41,"body":"in supporting coverage"},{"startTime":1687.41,"endTime":1688.52,"body":"and reimbursement?"},{"startTime":1689.45,"endTime":1692.15,"body":"Shana, perhaps you could lead"},{"startTime":1689.45,"endTime":1692.15,"body":"from the pharma perspective"},{"startTime":1692.15,"endTime":1695.0,"body":"in terms of additional things"},{"startTime":1692.15,"endTime":1695.0,"body":"like the billing and coding"},{"startTime":1695.0,"endTime":1696.86,"body":"or patient support services."},{"startTime":1698.69,"endTime":1700.28,"body":"- Yeah, no thank you for the opportunity."},{"startTime":1700.28,"endTime":1702.62,"body":"I know we've already"},{"startTime":1700.28,"endTime":1702.62,"body":"talked about the trifecta,"},{"startTime":1702.62,"endTime":1705.86,"body":"we'll call it clinical efficacy, safety"},{"startTime":1705.86,"endTime":1707.33,"body":"and the economic story."},{"startTime":1707.33,"endTime":1709.58,"body":"But I agree that there are"},{"startTime":1707.33,"endTime":1709.58,"body":"other areas to consider."},{"startTime":1709.58,"endTime":1711.65,"body":"We had mentioned already"},{"startTime":1709.58,"endTime":1711.65,"body":"real world evidence,"},{"startTime":1711.65,"endTime":1714.95,"body":"we talked about patient reported outcomes"},{"startTime":1714.95,"endTime":1717.14,"body":"but certainly in addition"},{"startTime":1714.95,"endTime":1717.14,"body":"to that like payers"},{"startTime":1717.14,"endTime":1719.66,"body":"and PBMs are going to be"},{"startTime":1717.14,"endTime":1719.66,"body":"thinking about things such as"},{"startTime":1719.66,"endTime":1722.39,"body":"what are the real world"},{"startTime":1719.66,"endTime":1722.39,"body":"implications of how"},{"startTime":1722.39,"endTime":1725.0,"body":"that product is truly going to move across"},{"startTime":1725.0,"endTime":1727.04,"body":"that patient's treatment journey."},{"startTime":1727.04,"endTime":1730.76,"body":"So just some examples of"},{"startTime":1727.04,"endTime":1730.76,"body":"what I mean by that are,"},{"startTime":1731.96,"endTime":1734.6,"body":"so you can think about a"},{"startTime":1731.96,"endTime":1734.6,"body":"patient who may have a,"},{"startTime":1734.6,"endTime":1737.06,"body":"a complicated diagnostic journey."},{"startTime":1737.06,"endTime":1739.55,"body":"So think about like"},{"startTime":1737.06,"endTime":1739.55,"body":"comprehensive genomic testing"},{"startTime":1739.55,"endTime":1742.31,"body":"for a precision medicine oncology product."},{"startTime":1742.31,"endTime":1743.9,"body":"We know that even if the,"},{"startTime":1743.9,"endTime":1747.26,"body":"that product has great"},{"startTime":1743.9,"endTime":1747.26,"body":"outcomes in the clinical trial,"},{"startTime":1747.26,"endTime":1749.84,"body":"if there's a lot of barriers"},{"startTime":1747.26,"endTime":1749.84,"body":"for that patient in terms"},{"startTime":1749.84,"endTime":1751.46,"body":"of even getting the diagnosis"},{"startTime":1751.46,"endTime":1754.82,"body":"or identifying the patient,"},{"startTime":1751.46,"endTime":1754.82,"body":"it's going to limit the outcomes"},{"startTime":1754.82,"endTime":1756.95,"body":"that that product can have."},{"startTime":1756.95,"endTime":1759.11,"body":"Additionally, I think if"},{"startTime":1756.95,"endTime":1759.11,"body":"products are started in the"},{"startTime":1759.11,"endTime":1762.11,"body":"hospital and then the patient"},{"startTime":1759.11,"endTime":1762.11,"body":"continues the treatment in the"},{"startTime":1762.11,"endTime":1763.85,"body":"outpatient setting, how"},{"startTime":1763.85,"endTime":1766.94,"body":"that product actually transitions"},{"startTime":1763.85,"endTime":1766.94,"body":"across benefit designs"},{"startTime":1766.94,"endTime":1768.74,"body":"and really creating I would say kind"},{"startTime":1768.74,"endTime":1772.04,"body":"of a frictionless patient"},{"startTime":1768.74,"endTime":1772.04,"body":"journey becomes incredibly"},{"startTime":1772.04,"endTime":1773.87,"body":"important as well as some"},{"startTime":1773.87,"endTime":1775.73,"body":"of the heavy monitoring requirements"},{"startTime":1775.73,"endTime":1777.32,"body":"that some of the products have."},{"startTime":1777.32,"endTime":1780.32,"body":"We know that that cannot"},{"startTime":1777.32,"endTime":1780.32,"body":"only add to increased costs"},{"startTime":1780.32,"endTime":1783.27,"body":"but it also can reduce I"},{"startTime":1780.32,"endTime":1783.27,"body":"think some of the adherence"},{"startTime":1783.27,"endTime":1786.72,"body":"and safety parameters around"},{"startTime":1783.27,"endTime":1786.72,"body":"that particular treatment."},{"startTime":1786.72,"endTime":1787.77,"body":"So in addition to that,"},{"startTime":1787.77,"endTime":1790.02,"body":"I think there are some key"},{"startTime":1787.77,"endTime":1790.02,"body":"considerations around some"},{"startTime":1790.02,"endTime":1792.66,"body":"of the distribution aspects as well."},{"startTime":1792.66,"endTime":1794.1,"body":"So one of the things"},{"startTime":1792.66,"endTime":1794.1,"body":"you mentioned, Louise,"},{"startTime":1794.1,"endTime":1796.8,"body":"is thinking about patient support services"},{"startTime":1796.8,"endTime":1798.87,"body":"or even hub services"},{"startTime":1798.87,"endTime":1801.57,"body":"and the idea of leveraging"},{"startTime":1798.87,"endTime":1801.57,"body":"some of these entities are"},{"startTime":1801.57,"endTime":1805.2,"body":"to think about, okay, how can"},{"startTime":1801.57,"endTime":1805.2,"body":"you actually compress the time"},{"startTime":1805.2,"endTime":1807.6,"body":"from when a patient has a diagnosis"},{"startTime":1807.6,"endTime":1810.12,"body":"to when they can actually get on treatment"},{"startTime":1810.12,"endTime":1812.43,"body":"and really make that an easier journey And"},{"startTime":1812.43,"endTime":1814.71,"body":"that becomes critically important."},{"startTime":1814.71,"endTime":1816.24,"body":"I also think the design"},{"startTime":1816.24,"endTime":1819.99,"body":"of the distribution model"},{"startTime":1816.24,"endTime":1819.99,"body":"also plays an important role,"},{"startTime":1819.99,"endTime":1823.5,"body":"particularly when we're thinking"},{"startTime":1819.99,"endTime":1823.5,"body":"about specialty pharmacy"},{"startTime":1823.5,"endTime":1825.9,"body":"products that are limited distribution."},{"startTime":1825.9,"endTime":1829.56,"body":"So as an example, you can"},{"startTime":1825.9,"endTime":1829.56,"body":"imagine if a limited distribution"},{"startTime":1829.56,"endTime":1832.2,"body":"product can only be"},{"startTime":1829.56,"endTime":1832.2,"body":"dispensed from one kind"},{"startTime":1832.2,"endTime":1835.68,"body":"of NA national centralised"},{"startTime":1832.2,"endTime":1835.68,"body":"specialty pharmacy,"},{"startTime":1835.68,"endTime":1837.21,"body":"it's going to be a different experience."},{"startTime":1837.21,"endTime":1838.5,"body":"And if that patient's able"},{"startTime":1838.5,"endTime":1841.08,"body":"to get maybe an oral oncology product"},{"startTime":1841.08,"endTime":1843.12,"body":"through an in-office dispensing pharmacy"},{"startTime":1843.12,"endTime":1846.12,"body":"that's actually integrated"},{"startTime":1843.12,"endTime":1846.12,"body":"with their physician practise"},{"startTime":1846.12,"endTime":1848.97,"body":"where you can marry"},{"startTime":1846.12,"endTime":1848.97,"body":"together that oral agent"},{"startTime":1848.97,"endTime":1852.87,"body":"with the patient's IV"},{"startTime":1848.97,"endTime":1852.87,"body":"treatment as a package regimen."},{"startTime":1852.87,"endTime":1855.27,"body":"And I know that there's"},{"startTime":1852.87,"endTime":1855.27,"body":"some data out there showing"},{"startTime":1855.27,"endTime":1858.39,"body":"that those two distribution"},{"startTime":1855.27,"endTime":1858.39,"body":"models may actually have a"},{"startTime":1858.39,"endTime":1861.66,"body":"difference when it does"},{"startTime":1858.39,"endTime":1861.66,"body":"come to treatment adherence"},{"startTime":1861.66,"endTime":1863.28,"body":"as an example."},{"startTime":1863.28,"endTime":1865.05,"body":"And I would say the last element"},{"startTime":1865.05,"endTime":1866.82,"body":"that doesn't get talked about as much"},{"startTime":1866.82,"endTime":1868.89,"body":"but I think is going to become"},{"startTime":1868.89,"endTime":1870.6,"body":"or is continuing to become more important,"},{"startTime":1870.6,"endTime":1874.41,"body":"is really thinking about how"},{"startTime":1870.6,"endTime":1874.41,"body":"biopharma can actually engage"},{"startTime":1874.41,"endTime":1877.29,"body":"with areas such as"},{"startTime":1874.41,"endTime":1877.29,"body":"patient advocacy groups."},{"startTime":1877.29,"endTime":1880.35,"body":"And I think the area that"},{"startTime":1877.29,"endTime":1880.35,"body":"stands out most for this type"},{"startTime":1880.35,"endTime":1882.21,"body":"of concept is just thinking about how"},{"startTime":1882.21,"endTime":1884.61,"body":"that operates in the rare disease realm."},{"startTime":1886.32,"endTime":1887.88,"body":"And I don't know Dan or Rory,"},{"startTime":1887.88,"endTime":1889.86,"body":"I'm sure you've got other ideas as well."},{"startTime":1891.255,"endTime":1893.67,"body":"- Yeah, I might expand"},{"startTime":1891.255,"endTime":1893.67,"body":"just a little bit on, on"},{"startTime":1893.67,"endTime":1895.41,"body":"what Shana had shared and one element"},{"startTime":1895.41,"endTime":1897.75,"body":"that we haven't discussed"},{"startTime":1895.41,"endTime":1897.75,"body":"yet is this notion of"},{"startTime":1897.75,"endTime":1900.39,"body":"how should we be thinking"},{"startTime":1897.75,"endTime":1900.39,"body":"about the US payer marketplace?"},{"startTime":1900.39,"endTime":1902.67,"body":"And we, we spent a bit of"},{"startTime":1900.39,"endTime":1902.67,"body":"time at the beginning of kind"},{"startTime":1902.67,"endTime":1904.77,"body":"of defining who the players are there,"},{"startTime":1904.77,"endTime":1906.99,"body":"but I think it's an important"},{"startTime":1904.77,"endTime":1906.99,"body":"distinction if we think about"},{"startTime":1906.99,"endTime":1909.33,"body":"the audiences that oftentimes biopharma"},{"startTime":1909.33,"endTime":1910.98,"body":"is communicating with."},{"startTime":1910.98,"endTime":1912.87,"body":"The vast majority of people employed"},{"startTime":1912.87,"endTime":1915.99,"body":"by the payer organisations"},{"startTime":1912.87,"endTime":1915.99,"body":"are thinking about this from a"},{"startTime":1915.99,"endTime":1917.73,"body":"population health standpoint."