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Sybil Mead

Senior Research Director


Pricing, Reimbursement & Market Access, Research & Insights

Sybil Mead is a senior research director. She directs the Value, Quality and Reimbursement and Delivery of Care services from Health Strategies Insights by EVERSANA. Her expertise is in managed Medicare, on which she led a service for 8 years. She also led the Medicaid Rx Payers, Accountable Care Organizations and Health Insurance Exchanges service and has served as an analyst and consultant on employer market intelligence as well as various custom client engagements.

Last year, Sybil led policy-specific reports affecting pharma government payer access including: Balanced Budget Act (coverage gap fill), Trump Patients First Blueprint, several CMS Medicare announcements including changes to Part D indications-based formulary access, Part B step edits flexibility, Part B international reference pricing, CAPs and reimbursement changes.

Sybil is launching a new Medicare service in 2019 addressing potential effects of rebate transparency and elimination in Part D. A market alert is forthcoming on the implications of VBID expansion and Part D payment modernization models.

Articles by Sybil Mead

How Could Policy Changes to Protected Classes Impact Part D Access and Contracting?

(Content Updated 5/17) CMS Protected Class Rule Finalized, Slightly Loosened for Biopharma Following CMS’ 2018 proposed rule allowing for new protected class exceptions and a comment period for stakeholders through the beginning of this year, CMS has released a final rule addressing the Medicare Part D Protected Classes. The proposed rule allowed plans to restrict their formularies for the six protected classes—anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals (ARVs), and immunosuppressants in several areas. Proposed Rule Final Rule 1.    Broader use of prior authorization and step therapy to control utilization Amended to include only new therapy starts and completely excludes ARVs 2.    exclusions of new formulations of existing sole-source drugs REMOVED 3.    […]

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