},{"startTime":1917.73,"endTime":1920.88,"body":"We're making decisions that"},{"startTime":1917.73,"endTime":1920.88,"body":"impact the entire population,"},{"startTime":1920.88,"endTime":1922.17,"body":"but several of those elements"},{"startTime":1922.17,"endTime":1925.02,"body":"that Shana just mentioned"},{"startTime":1922.17,"endTime":1925.02,"body":"are more patient centric"},{"startTime":1925.02,"endTime":1926.34,"body":"or patient specific."},{"startTime":1926.34,"endTime":1928.56,"body":"It does become a really"},{"startTime":1926.34,"endTime":1928.56,"body":"important aspect to start"},{"startTime":1928.56,"endTime":1931.41,"body":"to think about there are"},{"startTime":1928.56,"endTime":1931.41,"body":"audiences within payers"},{"startTime":1931.41,"endTime":1932.97,"body":"or even as we think about the extension"},{"startTime":1932.97,"endTime":1935.58,"body":"of managed care into"},{"startTime":1932.97,"endTime":1935.58,"body":"integrated delivery networks"},{"startTime":1935.58,"endTime":1937.65,"body":"and health systems of individuals"},{"startTime":1937.65,"endTime":1939.75,"body":"and entities that are far more focused on"},{"startTime":1939.75,"endTime":1941.04,"body":"individual patients."},{"startTime":1941.04,"endTime":1943.02,"body":"That's where some of those"},{"startTime":1941.04,"endTime":1943.02,"body":"distribution elements"},{"startTime":1943.02,"endTime":1944.94,"body":"or some of the patient support elements"},{"startTime":1944.94,"endTime":1946.17,"body":"that Shana was starting to speak"},{"startTime":1946.17,"endTime":1949.5,"body":"to become really important"},{"startTime":1946.17,"endTime":1949.5,"body":"talking points to say"},{"startTime":1949.5,"endTime":1951.36,"body":"how are these therapies being supported"},{"startTime":1951.36,"endTime":1953.55,"body":"and what are we doing"},{"startTime":1951.36,"endTime":1953.55,"body":"directly for the patients"},{"startTime":1953.55,"endTime":1955.17,"body":"to help keep them on therapy"},{"startTime":1955.17,"endTime":1957.03,"body":"or help support their journey"},{"startTime":1957.03,"endTime":1958.56,"body":"through adherence and persistence."},{"startTime":1958.56,"endTime":1960.49,"body":"So just want to make sure"},{"startTime":1958.56,"endTime":1960.49,"body":"that it's, it's kind"},{"startTime":1960.49,"endTime":1963.31,"body":"of understood the vast majority"},{"startTime":1960.49,"endTime":1963.31,"body":"of us in the payer space,"},{"startTime":1963.31,"endTime":1964.84,"body":"we think about the population"},{"startTime":1964.84,"endTime":1966.925,"body":"but it should not be lost"},{"startTime":1964.84,"endTime":1966.925,"body":"that there still is a,"},{"startTime":1966.925,"endTime":1970.15,"body":"a large portion that think"},{"startTime":1966.925,"endTime":1970.15,"body":"about individual patient care."},{"startTime":1972.25,"endTime":1973.78,"body":"- We, we talk about,"},{"startTime":1973.78,"endTime":1976.0,"body":"I mean the FDA approval is like the"},{"startTime":1976.0,"endTime":1977.65,"body":"first step in the journey."},{"startTime":1977.65,"endTime":1979.75,"body":"You could actually have"},{"startTime":1977.65,"endTime":1979.75,"body":"an FDA approved drug"},{"startTime":1979.75,"endTime":1982.72,"body":"that has good coverage that nobody uses."},{"startTime":1982.72,"endTime":1983.89,"body":"So within the US"},{"startTime":1983.89,"endTime":1986.535,"body":"because we're such a"},{"startTime":1983.89,"endTime":1986.535,"body":"fractionated healthcare system,"},{"startTime":1986.535,"endTime":1988.52,"body":"you you, you, you"},{"startTime":1986.535,"endTime":1988.52,"body":"potentially could have a,"},{"startTime":1988.52,"endTime":1992.05,"body":"a provider problem, a payer"},{"startTime":1988.52,"endTime":1992.05,"body":"problem, a pharmacy problem,"},{"startTime":1992.05,"endTime":1996.67,"body":"a patient problem that it,"},{"startTime":1992.05,"endTime":1996.67,"body":"it's, it goes beyond payer."},{"startTime":1996.67,"endTime":1998.98,"body":"One of the things that that"},{"startTime":1996.67,"endTime":1998.98,"body":"we haven't talked about is,"},{"startTime":1998.98,"endTime":2001.08,"body":"is utilisation management, right?"},{"startTime":2001.08,"endTime":2003.72,"body":"Where we, we get the"},{"startTime":2001.08,"endTime":2003.72,"body":"drug FDA approved, the,"},{"startTime":2003.72,"endTime":2005.61,"body":"the payer looks at the information"},{"startTime":2005.61,"endTime":2007.08,"body":"and says, we're going"},{"startTime":2007.08,"endTime":2010.23,"body":"to make a determination"},{"startTime":2007.08,"endTime":2010.23,"body":"if this is the right drug"},{"startTime":2010.23,"endTime":2013.38,"body":"for the right patient at the"},{"startTime":2010.23,"endTime":2013.38,"body":"right time, at the right dose,"},{"startTime":2013.38,"endTime":2014.91,"body":"at the right site of care."},{"startTime":2014.91,"endTime":2016.62,"body":"And then when they add that all up,"},{"startTime":2016.62,"endTime":2019.02,"body":"they put in a utilisation"},{"startTime":2016.62,"endTime":2019.02,"body":"management programme such"},{"startTime":2019.02,"endTime":2020.61,"body":"as a prior authorization."},{"startTime":2020.61,"endTime":2024.12,"body":"So it's in the commercial"},{"startTime":2020.61,"endTime":2024.12,"body":"space they in in the US the,"},{"startTime":2024.12,"endTime":2027.3,"body":"the payers like Cigna are"},{"startTime":2024.12,"endTime":2027.3,"body":"making a determination if they"},{"startTime":2027.3,"endTime":2028.62,"body":"should pay for that drug even"},{"startTime":2028.62,"endTime":2031.26,"body":"after it's FDA approved"},{"startTime":2028.62,"endTime":2031.26,"body":"so they could cover it"},{"startTime":2031.26,"endTime":2033.39,"body":"and still have prior authorization on it."},{"startTime":2034.255,"endTime":2037.11,"body":"And sometimes the providers"},{"startTime":2034.255,"endTime":2037.11,"body":"don't get the prior"},{"startTime":2037.11,"endTime":2039.06,"body":"authorization, sometimes"},{"startTime":2037.11,"endTime":2039.06,"body":"it rejects the pharmacy."},{"startTime":2039.06,"endTime":2041.1,"body":"So there is, there's a lot more"},{"startTime":2041.1,"endTime":2044.16,"body":"to market access than just"},{"startTime":2041.1,"endTime":2044.16,"body":"getting the FDA approved drug"},{"startTime":2044.16,"endTime":2045.69,"body":"and then getting coverage."},{"startTime":2045.69,"endTime":2047.97,"body":"It's what does the utilisation"},{"startTime":2045.69,"endTime":2047.97,"body":"management look like?"},{"startTime":2047.97,"endTime":2051.33,"body":"How does the provider know"},{"startTime":2047.97,"endTime":2051.33,"body":"that there's a PA on this drug?"},{"startTime":2051.33,"endTime":2054.12,"body":"How do they submit that? Does"},{"startTime":2051.33,"endTime":2054.12,"body":"it require a genetic test?"},{"startTime":2054.12,"endTime":2055.17,"body":"Have you done the genetic test?"},{"startTime":2055.17,"endTime":2057.75,"body":"Does the genetic test require"},{"startTime":2055.17,"endTime":2057.75,"body":"a prior authorization?"},{"startTime":2057.75,"endTime":2060.12,"body":"It's, it's a really fractionated system"},{"startTime":2060.12,"endTime":2062.31,"body":"and it's important to understand each one"},{"startTime":2062.31,"endTime":2064.35,"body":"of these key stakeholders"},{"startTime":2064.35,"endTime":2066.63,"body":"and what they need in order to streamline"},{"startTime":2066.63,"endTime":2068.34,"body":"that process for the patient."},{"startTime":2068.34,"endTime":2071.04,"body":"We have a tonne of prescription"},{"startTime":2068.34,"endTime":2071.04,"body":"abandonment in the US"},{"startTime":2071.04,"endTime":2073.74,"body":"and it goes from non-specialty"},{"startTime":2071.04,"endTime":2073.74,"body":"drugs to specialty drugs"},{"startTime":2073.74,"endTime":2076.83,"body":"to oncology drugs to infusion products."},{"startTime":2076.83,"endTime":2078.33,"body":"There are challenges throughout"},{"startTime":2078.33,"endTime":2079.47,"body":"'cause we're so fraction in it"},{"startTime":2079.47,"endTime":2080.7,"body":"and you have to understand each one"},{"startTime":2080.7,"endTime":2081.75,"body":"of these key stakeholders"},{"startTime":2081.75,"endTime":2084.0,"body":"and what they need in order to streamline"},{"startTime":2084.0,"endTime":2085.0,"body":"- That process."},{"startTime":2088.77,"endTime":2092.49,"body":"- Thank you. - So now we've"},{"startTime":2088.77,"endTime":2092.49,"body":"talked a little bit about the"},{"startTime":2092.49,"endTime":2094.44,"body":"evidence requirements."},{"startTime":2094.44,"endTime":2097.83,"body":"How do you communicate that"},{"startTime":2094.44,"endTime":2097.83,"body":"value in terms of the messaging"},{"startTime":2097.83,"endTime":2100.53,"body":"that resonates in the us"},{"startTime":2097.83,"endTime":2100.53,"body":"especially when you've got all"},{"startTime":2100.53,"endTime":2103.38,"body":"these different audiences to manage Dan?"},{"startTime":2104.97,"endTime":2106.59,"body":"- Yeah, I'll take a stab at that."},{"startTime":2106.59,"endTime":2110.13,"body":"I think the most important"},{"startTime":2106.59,"endTime":2110.13,"body":"aspect in my opinion"},{"startTime":2110.13,"endTime":2113.07,"body":"of communicating product"},{"startTime":2110.13,"endTime":2113.07,"body":"value is being able"},{"startTime":2113.07,"endTime":2115.41,"body":"to accurately anticipate the objections"},{"startTime":2115.41,"endTime":2118.29,"body":"or the challenges that"},{"startTime":2115.41,"endTime":2118.29,"body":"the US payer audiences"},{"startTime":2118.29,"endTime":2119.64,"body":"may throw at you."},{"startTime":2119.64,"endTime":2120.78,"body":"So said differently."},{"startTime":2120.78,"endTime":2123.78,"body":"If we're creating value"},{"startTime":2120.78,"endTime":2123.78,"body":"stories for US payers"},{"startTime":2123.78,"endTime":2124.98,"body":"that are simply the features"},{"startTime":2124.98,"endTime":2126.48,"body":"and the benefits of the product,"},{"startTime":2126.48,"endTime":2129.27,"body":"we're probably missing a"},{"startTime":2126.48,"endTime":2129.27,"body":"really good opportunity"},{"startTime":2129.27,"endTime":2131.46,"body":"to more proactively"},{"startTime":2129.27,"endTime":2131.46,"body":"address some of the things"},{"startTime":2131.46,"endTime":2135.87,"body":"that we are going to payers"},{"startTime":2131.46,"endTime":2135.87,"body":"challenging with respect that"},{"startTime":2137.08,"endTime":2138.37,"body":"to the best of our abilities."},{"startTime":2138.37,"endTime":2139.42,"body":"Making sure that"},{"startTime":2139.42,"endTime":2143.35,"body":"that development process"},{"startTime":2139.42,"endTime":2143.35,"body":"anticipates those challenges makes"},{"startTime":2143.35,"endTime":2145.15,"body":"for a much better value proposition"},{"startTime":2145.15,"endTime":2147.91,"body":"or value story in, in my"},{"startTime":2145.15,"endTime":2147.91,"body":"opinion that that said,"},{"startTime":2147.91,"endTime":2149.59,"body":"there's only so far that"},{"startTime":2147.91,"endTime":2149.59,"body":"we can go with that."},{"startTime":2149.59,"endTime":2152.2,"body":"Obviously it still has to"},{"startTime":2149.59,"endTime":2152.2,"body":"stay within the bounds of sort"},{"startTime":2152.2,"endTime":2156.19,"body":"of medically and legally and"},{"startTime":2152.2,"endTime":2156.19,"body":"regulatory approved content."},{"startTime":2156.19,"endTime":2158.65,"body":"But I still think a really sound value"},{"startTime":2158.65,"endTime":2160.06,"body":"proposition has an ability"},{"startTime":2160.06,"endTime":2161.59,"body":"- To anticipate those things."},{"startTime":2165.1,"endTime":2167.35,"body":"- Okay. And what lessons"},{"startTime":2165.1,"endTime":2167.35,"body":"can med tech companies"},{"startTime":2167.35,"endTime":2170.32,"body":"and pharma companies learn"},{"startTime":2167.35,"endTime":2170.32,"body":"from your experience?"},{"startTime":2171.4,"endTime":2173.23,"body":"Where have you potentially had challenges"},{"startTime":2173.23,"endTime":2174.43,"body":"that you can learn from?"},{"startTime":2176.95,"endTime":2178.87,"body":"- Yeah, I think I, I'll"},{"startTime":2176.95,"endTime":2178.87,"body":"take a first stab at that"},{"startTime":2178.87,"endTime":2181.42,"body":"and then pivot to Shana and Rory,"},{"startTime":2181.42,"endTime":2183.76,"body":"but I think the diversity of audiences"},{"startTime":2183.76,"endTime":2187.27,"body":"that do exist within the US"},{"startTime":2183.76,"endTime":2187.27,"body":"healthcare landscape is such an"},{"startTime":2187.27,"endTime":2188.56,"body":"important lesson."},{"startTime":2188.56,"endTime":2191.8,"body":"Rory started to say it is"},{"startTime":2188.56,"endTime":2191.8,"body":"a very fractionated system."},{"startTime":2191.8,"endTime":2194.11,"body":"So to ensure that MedTech"},{"startTime":2194.11,"endTime":2197.2,"body":"and biopharmaceutical"},{"startTime":2194.11,"endTime":2197.2,"body":"companies do not perceive it"},{"startTime":2197.2,"endTime":2199.0,"body":"to be a single audience"},{"startTime":2199.0,"endTime":2202.42,"body":"or a single audience with"},{"startTime":2199.0,"endTime":2202.42,"body":"similar business motivations"},{"startTime":2202.42,"endTime":2204.67,"body":"or business perspectives is probably one"},{"startTime":2204.67,"endTime":2206.56,"body":"of the most important lessons."},{"startTime":2206.56,"endTime":2209.68,"body":"Understand that everybody is"},{"startTime":2206.56,"endTime":2209.68,"body":"going to be driven from a slightly"},{"startTime":2209.68,"endTime":2213.43,"body":"different sort of book, if you"},{"startTime":2209.68,"endTime":2213.43,"body":"will, of what if they attempt"},{"startTime":2213.43,"endTime":2215.62,"body":"to achieve in this gigantic universe"},{"startTime":2215.62,"endTime":2217.42,"body":"that is the US healthcare space"},{"startTime":2217.42,"endTime":2219.49,"body":"and making sure that"},{"startTime":2217.42,"endTime":2219.49,"body":"we're having a bit more"},{"startTime":2219.49,"endTime":2220.81,"body":"of a targeted message"},{"startTime":2220.81,"endTime":2222.85,"body":"or a bit more of a targeted conversation"},{"startTime":2222.85,"endTime":2225.37,"body":"with those individuals"},{"startTime":2222.85,"endTime":2225.37,"body":"understanding what it's,"},{"startTime":2225.37,"endTime":2228.28,"body":"that their perspective is"},{"startTime":2225.37,"endTime":2228.28,"body":"not simply having a one-sided"},{"startTime":2228.28,"endTime":2230.8,"body":"conversation to tell"},{"startTime":2228.28,"endTime":2230.8,"body":"me what is the efficacy"},{"startTime":2230.8,"endTime":2232.75,"body":"and safety of a product, for example."},{"startTime":2232.75,"endTime":2235.6,"body":"The conversation should be"},{"startTime":2232.75,"endTime":2235.6,"body":"able to go much beyond that"},{"startTime":2235.6,"endTime":2237.82,"body":"and much more individualised to"},{"startTime":2237.82,"endTime":2238.87,"body":"what are some of those business"},{"startTime":2238.87,"endTime":2241.42,"body":"- Drivers that that"},{"startTime":2238.87,"endTime":2241.42,"body":"particular audience may have."},{"startTime":2243.76,"endTime":2245.68,"body":"- Shana."},{"startTime":2243.76,"endTime":2245.68,"body":"- Yeah, did you want to jump in?"},{"startTime":2245.68,"endTime":2248.5,"body":"- Yeah, I absolutely"},{"startTime":2245.68,"endTime":2248.5,"body":"agree with what Dan said."},{"startTime":2248.5,"endTime":2251.8,"body":"The one thing that I will"},{"startTime":2248.5,"endTime":2251.8,"body":"lean on just a little bit"},{"startTime":2251.8,"endTime":2253.39,"body":"and Louise, I think it"},{"startTime":2251.8,"endTime":2253.39,"body":"goes back a little bit"},{"startTime":2253.39,"endTime":2256.58,"body":"to your question when you"},{"startTime":2253.39,"endTime":2256.58,"body":"started talking about billing and"},{"startTime":2256.58,"endTime":2258.82,"body":"and coding and reimbursement"},{"startTime":2258.82,"endTime":2261.79,"body":"and while it can be a"},{"startTime":2258.82,"endTime":2261.79,"body":"little bit complex even"},{"startTime":2261.79,"endTime":2264.01,"body":"for a medical benefit product,"},{"startTime":2264.01,"endTime":2266.74,"body":"I really think it probably"},{"startTime":2264.01,"endTime":2266.74,"body":"stands out even more in"},{"startTime":2266.74,"endTime":2270.04,"body":"that med tech space for those companies."},{"startTime":2270.04,"endTime":2271.63,"body":"I think where they engage,"},{"startTime":2271.63,"endTime":2275.53,"body":"not only is it across a"},{"startTime":2271.63,"endTime":2275.53,"body":"fragmented healthcare system,"},{"startTime":2275.53,"endTime":2278.77,"body":"but based on my experience"},{"startTime":2275.53,"endTime":2278.77,"body":"doing the consulting work,"},{"startTime":2278.77,"endTime":2280.81,"body":"just really thinking about"},{"startTime":2278.77,"endTime":2280.81,"body":"like how they really need"},{"startTime":2280.81,"endTime":2283.75,"body":"to engage across different"},{"startTime":2280.81,"endTime":2283.75,"body":"stakeholders as well."},{"startTime":2283.75,"endTime":2287.41,"body":"So just thinking about"},{"startTime":2283.75,"endTime":2287.41,"body":"individuals such as those"},{"startTime":2287.41,"endTime":2291.25,"body":"that are really supporting"},{"startTime":2287.41,"endTime":2291.25,"body":"like workflow and technology"},{"startTime":2291.25,"endTime":2294.67,"body":"and really thinking about, you"},{"startTime":2291.25,"endTime":2294.67,"body":"know, some of those aspects"},{"startTime":2294.67,"endTime":2298.48,"body":"around security and data"},{"startTime":2294.67,"endTime":2298.48,"body":"becomes critically important."},{"startTime":2298.48,"endTime":2301.18,"body":"But really I would say it's"},{"startTime":2298.48,"endTime":2301.18,"body":"that billing and reimbursement"},{"startTime":2301.18,"endTime":2305.29,"body":"and that coding structure"},{"startTime":2301.18,"endTime":2305.29,"body":"is a little less regulated"},{"startTime":2305.29,"endTime":2306.91,"body":"and I would say known"},{"startTime":2306.91,"endTime":2309.91,"body":"and creates maybe a few more hurdles than"},{"startTime":2309.91,"endTime":2312.67,"body":"what we experience on the drug side."},{"startTime":2312.67,"endTime":2314.98,"body":"And of course if that"},{"startTime":2312.67,"endTime":2314.98,"body":"isn't a well thought out,"},{"startTime":2316.22,"endTime":2317.78,"body":"it just becomes more challenging"},{"startTime":2317.78,"endTime":2320.6,"body":"to actually bring a"},{"startTime":2317.78,"endTime":2320.6,"body":"successful product to market"},{"startTime":2320.6,"endTime":2323.99,"body":"and then to be able to maintain"},{"startTime":2320.6,"endTime":2323.99,"body":"that technology long term."},{"startTime":2326.39,"endTime":2328.46,"body":"- Thank you. Rory, did"},{"startTime":2326.39,"endTime":2328.46,"body":"you have anything to add?"},{"startTime":2330.95,"endTime":2332.345,"body":"- No, I, I, I think they"},{"startTime":2330.95,"endTime":2332.345,"body":"captured it really well."},{"startTime":2334.58,"endTime":2338.81,"body":"- Great. Maybe we can talk a"},{"startTime":2334.58,"endTime":2338.81,"body":"little bit about the process"},{"startTime":2338.81,"endTime":2341.69,"body":"and timing for engaging with payer bodies."},{"startTime":2341.69,"endTime":2344.42,"body":"So how do companies ensure that"},{"startTime":2341.69,"endTime":2344.42,"body":"they have the right evidence"},{"startTime":2344.42,"endTime":2347.48,"body":"and tools to engage with"},{"startTime":2344.42,"endTime":2347.48,"body":"payer bodies in the US"},{"startTime":2347.48,"endTime":2348.83,"body":"and what is that timing"},{"startTime":2348.83,"endTime":2353.57,"body":"for engagement Shana?"},{"startTime":2354.83,"endTime":2357.2,"body":"- Yeah, so I think it's a great question"},{"startTime":2357.2,"endTime":2359.66,"body":"and I hate to say the"},{"startTime":2357.2,"endTime":2359.66,"body":"word, it depends in terms"},{"startTime":2359.66,"endTime":2361.85,"body":"of when to engage."},{"startTime":2361.85,"endTime":2365.99,"body":"So as an example, we, we talked"},{"startTime":2361.85,"endTime":2365.99,"body":"about tools such as the pre"},{"startTime":2365.99,"endTime":2369.2,"body":"information exchange or"},{"startTime":2365.99,"endTime":2369.2,"body":"PY Dex as an example."},{"startTime":2369.2,"endTime":2372.65,"body":"And so typically, you know, as"},{"startTime":2369.2,"endTime":2372.65,"body":"a biopharma company engaging"},{"startTime":2372.65,"endTime":2375.44,"body":"with a payer, I really think"},{"startTime":2372.65,"endTime":2375.44,"body":"it's important to start"},{"startTime":2375.44,"endTime":2376.61,"body":"that engagement."},{"startTime":2376.61,"endTime":2380.21,"body":"It could be, you know, even 18"},{"startTime":2376.61,"endTime":2380.21,"body":"to 24 months ahead of launch,"},{"startTime":2380.21,"endTime":2382.1,"body":"which sounds really early,"},{"startTime":2382.1,"endTime":2384.29,"body":"but what I mean by depends is"},{"startTime":2384.29,"endTime":2386.9,"body":"that's really important"},{"startTime":2384.29,"endTime":2386.9,"body":"If you've got a product"},{"startTime":2386.9,"endTime":2390.23,"body":"that's either very"},{"startTime":2386.9,"endTime":2390.23,"body":"complicated or expensive"},{"startTime":2390.23,"endTime":2394.34,"body":"or maybe it's a product that's"},{"startTime":2390.23,"endTime":2394.34,"body":"really going to tackle a disease"},{"startTime":2394.34,"endTime":2395.81,"body":"that doesn't have a treatment today."},{"startTime":2395.81,"endTime":2398.42,"body":"And so there's a longer education process"},{"startTime":2398.42,"endTime":2400.43,"body":"between the biopharma company"},{"startTime":2400.43,"endTime":2403.13,"body":"and the payer just in terms of education"},{"startTime":2403.13,"endTime":2406.34,"body":"around the disease"},{"startTime":2403.13,"endTime":2406.34,"body":"journey, the diagnostics"},{"startTime":2406.34,"endTime":2408.29,"body":"and the economic implications."},{"startTime":2409.16,"endTime":2412.34,"body":"I think certain therapies stand apart."},{"startTime":2412.34,"endTime":2415.49,"body":"So as an example, gene therapy"},{"startTime":2412.34,"endTime":2415.49,"body":"I think is a classic one"},{"startTime":2415.49,"endTime":2418.22,"body":"where that early"},{"startTime":2415.49,"endTime":2418.22,"body":"engagement really matters."},{"startTime":2418.22,"endTime":2423.17,"body":"Part of it is around, is part"},{"startTime":2418.22,"endTime":2423.17,"body":"of it's just even around,"},{"startTime":2423.17,"endTime":2426.53,"body":"you know, what is the"},{"startTime":2423.17,"endTime":2426.53,"body":"financial implications may look"},{"startTime":2426.53,"endTime":2427.88,"body":"like long term."},{"startTime":2427.88,"endTime":2431.51,"body":"I think it sets the stage as"},{"startTime":2427.88,"endTime":2431.51,"body":"well in terms of like what kind"},{"startTime":2431.51,"endTime":2435.59,"body":"of insights can be exchanged"},{"startTime":2431.51,"endTime":2435.59,"body":"between the, the organisations."},{"startTime":2435.59,"endTime":2438.53,"body":"I think if a company is going"},{"startTime":2435.59,"endTime":2438.53,"body":"to bring a product to market"},{"startTime":2438.53,"endTime":2441.41,"body":"and it's either a me too"},{"startTime":2438.53,"endTime":2441.41,"body":"product, it's something"},{"startTime":2441.41,"endTime":2442.82,"body":"that people are familiar with,"},{"startTime":2442.82,"endTime":2445.94,"body":"it doesn't have huge cost"},{"startTime":2442.82,"endTime":2445.94,"body":"implications, then I think some of"},{"startTime":2445.94,"endTime":2449.57,"body":"that pre-engagement"},{"startTime":2445.94,"endTime":2449.57,"body":"conversations doesn't need"},{"startTime":2449.57,"endTime":2450.95,"body":"to happen that far in advance."},{"startTime":2450.95,"endTime":2453.47,"body":"It could be closer to a"},{"startTime":2450.95,"endTime":2453.47,"body":"six to 12 month timeframe."},{"startTime":2456.05,"endTime":2457.545,"body":"- Right? I would agree with Shana."},{"startTime":2457.545,"endTime":2460.52,"body":"I think at a minimum we should"},{"startTime":2457.545,"endTime":2460.52,"body":"be engaging payers always at"},{"startTime":2460.52,"endTime":2463.85,"body":"least 180 days before the"},{"startTime":2460.52,"endTime":2463.85,"body":"p DFA date that's been set."},{"startTime":2463.85,"endTime":2466.46,"body":"And then I think all those"},{"startTime":2463.85,"endTime":2466.46,"body":"other, it depends elements"},{"startTime":2466.46,"endTime":2469.1,"body":"that Shana had mentioned then"},{"startTime":2466.46,"endTime":2469.1,"body":"start to adjust that timeline"},{"startTime":2469.1,"endTime":2472.19,"body":"to say, now is it a year, is it 18 months?"},{"startTime":2472.19,"endTime":2473.57,"body":"What does it look like? And"},{"startTime":2473.57,"endTime":2476.39,"body":"what behoves the biopharmaceutical"},{"startTime":2473.57,"endTime":2476.39,"body":"company for starting"},{"startTime":2476.39,"endTime":2479.03,"body":"to engage some of those"},{"startTime":2476.39,"endTime":2479.03,"body":"conversations much earlier than"},{"startTime":2479.03,"endTime":2482.75,"body":"month, say that minimum"},{"startTime":2479.03,"endTime":2482.75,"body":"of hundred 80 days."},{"startTime":2482.75,"endTime":2484.52,"body":"I do think this is one"},{"startTime":2482.75,"endTime":2484.52,"body":"of those times too that,"},{"startTime":2484.52,"endTime":2486.71,"body":"that thinks about the direct engagement"},{"startTime":2486.71,"endTime":2489.89,"body":"between biopharmaceutical,"},{"startTime":2486.71,"endTime":2489.89,"body":"med tech and payers."},{"startTime":2489.89,"endTime":2491.78,"body":"But I think there's so"},{"startTime":2489.89,"endTime":2491.78,"body":"much of those elements"},{"startTime":2491.78,"endTime":2493.95,"body":"behind the scenes that we tend to work on"},{"startTime":2493.95,"endTime":2495.54,"body":"with our partners from MedTech"},{"startTime":2495.54,"endTime":2497.61,"body":"and biopharmaceutical companies as well."},{"startTime":2497.61,"endTime":2499.89,"body":"And I think we start to"},{"startTime":2497.61,"endTime":2499.89,"body":"see these really nice close"},{"startTime":2499.89,"endTime":2503.4,"body":"alignments and synergies"},{"startTime":2499.89,"endTime":2503.4,"body":"with our HUR friends as well"},{"startTime":2503.4,"endTime":2505.53,"body":"as those of us that kind of"},{"startTime":2503.4,"endTime":2505.53,"body":"sit on the market access side"},{"startTime":2505.53,"endTime":2507.69,"body":"of the fence to really"},{"startTime":2505.53,"endTime":2507.69,"body":"start to think about"},{"startTime":2507.69,"endTime":2510.03,"body":"what is the evidence that's"},{"startTime":2507.69,"endTime":2510.03,"body":"going to move the needle,"},{"startTime":2510.03,"endTime":2511.8,"body":"what do we need to think"},{"startTime":2510.03,"endTime":2511.8,"body":"about, what do we need"},{"startTime":2511.8,"endTime":2513.78,"body":"to communicate, what do"},{"startTime":2511.8,"endTime":2513.78,"body":"we actually need to go try"},{"startTime":2513.78,"endTime":2516.9,"body":"to procure if you'll throughout"},{"startTime":2513.78,"endTime":2516.9,"body":"the development process"},{"startTime":2516.9,"endTime":2519.0,"body":"to make sure that that value story"},{"startTime":2519.0,"endTime":2521.76,"body":"and that value creation is"},{"startTime":2519.0,"endTime":2521.76,"body":"as well rounded as possible"},{"startTime":2521.76,"endTime":2523.08,"body":"for us payer audiences."},{"startTime":2525.45,"endTime":2527.61,"body":"- Thank you Rory."},{"startTime":2525.45,"endTime":2527.61,"body":"- My,"},{"startTime":2527.61,"endTime":2530.55,"body":"my wife runs our household"},{"startTime":2527.61,"endTime":2530.55,"body":"under a no surprise rule."},{"startTime":2530.55,"endTime":2532.38,"body":"We don't want any"},{"startTime":2530.55,"endTime":2532.38,"body":"surprises in our household"},{"startTime":2533.25,"endTime":2535.65,"body":"payers the same way payers"},{"startTime":2533.25,"endTime":2535.65,"body":"don't want to get surprised."},{"startTime":2535.65,"endTime":2536.85,"body":"And there have been some,"},{"startTime":2536.85,"endTime":2538.68,"body":"some launches over the last 20 years"},{"startTime":2538.68,"endTime":2540.6,"body":"that have actually surprised payers"},{"startTime":2540.6,"endTime":2544.05,"body":"and surprise payers by, by"},{"startTime":2540.6,"endTime":2544.05,"body":"how much things cost and,"},{"startTime":2544.05,"endTime":2547.44,"body":"and how impactful within the"},{"startTime":2544.05,"endTime":2547.44,"body":"population it was going to be."},{"startTime":2548.49,"endTime":2550.95,"body":"Payers are better at this"},{"startTime":2548.49,"endTime":2550.95,"body":"now, they're not perfect."},{"startTime":2550.95,"endTime":2553.17,"body":"So operate under the no surprise rule."},{"startTime":2553.17,"endTime":2556.32,"body":"If you're going to see an A"},{"startTime":2553.17,"endTime":2556.32,"body":"WP change, a WAC change,"},{"startTime":2556.32,"endTime":2558.3,"body":"educate the payer in advance as much"},{"startTime":2558.3,"endTime":2561.0,"body":"as you can about what's"},{"startTime":2558.3,"endTime":2561.0,"body":"going to happen as a payer,"},{"startTime":2561.0,"endTime":2563.7,"body":"you're underwriting your"},{"startTime":2561.0,"endTime":2563.7,"body":"business for three years."},{"startTime":2563.7,"endTime":2565.92,"body":"So I'm trying to forecast"},{"startTime":2563.7,"endTime":2565.92,"body":"what's going to happen"},{"startTime":2565.92,"endTime":2567.75,"body":"three years from now."},{"startTime":2567.75,"endTime":2570.18,"body":"I, I can barely forecast what's"},{"startTime":2567.75,"endTime":2570.18,"body":"going to happen next week in"},{"startTime":2570.18,"endTime":2571.53,"body":"the US right now,"},{"startTime":2571.53,"endTime":2573.72,"body":"but I'm trying to forecast"},{"startTime":2571.53,"endTime":2573.72,"body":"over three years of"},{"startTime":2573.72,"endTime":2575.01,"body":"what the spends going to be."},{"startTime":2575.01,"endTime":2577.83,"body":"And so I'm working with my"},{"startTime":2575.01,"endTime":2577.83,"body":"biopharma partners to try"},{"startTime":2577.83,"endTime":2581.04,"body":"to understand what your, what"},{"startTime":2577.83,"endTime":2581.04,"body":"is your drug going to do today?"},{"startTime":2581.04,"endTime":2582.42,"body":"What's it going to be priced at?"},{"startTime":2582.42,"endTime":2584.13,"body":"What's the impact of my population?"},{"startTime":2584.13,"endTime":2586.08,"body":"What are you going to"},{"startTime":2584.13,"endTime":2586.08,"body":"do next year, the year"},{"startTime":2586.08,"endTime":2588.3,"body":"after with your expanding indications?"},{"startTime":2588.3,"endTime":2590.49,"body":"Really try to operate under"},{"startTime":2588.3,"endTime":2590.49,"body":"a no surprise rule And,"},{"startTime":2590.49,"endTime":2593.19,"body":"and Dan, Dan hit it"},{"startTime":2590.49,"endTime":2593.19,"body":"within six months of P dfa"},{"startTime":2593.19,"endTime":2596.01,"body":"if you're going to make"},{"startTime":2593.19,"endTime":2596.01,"body":"some changes to, to whack"},{"startTime":2596.01,"endTime":2600.6,"body":"or a WP get in front of payers"},{"startTime":2596.01,"endTime":2600.6,"body":"in advance if you can and"},{"startTime":2600.6,"endTime":2602.22,"body":"and educate them on what's happening."},{"startTime":2602.22,"endTime":2604.83,"body":"New indications or"},{"startTime":2602.22,"endTime":2604.83,"body":"really important as well."},{"startTime":2604.83,"endTime":2608.1,"body":"It's not a set it and forget"},{"startTime":2604.83,"endTime":2608.1,"body":"it, it's educate the payer"},{"startTime":2608.1,"endTime":2609.15,"body":"and when, when you have"},{"startTime":2609.15,"endTime":2611.01,"body":"opportunities to get in front of 'em."},{"startTime":2611.01,"endTime":2612.66,"body":"And then if you see changes in the data,"},{"startTime":2612.66,"endTime":2613.86,"body":"and this is something I used to work"},{"startTime":2613.86,"endTime":2616.8,"body":"with my biopharma partners"},{"startTime":2613.86,"endTime":2616.8,"body":"on, like what are,"},{"startTime":2616.8,"endTime":2618.21,"body":"what are you seeing in the marketplace?"},{"startTime":2618.21,"endTime":2619.47,"body":"What are you seeing my peers do?"},{"startTime":2619.47,"endTime":2621.93,"body":"What are you seeing with,"},{"startTime":2619.47,"endTime":2621.93,"body":"with spend and trend?"},{"startTime":2621.93,"endTime":2624.15,"body":"And we actually with within"},{"startTime":2621.93,"endTime":2624.15,"body":"the Sigma population,"},{"startTime":2624.15,"endTime":2625.56,"body":"we adjusted one of our programmes"},{"startTime":2625.56,"endTime":2627.0,"body":"because of hey, this is"},{"startTime":2627.0,"endTime":2628.77,"body":"what we're seeing in"},{"startTime":2627.0,"endTime":2628.77,"body":"the marketplace, this is"},{"startTime":2628.77,"endTime":2630.12,"body":"what your data's showing."},{"startTime":2630.12,"endTime":2632.1,"body":"Oh we need to go look at that,"},{"startTime":2630.12,"endTime":2632.1,"body":"let's make some adjustments."},{"startTime":2632.1,"endTime":2635.61,"body":"So get get in front of payers"},{"startTime":2632.1,"endTime":2635.61,"body":"early often. No surprise."},{"startTime":2637.53,"endTime":2639.66,"body":"- Yeah, I really like what you said Rory."},{"startTime":2639.66,"endTime":2642.6,"body":"I mean generally when"},{"startTime":2639.66,"endTime":2642.6,"body":"there's a relationship,"},{"startTime":2642.6,"endTime":2644.64,"body":"like you're having ongoing conversations"},{"startTime":2644.64,"endTime":2647.58,"body":"and a lot of times what"},{"startTime":2644.64,"endTime":2647.58,"body":"I found is that it's kind"},{"startTime":2647.58,"endTime":2651.21,"body":"of regular pipeline updates"},{"startTime":2647.58,"endTime":2651.21,"body":"so they know in advance, okay,"},{"startTime":2651.21,"endTime":2655.14,"body":"big picture wise, you know,"},{"startTime":2651.21,"endTime":2655.14,"body":"what do things look like?"},{"startTime":2655.14,"endTime":2657.0,"body":"And then as a product"},{"startTime":2655.14,"endTime":2657.0,"body":"gets closer to launch,"},{"startTime":2657.0,"endTime":2659.94,"body":"you start moving into more"},{"startTime":2657.0,"endTime":2659.94,"body":"detailed pre-engagement"},{"startTime":2659.94,"endTime":2663.66,"body":"exchanges, focus more on"},{"startTime":2659.94,"endTime":2663.66,"body":"one particular product."},{"startTime":2663.66,"endTime":2666.12,"body":"And then definitely once a"},{"startTime":2663.66,"endTime":2666.12,"body":"product does come to market,"},{"startTime":2666.12,"endTime":2668.97,"body":"that's where you start really"},{"startTime":2666.12,"endTime":2668.97,"body":"focusing on those bims some"},{"startTime":2668.97,"endTime":2670.65,"body":"of the economic stories."},{"startTime":2670.65,"endTime":2672.67,"body":"And then I really like what"},{"startTime":2670.65,"endTime":2672.67,"body":"Rory said just in terms"},{"startTime":2672.67,"endTime":2674.74,"body":"of thinking about the"},{"startTime":2672.67,"endTime":2674.74,"body":"expanding indications"},{"startTime":2674.74,"endTime":2677.47,"body":"and really starting to"},{"startTime":2674.74,"endTime":2677.47,"body":"share insights as well"},{"startTime":2677.47,"endTime":2678.73,"body":"with payers in terms of, okay,"},{"startTime":2678.73,"endTime":2681.19,"body":"what are biopharma"},{"startTime":2678.73,"endTime":2681.19,"body":"companies seeing out there"},{"startTime":2681.19,"endTime":2682.39,"body":"in the marketplace?"},{"startTime":2682.39,"endTime":2684.46,"body":"So that exchange, that"},{"startTime":2682.39,"endTime":2684.46,"body":"information exchange,"},{"startTime":2684.46,"endTime":2687.13,"body":"really thinking about like"},{"startTime":2684.46,"endTime":2687.13,"body":"how do we optimise, you know,"},{"startTime":2687.13,"endTime":2688.63,"body":"the outcomes of that product in"},{"startTime":2688.63,"endTime":2691.21,"body":"that payer's population is an example."},{"startTime":2691.21,"endTime":2694.57,"body":"So it really should be an"},{"startTime":2691.21,"endTime":2694.57,"body":"ongoing conversation as opposed"},{"startTime":2694.57,"endTime":2696.43,"body":"to just a start and a stop."},{"startTime":2696.43,"endTime":2698.17,"body":"And I think in that way I think it's,"},{"startTime":2698.17,"endTime":2699.73,"body":"it's a good foundation in terms"},{"startTime":2699.73,"endTime":2703.33,"body":"of really bringing like"},{"startTime":2699.73,"endTime":2703.33,"body":"two key players together"},{"startTime":2703.33,"endTime":2705.4,"body":"that are really working hard"},{"startTime":2703.33,"endTime":2705.4,"body":"to try to provide, you know,"},{"startTime":2705.4,"endTime":2706.96,"body":"benefits for patients with some"},{"startTime":2706.96,"endTime":2708.34,"body":"of these innovative treatments."},{"startTime":2710.53,"endTime":2714.52,"body":"- Thank you. Could we talk"},{"startTime":2710.53,"endTime":2714.52,"body":"a little bit more about the"},{"startTime":2714.52,"endTime":2717.13,"body":"changes that are happening"},{"startTime":2714.52,"endTime":2717.13,"body":"in the payer landscape"},{"startTime":2717.13,"endTime":2720.64,"body":"and what our audience should be aware of?"},{"startTime":2720.64,"endTime":2722.2,"body":"Maybe go to Dan first?"},{"startTime":2724.18,"endTime":2727.99,"body":"- Yeah, I feel like Rory hit"},{"startTime":2724.18,"endTime":2727.99,"body":"it early on is we have a fairly"},{"startTime":2727.99,"endTime":2729.1,"body":"fragmented market."},{"startTime":2729.1,"endTime":2732.49,"body":"We always have. I think there"},{"startTime":2729.1,"endTime":2732.49,"body":"has been an ongoing desire"},{"startTime":2732.49,"endTime":2734.47,"body":"for us to make sure that"},{"startTime":2732.49,"endTime":2734.47,"body":"we can marry pharmacy"},{"startTime":2734.47,"endTime":2738.19,"body":"and me medical a little bit"},{"startTime":2734.47,"endTime":2738.19,"body":"closer in the United States."},{"startTime":2738.19,"endTime":2740.44,"body":"I think anybody with common"},{"startTime":2738.19,"endTime":2740.44,"body":"sense would understand"},{"startTime":2740.44,"endTime":2743.53,"body":"that it's going to be a benefit"},{"startTime":2740.44,"endTime":2743.53,"body":"if you're managing a patient"},{"startTime":2743.53,"endTime":2746.32,"body":"in totality across what's"},{"startTime":2743.53,"endTime":2746.32,"body":"going on in the pharmacy"},{"startTime":2746.32,"endTime":2747.76,"body":"and the medical side."},{"startTime":2747.76,"endTime":2750.22,"body":"That said, I feel like"},{"startTime":2747.76,"endTime":2750.22,"body":"this has been a little bit"},{"startTime":2750.22,"endTime":2752.95,"body":"of Groundhogs Day where we've"},{"startTime":2750.22,"endTime":2752.95,"body":"had this same conversation now"},{"startTime":2752.95,"endTime":2755.14,"body":"for 20 plus years."},{"startTime":2755.14,"endTime":2757.12,"body":"Are we making progress? Yes."},{"startTime":2757.12,"endTime":2759.13,"body":"Is there more progress"},{"startTime":2757.12,"endTime":2759.13,"body":"that we need to make?"},{"startTime":2759.13,"endTime":2761.71,"body":"Yes, I would say that is one of the things"},{"startTime":2761.71,"endTime":2765.46,"body":"that we're seeing from a US"},{"startTime":2761.71,"endTime":2765.46,"body":"market standpoint is so many"},{"startTime":2765.46,"endTime":2768.16,"body":"of the different players"},{"startTime":2765.46,"endTime":2768.16,"body":"in this space all having a"},{"startTime":2768.16,"endTime":2769.9,"body":"concerted effort to try to say"},{"startTime":2769.9,"endTime":2771.94,"body":"how do we have better"},{"startTime":2769.9,"endTime":2771.94,"body":"accessibility to the data?"},{"startTime":2771.94,"endTime":2775.36,"body":"How do we start to understand"},{"startTime":2771.94,"endTime":2775.36,"body":"the patient holistically a"},{"startTime":2775.36,"endTime":2776.83,"body":"little bit better than saying,"},{"startTime":2776.83,"endTime":2779.41,"body":"I simply understand what's"},{"startTime":2776.83,"endTime":2779.41,"body":"happening when they have a"},{"startTime":2779.41,"endTime":2781.63,"body":"medication dispense study pharmacy."},{"startTime":2781.63,"endTime":2783.52,"body":"I honestly have no idea what's going on"},{"startTime":2783.52,"endTime":2784.9,"body":"with their physician office"},{"startTime":2784.9,"endTime":2786.61,"body":"or even with infusible medications."},{"startTime":2786.61,"endTime":2789.49,"body":"That's just not a great system"},{"startTime":2786.61,"endTime":2789.49,"body":"that we've had for years."},{"startTime":2789.49,"endTime":2791.77,"body":"So that, that might be the"},{"startTime":2789.49,"endTime":2791.77,"body":"first thing that I touch on."},{"startTime":2791.77,"endTime":2793.81,"body":"But happy to Shane and Rory go"},{"startTime":2793.81,"endTime":2794.81,"body":"- Farther."},{"startTime":2796.45,"endTime":2799.9,"body":"- Yeah, Dan, I really liked"},{"startTime":2796.45,"endTime":2799.9,"body":"what you were aiming for"},{"startTime":2799.9,"endTime":2802.33,"body":"and so where I'll take"},{"startTime":2799.9,"endTime":2802.33,"body":"it is just thinking about"},{"startTime":2802.33,"endTime":2803.86,"body":"vertical integration."},{"startTime":2803.86,"endTime":2805.72,"body":"I think it's a story"},{"startTime":2803.86,"endTime":2805.72,"body":"that everyone continues"},{"startTime":2805.72,"endTime":2808.42,"body":"to talk about is some"},{"startTime":2805.72,"endTime":2808.42,"body":"of that consolidation."},{"startTime":2808.42,"endTime":2811.15,"body":"I know we talked a little"},{"startTime":2808.42,"endTime":2811.15,"body":"bit about the big three"},{"startTime":2811.15,"endTime":2814.24,"body":"and it just feels like everything"},{"startTime":2811.15,"endTime":2814.24,"body":"just keeps getting bigger"},{"startTime":2814.24,"endTime":2818.59,"body":"and the marketplace is, is"},{"startTime":2814.24,"endTime":2818.59,"body":"condensing in certain facets."},{"startTime":2818.59,"endTime":2820.87,"body":"And I think part of what's driving that is"},{"startTime":2820.87,"endTime":2822.85,"body":"what Dan talked a little"},{"startTime":2820.87,"endTime":2822.85,"body":"bit about is just really"},{"startTime":2822.85,"endTime":2825.16,"body":"understanding the patient"},{"startTime":2822.85,"endTime":2825.16,"body":"more holistically."},{"startTime":2825.16,"endTime":2827.23,"body":"And part of that's just"},{"startTime":2825.16,"endTime":2827.23,"body":"being driven, I think"},{"startTime":2827.23,"endTime":2830.92,"body":"by more value-based care"},{"startTime":2827.23,"endTime":2830.92,"body":"arrangements happening at a variety"},{"startTime":2830.92,"endTime":2834.31,"body":"of different levels, which"},{"startTime":2830.92,"endTime":2834.31,"body":"are really creating some"},{"startTime":2834.31,"endTime":2836.47,"body":"of this vertical integration."},{"startTime":2836.47,"endTime":2839.29,"body":"So I think that that's a"},{"startTime":2836.47,"endTime":2839.29,"body":"really important market dynamic"},{"startTime":2839.29,"endTime":2841.96,"body":"that's going to continue to"},{"startTime":2839.29,"endTime":2841.96,"body":"blossom over the next few years"},{"startTime":2841.96,"endTime":2844.54,"body":"and will certainly change"},{"startTime":2841.96,"endTime":2844.54,"body":"the way I think biopharma"},{"startTime":2844.54,"endTime":2846.58,"body":"companies need to think"},{"startTime":2844.54,"endTime":2846.58,"body":"about engaging with some"},{"startTime":2846.58,"endTime":2847.87,"body":"of these different entities."},{"startTime":2851.035,"endTime":2853.88,"body":"- I I'm going to, I'm going to add"},{"startTime":2851.035,"endTime":2853.88,"body":"a little bit from what we kind"},{"startTime":2853.88,"endTime":2855.32,"body":"of kicked the conversation off with."},{"startTime":2855.32,"endTime":2859.82,"body":"So, and the, the end payer"},{"startTime":2855.32,"endTime":2859.82,"body":"in a lot of, in a lot of the,"},{"startTime":2859.82,"endTime":2863.24,"body":"in the, a lot of the US"},{"startTime":2859.82,"endTime":2863.24,"body":"right now is employers"},{"startTime":2863.24,"endTime":2866.18,"body":"and employers don't have a"},{"startTime":2863.24,"endTime":2866.18,"body":"lot of line of sight into"},{"startTime":2866.18,"endTime":2868.97,"body":"what they're actually"},{"startTime":2866.18,"endTime":2868.97,"body":"paying for medication"},{"startTime":2868.97,"endTime":2870.62,"body":"and costs keep going up"},{"startTime":2870.62,"endTime":2872.27,"body":"and outcomes aren't necessarily"},{"startTime":2872.27,"endTime":2874.55,"body":"changing and that's a problem."},{"startTime":2874.55,"endTime":2879.55,"body":"And employers and going, going"},{"startTime":2874.55,"endTime":2879.55,"body":"into 2025 out of 2024 and,"},{"startTime":2879.59,"endTime":2881.54,"body":"and, and some of the"},{"startTime":2879.59,"endTime":2881.54,"body":"federal investigations,"},{"startTime":2881.54,"endTime":2885.05,"body":"there's been a push for,"},{"startTime":2881.54,"endTime":2885.05,"body":"for more transparency and,"},{"startTime":2885.05,"endTime":2887.12,"body":"and you've seen this from, from some"},{"startTime":2887.12,"endTime":2889.37,"body":"of the reports on on gross to net"},{"startTime":2889.37,"endTime":2892.61,"body":"and how how PBMs are, are making money"},{"startTime":2892.61,"endTime":2896.57,"body":"and the shift away from"},{"startTime":2892.61,"endTime":2896.57,"body":"rebates over to specialty drugs"},{"startTime":2896.57,"endTime":2900.62,"body":"specifically within their own"},{"startTime":2896.57,"endTime":2900.62,"body":"SP and some of the cha there."},{"startTime":2900.62,"endTime":2902.93,"body":"And, and then we see this also push for,"},{"startTime":2902.93,"endTime":2905.6,"body":"for less high whack, high"},{"startTime":2902.93,"endTime":2905.6,"body":"rebate products, right?"},{"startTime":2905.6,"endTime":2908.57,"body":"If we trend that over the last"},{"startTime":2905.6,"endTime":2908.57,"body":"20 years we're seeing less"},{"startTime":2908.57,"endTime":2910.37,"body":"high whack, high rebate products"},{"startTime":2910.37,"endTime":2912.02,"body":"and there's just an a a sense"},{"startTime":2912.02,"endTime":2914.48,"body":"and a pulse within the"},{"startTime":2912.02,"endTime":2914.48,"body":"employers within the US"},{"startTime":2914.48,"endTime":2917.84,"body":"who are buying this coverage,"},{"startTime":2914.48,"endTime":2917.84,"body":"paying for this coverage"},{"startTime":2917.84,"endTime":2919.34,"body":"that they're demanding more"},{"startTime":2919.34,"endTime":2920.84,"body":"and they're demanding more transparency."},{"startTime":2920.84,"endTime":2923.06,"body":"They want to know what they're"},{"startTime":2920.84,"endTime":2923.06,"body":"actually paying for goods"},{"startTime":2923.06,"endTime":2926.12,"body":"and if they're not seeing"},{"startTime":2923.06,"endTime":2926.12,"body":"the transparency that,"},{"startTime":2926.12,"endTime":2928.4,"body":"that they want or hope"},{"startTime":2926.12,"endTime":2928.4,"body":"they're going to push"},{"startTime":2928.4,"endTime":2930.29,"body":"for a more fractionated system."},{"startTime":2930.29,"endTime":2932.6,"body":"And we've seen this actually from,"},{"startTime":2932.6,"endTime":2934.58,"body":"from some large regional plans"},{"startTime":2932.6,"endTime":2934.58,"body":"that are saying, you know"},{"startTime":2934.58,"endTime":2936.41,"body":"what, we're going to start,"},{"startTime":2934.58,"endTime":2936.41,"body":"we're we're going to blow it up"},{"startTime":2936.41,"endTime":2937.85,"body":"and try to try it again."},{"startTime":2937.85,"endTime":2940.64,"body":"Will they have se success? I don't know."},{"startTime":2940.64,"endTime":2942.86,"body":"But there is a shift in"},{"startTime":2940.64,"endTime":2942.86,"body":"the US marketplace and,"},{"startTime":2942.86,"endTime":2945.14,"body":"and some of this is as a result of,"},{"startTime":2945.14,"endTime":2948.26,"body":"of some pending legislation,"},{"startTime":2945.14,"endTime":2948.26,"body":"some investigations"},{"startTime":2948.26,"endTime":2951.5,"body":"and just employers generally unhappy"},{"startTime":2951.5,"endTime":2953.435,"body":"with their current"},{"startTime":2951.5,"endTime":2953.435,"body":"arrangement with their PBMs."},{"startTime":2956.33,"endTime":2958.49,"body":"- Okay. It's interesting."},{"startTime":2958.49,"endTime":2960.44,"body":"Anyone else got anything"},{"startTime":2958.49,"endTime":2960.44,"body":"else to add there?"},{"startTime":2962.685,"endTime":2964.94,"body":"- I would say the thing that"},{"startTime":2962.685,"endTime":2964.94,"body":"we probably need three extra"},{"startTime":2964.94,"endTime":2967.185,"body":"hours to talk about is"},{"startTime":2964.94,"endTime":2967.185,"body":"policy change in the US"},{"startTime":2967.185,"endTime":2968.54,"body":"and how impactful that is."},{"startTime":2968.54,"endTime":2971.96,"body":"So I think that's a whole nother"},{"startTime":2968.54,"endTime":2971.96,"body":"series of webinars, Louise,"},{"startTime":2971.96,"endTime":2974.69,"body":"but obviously I think it's"},{"startTime":2971.96,"endTime":2974.69,"body":"a miss if we don't at least"},{"startTime":2974.69,"endTime":2977.84,"body":"mention the fact that policy"},{"startTime":2974.69,"endTime":2977.84,"body":"change in the US is so,"},{"startTime":2977.84,"endTime":2979.25,"body":"so impactful to us payers."},{"startTime":2980.63,"endTime":2982.82,"body":"- Yeah, I agree. I was waiting"},{"startTime":2980.63,"endTime":2982.82,"body":"for someone to bring up IRA"},{"startTime":2982.82,"endTime":2984.47,"body":"so I wasn't going to be the one to do it."},{"startTime":2984.47,"endTime":2987.17,"body":"'cause we need a whole"},{"startTime":2984.47,"endTime":2987.17,"body":"new podcast for that."},{"startTime":2987.17,"endTime":2988.94,"body":"Rory, I was waiting for"},{"startTime":2987.17,"endTime":2988.94,"body":"you to talk about"},{"startTime":2989.78,"endTime":2991.25,"body":"PBM reform, right?"},{"startTime":2991.25,"endTime":2992.975,"body":"Or 340 B reforms."},{"startTime":2992.975,"endTime":2997.37,"body":"I think all of those potentially"},{"startTime":2992.975,"endTime":2997.37,"body":"huge implications there."},{"startTime":2997.37,"endTime":2999.86,"body":"And then when I was thinking"},{"startTime":2997.37,"endTime":2999.86,"body":"about vertical integration,"},{"startTime":2999.86,"endTime":3002.08,"body":"you could start thinking about"},{"startTime":2999.86,"endTime":3002.08,"body":"things such as site of care."},{"startTime":3002.08,"endTime":3003.13,"body":"I think that's, you know,"},{"startTime":3003.13,"endTime":3006.46,"body":"ongoing issues in an"},{"startTime":3003.13,"endTime":3006.46,"body":"ongoing tactic that payers"},{"startTime":3006.46,"endTime":3008.29,"body":"and PBMs are continuing"},{"startTime":3006.46,"endTime":3008.29,"body":"to leverage, right,"},{"startTime":3008.29,"endTime":3011.35,"body":"when they're thinking about"},{"startTime":3008.29,"endTime":3011.35,"body":"cost containment initiatives."},{"startTime":3011.35,"endTime":3012.4,"body":"So those are just a lot"},{"startTime":3012.4,"endTime":3015.25,"body":"of little tidbits I feel"},{"startTime":3012.4,"endTime":3015.25,"body":"like they're worth at least"},{"startTime":3015.25,"endTime":3016.96,"body":"mentioning on the call,"},{"startTime":3015.25,"endTime":3016.96,"body":"but certainly each one"},{"startTime":3016.96,"endTime":3018.61,"body":"of them deserves its own podcast."},{"startTime":3020.65,"endTime":3024.19,"body":"- Thank you. So I guess"},{"startTime":3020.65,"endTime":3024.19,"body":"maybe we'll move to some"},{"startTime":3024.19,"endTime":3027.8,"body":"of the questions that have"},{"startTime":3024.19,"endTime":3027.8,"body":"been sent in by our today."},{"startTime":3027.8,"endTime":3030.92,"body":"So thank you for sending"},{"startTime":3027.8,"endTime":3030.92,"body":"your questions in advance."},{"startTime":3030.92,"endTime":3034.07,"body":"So we have a few here"},{"startTime":3030.92,"endTime":3034.07,"body":"to share and discuss."},{"startTime":3034.07,"endTime":3037.67,"body":"So the first question"},{"startTime":3034.07,"endTime":3037.67,"body":"we have is in two parts."},{"startTime":3037.67,"endTime":3041.09,"body":"So if we consider a new"},{"startTime":3037.67,"endTime":3041.09,"body":"drug coming to market,"},{"startTime":3041.09,"endTime":3044.45,"body":"what could an impactful"},{"startTime":3041.09,"endTime":3044.45,"body":"evidence package look like"},{"startTime":3044.45,"endTime":3047.15,"body":"to communicate value to payers?"},{"startTime":3047.15,"endTime":3049.82,"body":"And the second part of"},{"startTime":3047.15,"endTime":3049.82,"body":"that question is, if"},{"startTime":3049.82,"endTime":3052.22,"body":"that market already has a few competitors,"},{"startTime":3052.22,"endTime":3054.92,"body":"what would payers consider as meaningful"},{"startTime":3054.92,"endTime":3056.66,"body":"to differentiate that asset?"},{"startTime":3057.65,"endTime":3061.67,"body":"So perhaps I should lead"},{"startTime":3057.65,"endTime":3061.67,"body":"ask Rory to lead on this."},{"startTime":3063.41,"endTime":3065.63,"body":"- I'll take in, I'm going to"},{"startTime":3063.41,"endTime":3065.63,"body":"steal one of shana's answers."},{"startTime":3065.63,"endTime":3068.03,"body":"It depends. It really does."},{"startTime":3068.03,"endTime":3069.47,"body":"It depends on the therapeutic class."},{"startTime":3069.47,"endTime":3070.94,"body":"I think that that that is key."},{"startTime":3072.14,"endTime":3075.26,"body":"Like we, we have a new"},{"startTime":3072.14,"endTime":3075.26,"body":"pain drug in the US and"},{"startTime":3075.26,"endTime":3076.94,"body":"and the opioid epidemic has, has,"},{"startTime":3076.94,"endTime":3078.41,"body":"has been well documented within the"},{"startTime":3078.41,"endTime":3080.6,"body":"United States and, and abroad."},{"startTime":3080.6,"endTime":3084.38,"body":"We, we've got a new agent,"},{"startTime":3080.6,"endTime":3084.38,"body":"this new agent, it, it, it,"},{"startTime":3084.38,"endTime":3087.65,"body":"it's a good agent and it's"},{"startTime":3084.38,"endTime":3087.65,"body":"going to see widespread adoption"},{"startTime":3087.65,"endTime":3089.24,"body":"and payers would like to control this,"},{"startTime":3089.24,"endTime":3090.8,"body":"but they're not going to be able to,"},{"startTime":3090.8,"endTime":3092.69,"body":"they're going to have challenges"},{"startTime":3090.8,"endTime":3092.69,"body":"controlling this pro,"},{"startTime":3092.69,"endTime":3094.07,"body":"this specific product."},{"startTime":3094.07,"endTime":3096.89,"body":"So I, I think it really does depend."},{"startTime":3096.89,"endTime":3100.07,"body":"If it's a new ACE"},{"startTime":3096.89,"endTime":3100.07,"body":"inhibitor for hypertension,"},{"startTime":3100.07,"endTime":3101.51,"body":"payers are going to go"},{"startTime":3100.07,"endTime":3101.51,"body":"back to their p and t"},{"startTime":3101.51,"endTime":3103.88,"body":"and they're going to say,"},{"startTime":3101.51,"endTime":3103.88,"body":"well, it's a may add."},{"startTime":3103.88,"endTime":3106.82,"body":"And what may add means is I'm"},{"startTime":3103.88,"endTime":3106.82,"body":"going to extract as much value"},{"startTime":3106.82,"endTime":3109.61,"body":"as possible in order"},{"startTime":3106.82,"endTime":3109.61,"body":"for you to get coverage."},{"startTime":3109.61,"endTime":3110.78,"body":"And when I benchmark you,"},{"startTime":3110.78,"endTime":3114.98,"body":"I might benchmark you against"},{"startTime":3110.78,"endTime":3114.98,"body":"a a $5 generic product that's,"},{"startTime":3114.98,"endTime":3116.72,"body":"that's widely available."},{"startTime":3116.72,"endTime":3118.88,"body":"If it's oncology, that's"},{"startTime":3116.72,"endTime":3118.88,"body":"something different."},{"startTime":3118.88,"endTime":3121.34,"body":"If it's a first in class agent,"},{"startTime":3118.88,"endTime":3121.34,"body":"that's something different."},{"startTime":3121.34,"endTime":3122.9,"body":"It's for an orphan disease,"},{"startTime":3121.34,"endTime":3122.9,"body":"it doesn't have any other"},{"startTime":3122.9,"endTime":3124.28,"body":"treatments, that's something different."},{"startTime":3124.28,"endTime":3126.89,"body":"And so it really is a"},{"startTime":3124.28,"endTime":3126.89,"body":"disease state dependent,"},{"startTime":3126.89,"endTime":3128.24,"body":"therapeutic care dependent."},{"startTime":3128.24,"endTime":3130.37,"body":"And unfortunately I would"},{"startTime":3128.24,"endTime":3130.37,"body":"like to say, you know"},{"startTime":3130.37,"endTime":3132.65,"body":"what you need to bring"},{"startTime":3130.37,"endTime":3132.65,"body":"this package for for this,"},{"startTime":3132.65,"endTime":3133.76,"body":"it, it's just not the case."},{"startTime":3133.76,"endTime":3135.11,"body":"It really is dependent and,"},{"startTime":3135.11,"endTime":3137.24,"body":"and payers will look"},{"startTime":3135.11,"endTime":3137.24,"body":"at them all differently"},{"startTime":3137.24,"endTime":3139.88,"body":"and they, they look at it"},{"startTime":3137.24,"endTime":3139.88,"body":"from a competitive marketplace"},{"startTime":3139.88,"endTime":3141.29,"body":"environment and,"},{"startTime":3141.29,"endTime":3143.72,"body":"and all payers are going"},{"startTime":3141.29,"endTime":3143.72,"body":"to say the same thing."},{"startTime":3143.72,"endTime":3145.31,"body":"It doesn't matter about the"},{"startTime":3143.72,"endTime":3145.31,"body":"therapeutic area though."},{"startTime":3145.31,"endTime":3148.25,"body":"They will say one thing, and"},{"startTime":3145.31,"endTime":3148.25,"body":"this is really common in order"},{"startTime":3148.25,"endTime":3151.01,"body":"to get access, you've"},{"startTime":3148.25,"endTime":3151.01,"body":"got to give me a rebate."},{"startTime":3151.01,"endTime":3153.89,"body":"Even if underlying they know"},{"startTime":3151.01,"endTime":3153.89,"body":"that you're not going to be able"},{"startTime":3153.89,"endTime":3156.5,"body":"to control spend and trend"},{"startTime":3153.89,"endTime":3156.5,"body":"here, they will come back"},{"startTime":3156.5,"endTime":3159.53,"body":"and say, I don't, I don't"},{"startTime":3156.5,"endTime":3159.53,"body":"care what the data says,"},{"startTime":3159.53,"endTime":3160.76,"body":"you're going to have to give a rebate"},{"startTime":3160.76,"endTime":3162.05,"body":"more to get access for this product."},{"startTime":3165.53,"endTime":3168.44,"body":"- Yeah, I agree with Rory."},{"startTime":3165.53,"endTime":3168.44,"body":"We just Go ahead Dan."},{"startTime":3169.61,"endTime":3173.66,"body":"- No, you go Shana."},{"startTime":3169.61,"endTime":3173.66,"body":"- Yeah, I mean I think Rory,"},{"startTime":3173.66,"endTime":3176.12,"body":"Rory raises a really good point."},{"startTime":3176.12,"endTime":3177.89,"body":"You know, new product comes to market,"},{"startTime":3177.89,"endTime":3180.53,"body":"typically it falls within"},{"startTime":3177.89,"endTime":3180.53,"body":"some type of market basket."},{"startTime":3180.53,"endTime":3182.87,"body":"Rarely are there"},{"startTime":3180.53,"endTime":3182.87,"body":"head-to-head trials, right?"},{"startTime":3183.95,"endTime":3186.2,"body":"So the best you can really"},{"startTime":3183.95,"endTime":3186.2,"body":"do is think about, okay,"},{"startTime":3186.2,"endTime":3189.29,"body":"the design of the clinical"},{"startTime":3186.2,"endTime":3189.29,"body":"trial is that new product coming"},{"startTime":3189.29,"endTime":3191.84,"body":"to market, you know, really"},{"startTime":3189.29,"endTime":3191.84,"body":"was it compared versus"},{"startTime":3191.84,"endTime":3193.58,"body":"standard of care?"},{"startTime":3193.58,"endTime":3195.83,"body":"And then you have to"},{"startTime":3193.58,"endTime":3195.83,"body":"look at the populations"},{"startTime":3195.83,"endTime":3198.56,"body":"and really think hard about,"},{"startTime":3195.83,"endTime":3198.56,"body":"okay, are the benefits from"},{"startTime":3198.56,"endTime":3200.54,"body":"that clinical trial"},{"startTime":3198.56,"endTime":3200.54,"body":"actually going to translate"},{"startTime":3200.54,"endTime":3202.94,"body":"to my specific population?"},{"startTime":3202.94,"endTime":3204.71,"body":"So there's got to be"},{"startTime":3202.94,"endTime":3204.71,"body":"some credibility there"},{"startTime":3204.71,"endTime":3206.28,"body":"that you really believe in the evidence"},{"startTime":3206.28,"endTime":3209.61,"body":"and that it's going to deliver the"},{"startTime":3206.28,"endTime":3209.61,"body":"value that you're expecting."},{"startTime":3209.61,"endTime":3211.47,"body":"And then of course beyond"},{"startTime":3209.61,"endTime":3211.47,"body":"that, I think it's valuable"},{"startTime":3211.47,"endTime":3214.56,"body":"to have conversations around"},{"startTime":3211.47,"endTime":3214.56,"body":"downstream implications."},{"startTime":3214.56,"endTime":3216.84,"body":"So cost offsets as well."},{"startTime":3216.84,"endTime":3218.37,"body":"So again, that comes into line with"},{"startTime":3218.37,"endTime":3219.6,"body":"that affordability picture."},{"startTime":3219.6,"endTime":3222.36,"body":"So starting to think about"},{"startTime":3219.6,"endTime":3222.36,"body":"things like hospitalisation,"},{"startTime":3222.36,"endTime":3225.99,"body":"ER visits or if it's a commercial"},{"startTime":3222.36,"endTime":3225.99,"body":"population thinking about"},{"startTime":3225.99,"endTime":3228.81,"body":"things such as quality of life measures."},{"startTime":3228.81,"endTime":3230.94,"body":"And so while those are softer endpoints"},{"startTime":3230.94,"endTime":3234.21,"body":"and considerations, I think"},{"startTime":3230.94,"endTime":3234.21,"body":"sometimes they're necessary"},{"startTime":3234.21,"endTime":3237.84,"body":"to try to differentiate one"},{"startTime":3234.21,"endTime":3237.84,"body":"product from another product."},{"startTime":3243.515,"endTime":3245.16,"body":"- Does he have a point to raise?"},{"startTime":3246.54,"endTime":3247.8,"body":"- No, Shana stole my thunder."},{"startTime":3247.8,"endTime":3250.98,"body":"I was going to say"},{"startTime":3247.8,"endTime":3250.98,"body":"economic endpoints, while"},{"startTime":3250.98,"endTime":3253.17,"body":"they may seem softer on the surface,"},{"startTime":3253.17,"endTime":3254.67,"body":"provide tremendous value."},{"startTime":3254.67,"endTime":3257.34,"body":"So Shana mentioned several"},{"startTime":3254.67,"endTime":3257.34,"body":"of the different endpoints"},{"startTime":3257.34,"endTime":3259.2,"body":"that we're starting to see"},{"startTime":3257.34,"endTime":3259.2,"body":"more frequently in trials."},{"startTime":3259.2,"endTime":3262.17,"body":"I do think that they're greeted"},{"startTime":3259.2,"endTime":3262.17,"body":"warmly even though they may"},{"startTime":3262.17,"endTime":3265.23,"body":"on the surface look like"},{"startTime":3262.17,"endTime":3265.23,"body":"they're not quite as tangible"},{"startTime":3265.23,"endTime":3266.4,"body":"as some of the clinical endpoints"},{"startTime":3266.4,"endTime":3267.54,"body":"that we're accustomed to seeing."},{"startTime":3268.92,"endTime":3272.64,"body":"- Okay, thank you. So a"},{"startTime":3268.92,"endTime":3272.64,"body":"second question we've had is"},{"startTime":3272.64,"endTime":3274.17,"body":"how best to test"},{"startTime":3274.17,"endTime":3278.22,"body":"and refine value messaging in the us Dan,"},{"startTime":3278.22,"endTime":3279.36,"body":"could you give some insight here?"},{"startTime":3280.95,"endTime":3283.68,"body":"- Absolutely. And you may find"},{"startTime":3280.95,"endTime":3283.68,"body":"some bias in the three of us"},{"startTime":3283.68,"endTime":3286.74,"body":"because we feel very strongly"},{"startTime":3283.68,"endTime":3286.74,"body":"that testing is best done"},{"startTime":3286.74,"endTime":3288.3,"body":"with former payers."},{"startTime":3288.3,"endTime":3292.11,"body":"So especially in a safe"},{"startTime":3288.3,"endTime":3292.11,"body":"space. So let's just talk."},{"startTime":3292.11,"endTime":3295.715,"body":"So as we're developing value"},{"startTime":3292.11,"endTime":3295.715,"body":"stories for us payer audiences,"},{"startTime":3295.715,"endTime":3298.44,"body":"it it is incumbent upon us to make sure"},{"startTime":3298.44,"endTime":3301.53,"body":"that actual payers are"},{"startTime":3298.44,"endTime":3301.53,"body":"looking at those messages."},{"startTime":3301.53,"endTime":3304.35,"body":"I think that is best done when"},{"startTime":3301.53,"endTime":3304.35,"body":"you have a quote unquote safe"},{"startTime":3304.35,"endTime":3305.91,"body":"space to do that in."},{"startTime":3305.91,"endTime":3307.62,"body":"So as you think about"},{"startTime":3305.91,"endTime":3307.62,"body":"the three of us now kind"},{"startTime":3307.62,"endTime":3309.3,"body":"of working on this side"},{"startTime":3307.62,"endTime":3309.3,"body":"of the fence instead of"},{"startTime":3309.3,"endTime":3311.1,"body":"that payer side of the fence, it makes"},{"startTime":3311.1,"endTime":3313.65,"body":"for a much different type of testing"},{"startTime":3313.65,"endTime":3317.61,"body":"that we can go magnitudes of"},{"startTime":3313.65,"endTime":3317.61,"body":"depth deeper of making sure"},{"startTime":3317.61,"endTime":3319.68,"body":"that we're not posturing for a rebate"},{"startTime":3319.68,"endTime":3323.16,"body":"or there's some bias in"},{"startTime":3319.68,"endTime":3323.16,"body":"our responses, if you will,"},{"startTime":3323.16,"endTime":3325.29,"body":"as we're going through some"},{"startTime":3323.16,"endTime":3325.29,"body":"of that testing process"},{"startTime":3325.29,"endTime":3328.59,"body":"that we know exists when we're"},{"startTime":3325.29,"endTime":3328.59,"body":"going to be taking some of that"},{"startTime":3328.59,"endTime":3331.8,"body":"to real payers or, or"},{"startTime":3328.59,"endTime":3331.8,"body":"currently employed payers."},{"startTime":3331.8,"endTime":3335.22,"body":"So what I would say it has"},{"startTime":3331.8,"endTime":3335.22,"body":"been done in a balanced method"},{"startTime":3335.22,"endTime":3338.04,"body":"of saying let's make"},{"startTime":3335.22,"endTime":3338.04,"body":"sure that we're testing"},{"startTime":3338.04,"endTime":3339.6,"body":"through a group like Roche"},{"startTime":3339.6,"endTime":3342.99,"body":"and myself that have had years"},{"startTime":3339.6,"endTime":3342.99,"body":"of experience in this world,"},{"startTime":3342.99,"endTime":3345.9,"body":"but also then testing with"},{"startTime":3342.99,"endTime":3345.9,"body":"currently employed payers"},{"startTime":3345.9,"endTime":3348.72,"body":"to ensure that there's kind"},{"startTime":3345.9,"endTime":3348.72,"body":"of two sides of that story"},{"startTime":3348.72,"endTime":3350.31,"body":"to make sure we're not missing anything."},{"startTime":3350.31,"endTime":3353.91,"body":"But I feel like it's that safe"},{"startTime":3350.31,"endTime":3353.91,"body":"space testing it, it's so,"},{"startTime":3353.91,"endTime":3356.97,"body":"so valuable anytime that"},{"startTime":3353.91,"endTime":3356.97,"body":"we're creating value messages."},{"startTime":3361.385,"endTime":3364.74,"body":"- The the payer model,"},{"startTime":3361.385,"endTime":3364.74,"body":"I'm, I'm going to steal Louise,"},{"startTime":3364.74,"endTime":3365.573,"body":"I'm going to steal it for two"},{"startTime":3365.573,"endTime":3366.36,"body":"seconds then I'll give it to Shane."},{"startTime":3367.53,"endTime":3371.19,"body":"Payer model is changing so rapidly"},{"startTime":3372.33,"endTime":3376.68,"body":"in, in, in 2010, 2011,"},{"startTime":3372.33,"endTime":3376.68,"body":"that the big three ppms"},{"startTime":3376.68,"endTime":3378.51,"body":"that I mentioned earlier"},{"startTime":3376.68,"endTime":3378.51,"body":"that controlled about 80%"},{"startTime":3378.51,"endTime":3380.79,"body":"of the population introduced"},{"startTime":3378.51,"endTime":3380.79,"body":"closed formularies,"},{"startTime":3380.79,"endTime":3383.26,"body":"meaning they were going"},{"startTime":3380.79,"endTime":3383.26,"body":"to start excluding drugs"},{"startTime":3383.26,"endTime":3386.2,"body":"for coverage and they"},{"startTime":3383.26,"endTime":3386.2,"body":"were able to shift a lot"},{"startTime":3386.2,"endTime":3389.11,"body":"of market share over to"},{"startTime":3386.2,"endTime":3389.11,"body":"one product, enter the era"},{"startTime":3389.11,"endTime":3390.73,"body":"of rebates."},{"startTime":3390.73,"endTime":3394.57,"body":"PBM started generating"},{"startTime":3390.73,"endTime":3394.57,"body":"huge revenue from rebates."},{"startTime":3394.57,"endTime":3398.62,"body":"Really impactful year"},{"startTime":3394.57,"endTime":3398.62,"body":"20 10, 20 11, 20 24 was"},{"startTime":3398.62,"endTime":3401.77,"body":"as impactful as 20 10, 20 11."},{"startTime":3401.77,"endTime":3404.95,"body":"And there were a handful of"},{"startTime":3401.77,"endTime":3404.95,"body":"things that happened in 2024"},{"startTime":3404.95,"endTime":3408.19,"body":"that that really changed"},{"startTime":3404.95,"endTime":3408.19,"body":"commercial dynamics."},{"startTime":3408.19,"endTime":3410.95,"body":"And it's really important"},{"startTime":3408.19,"endTime":3410.95,"body":"to understand as a,"},{"startTime":3410.95,"endTime":3414.73,"body":"as a manufacturer coming into"},{"startTime":3410.95,"endTime":3414.73,"body":"the us what those changes are"},{"startTime":3414.73,"endTime":3416.68,"body":"and how they're going"},{"startTime":3414.73,"endTime":3416.68,"body":"to influence coverage"},{"startTime":3416.68,"endTime":3418.18,"body":"of your drug in the future"},{"startTime":3418.18,"endTime":3420.49,"body":"and what strategy that, that,"},{"startTime":3420.49,"endTime":3422.38,"body":"that you should really take on."},{"startTime":3422.38,"endTime":3424.57,"body":"And the only way you can do"},{"startTime":3422.38,"endTime":3424.57,"body":"it is actually with payers."},{"startTime":3424.57,"endTime":3425.86,"body":"So you have to understand what's in the"},{"startTime":3425.86,"endTime":3427.27,"body":"marketplace, what's happening."},{"startTime":3427.27,"endTime":3431.11,"body":"And unfortunately, 2024 does"},{"startTime":3427.27,"endTime":3431.11,"body":"not look like 2015 anymore"},{"startTime":3431.11,"endTime":3432.55,"body":"and you need to come in"},{"startTime":3431.11,"endTime":3432.55,"body":"with a new game plan."},{"startTime":3437.23,"endTime":3439.03,"body":"- Yeah, I think the only"},{"startTime":3437.23,"endTime":3439.03,"body":"thing I'll add since you know,"},{"startTime":3439.03,"endTime":3443.14,"body":"Dan took my point, was really"},{"startTime":3439.03,"endTime":3443.14,"body":"thinking about, you know,"},{"startTime":3443.14,"endTime":3445.45,"body":"typically when you're"},{"startTime":3443.14,"endTime":3445.45,"body":"engaging with a big entity"},{"startTime":3445.45,"endTime":3448.57,"body":"and call it a payer or a"},{"startTime":3445.45,"endTime":3448.57,"body":"health system, what I find is"},{"startTime":3448.57,"endTime":3452.32,"body":"that often there isn't just"},{"startTime":3448.57,"endTime":3452.32,"body":"one specific decision maker."},{"startTime":3452.32,"endTime":3454.45,"body":"Often it's a committee"},{"startTime":3454.45,"endTime":3456.64,"body":"and it could be a committee"},{"startTime":3454.45,"endTime":3456.64,"body":"of clinical people wearing"},{"startTime":3456.64,"endTime":3459.13,"body":"clinical hats and it"},{"startTime":3456.64,"endTime":3459.13,"body":"could be a then layered on"},{"startTime":3459.13,"endTime":3462.25,"body":"with a committee that is"},{"startTime":3459.13,"endTime":3462.25,"body":"wearing more of a financial hat."},{"startTime":3462.25,"endTime":3464.95,"body":"So I point that out simply"},{"startTime":3462.25,"endTime":3464.95,"body":"to say that a lot of times,"},{"startTime":3464.95,"endTime":3468.46,"body":"again, not never one and done"},{"startTime":3464.95,"endTime":3468.46,"body":"conversations with an entity."},{"startTime":3468.46,"endTime":3471.85,"body":"So think about engaging,"},{"startTime":3468.46,"endTime":3471.85,"body":"not just longitudinally,"},{"startTime":3471.85,"endTime":3473.895,"body":"but you've actually got to"},{"startTime":3471.85,"endTime":3473.895,"body":"engage across multiple"},{"startTime":3473.895,"endTime":3475.18,"body":"different stakeholders."},{"startTime":3475.18,"endTime":3477.13,"body":"'cause sometimes those stakeholders,"},{"startTime":3477.13,"endTime":3479.41,"body":"even though they influence decisions,"},{"startTime":3479.41,"endTime":3481.69,"body":"those decisions may not always be aligned."},{"startTime":3481.69,"endTime":3485.98,"body":"So my point to pointing that"},{"startTime":3481.69,"endTime":3485.98,"body":"out is not only, of course,"},{"startTime":3485.98,"endTime":3488.38,"body":"just thinking about what"},{"startTime":3485.98,"endTime":3488.38,"body":"Dan highlighted in terms"},{"startTime":3488.38,"endTime":3491.98,"body":"of really testing messaging"},{"startTime":3488.38,"endTime":3491.98,"body":"against maybe former payers,"},{"startTime":3491.98,"endTime":3494.11,"body":"but also thinking about"},{"startTime":3491.98,"endTime":3494.11,"body":"a little bit of diversity"},{"startTime":3494.11,"endTime":3497.8,"body":"as well in terms of who you're"},{"startTime":3494.11,"endTime":3497.8,"body":"testing that message with."},{"startTime":3497.8,"endTime":3500.86,"body":"So test it with someone"},{"startTime":3497.8,"endTime":3500.86,"body":"with a clinical hat, test it"},{"startTime":3500.86,"endTime":3503.59,"body":"with someone with a financial hat as"},{"startTime":3503.59,"endTime":3505.57,"body":"as a really simple example."},{"startTime":3508.39,"endTime":3510.835,"body":"- Thank you. So thank you all."},{"startTime":3510.835,"endTime":3513.46,"body":"It's been a really"},{"startTime":3510.835,"endTime":3513.46,"body":"interesting discussion today"},{"startTime":3513.46,"endTime":3515.8,"body":"and I thank you to the"},{"startTime":3513.46,"endTime":3515.8,"body":"audience as well for listening"},{"startTime":3515.8,"endTime":3517.69,"body":"to our conversation."},{"startTime":3517.69,"endTime":3519.7,"body":"We will follow up on any of the questions"},{"startTime":3519.7,"endTime":3521.02,"body":"that we didn't cover today,"},{"startTime":3521.02,"endTime":3523.54,"body":"and we're also happy"},{"startTime":3521.02,"endTime":3523.54,"body":"to help signpost anyone"},{"startTime":3523.54,"endTime":3524.77,"body":"to the right place if they want"},{"startTime":3524.77,"endTime":3526.84,"body":"to continue the conversation."},{"startTime":3526.84,"endTime":3528.55,"body":"But just for say thank you again."},{"startTime":3530.14,"endTime":3532.21,"body":"- Thank you for watching. If you'd like"},{"startTime":3532.21,"endTime":3534.97,"body":"to find out more about how we"},{"startTime":3532.21,"endTime":3534.97,"body":"can support your market access"},{"startTime":3534.97,"endTime":3537.58,"body":"goals, get in touch today."},{"startTime":3537.58,"endTime":3541.03,"body":"For more market access"},{"startTime":3537.58,"endTime":3541.03,"body":"insights, follow us on LinkedIn."},{"startTime":3541.985,"endTime":3542.818,"body":"Okay."}]}