RxEconomics Logo - Health Economics and Outcomes Research Consultancy specializing in AI-driven analytics

Health Policy & Market Access Consulting

Payers decide what gets covered, how it gets reimbursed, and what evidence it takes to earn formulary position. We help you win those decisions. RxEconomics pairs rigorous health economics with AI-accelerated analytics to build the payer evidence, reimbursement strategy, and health technology assessment (HTA) responses your product needs—typically 3× faster than traditional consultancies, without sacrificing rigor.

Market access today is a moving target. Medicare drug price negotiation is rewriting launch economics. Most-favored-nation (MFN) pricing has jumped from executive order to signed manufacturer deals. 340B, Medicaid rebates, and state affordability boards keep shifting the net-price floor beneath your commercial strategy. You need a partner who models these forces quantitatively—not one who summarizes the trade press. With 28+ years of experience and 120+ publications & research reports behind our work, we deliver policy and market access analysis with peer-reviewed rigor at AI speed.

Market Access Strategy Built on Payer Evidence

Every coverage decision comes down to a value question: does this product deliver enough clinical and economic benefit, at this price, for this population? Answering it requires the full HEOR toolkit—cost-effectiveness analysis, budget impact modeling, real-world evidence, and comparative effectiveness research—translated into the language payers, pharmacy and therapeutics committees, and HTA bodies actually use.

That is where a boutique HEOR firm outperforms a generalist market access shop. We do not hand off your economic model to a separate team; the economist who builds it is the economist who helps you defend it. Our health economics and outcomes research services supply the evidence engine, and this practice puts that evidence to work across pricing, reimbursement, and policy strategy.

Our Health Policy & Market Access Services

Pricing Strategy

  • Launch price positioning and price-corridor analysis
  • Gross-to-net modeling across rebates, discounts, and 340B exposure
  • Price-elasticity and demand modeling for pricing scenarios
  • International reference pricing and MFN exposure assessment
  • Value-based and indication-based pricing analysis

Reimbursement Pathways

  • Reimbursement landscape assessment across commercial, Medicare, and Medicaid channels
  • Formulary positioning and utilization management strategy
  • Benefit design and cost-sharing impact analysis
  • Coding, coverage, and payment pathway mapping
  • Value-based contracting strategy and outcomes-based agreement design

HTA Response & Payer Submissions

  • Health technology assessment (HTA) support and dossier development
  • AMCP Format dossier preparation and payer evidence packages
  • Response strategy for ICER and other value-framework reviews
  • Cost-effectiveness and budget impact models built to HTA methodological standards

Policy Analysis & Forecasting

  • Inflation Reduction Act (IRA) impact modeling, including Medicare Drug Price Negotiation exposure
  • Most-favored-nation (MFN) pricing scenario analysis
  • 340B program economics and contract pharmacy policy assessment
  • Medicaid rebate and best-price modeling
  • Disease-specific policy and budget-impact modeling, including hepatitis C treatment policy
  • Legislative and regulatory impact analysis with quantified fiscal estimates
  • Coverage mandate and preventive services policy evaluation

Value Communication

  • Value proposition development for payer, provider, and employer audiences
  • Global and U.S. value dossier development
  • Objection-handling evidence for payer negotiations
  • Publication planning and peer-reviewed dissemination of value evidence

Evidence Planning

  • Payer evidence requirements analysis by market segment
  • Integrated evidence generation planning across the product lifecycle
  • Real-world evidence study design to close payer evidence gaps
  • Post-launch value demonstration and outcomes tracking

How We Do the Work: Methodology You Can Defend

Market access claims survive scrutiny only when the methods underneath them do. Our models follow recognized good-practice standards for cost-effectiveness and budget impact analysis, and our policy evaluations use the econometric designs that health economists trust: difference-in-differences and event-study designs for policy shocks, elasticity-based demand models for pricing and cost-sharing changes, and microsimulation for population-level fiscal estimates. When we project how a rebate change or negotiation cycle flows through gross-to-net economics, we show the assumptions, the sensitivity analyses, and the uncertainty—so your team can defend every number in front of a payer, a board, or a congressional staffer.

This is the same standard we hold in print. Our founder's research on prescription drug economics has appeared in Health Affairs, Medical Care, The American Journal of Managed Care, and the American Economic Review—including work on how increased prescription drug use reduces medical costs in Medicaid populations and, more recently, "The Price of Progress: Understanding Innovation and Affordability of Prescription Drugs" in The American Journal of Managed Care. When your market access argument rests on our analysis, it rests on methods that have cleared peer review.

Most-Favored-Nation Pricing: From Executive Order to Signed Deals

MFN pricing moved faster than most manufacturers planned for. When the May 2025 executive order pledged that American patients would pay no more than the lowest price among comparably developed countries, we published a same-cycle analysis of how most-favored-nation drug pricing works and what it means for U.S. patients—the mechanics, the legal questions, and what each stakeholder should do next. When the first manufacturer deal arrived that September, we followed with an assessment of TrumpRx economics, from prediction to reality, examining what partial compliance actually means for Medicaid, commercial insurance, and global drug pricing.

That chronology is the point: we analyze policy as it breaks, not after the consensus forms. For your portfolio, we translate MFN developments into product-level exposure estimates—which assets face international reference pricing pressure, how direct-to-consumer channels change your net-price math, and where negotiation leverage actually sits.

The IRA and Medicare Drug Price Negotiation

The Inflation Reduction Act permanently changed U.S. pharmaceutical pricing strategy. Medicare Drug Price Negotiation is now producing maximum fair prices, with successive cycles pulling more drugs into scope. The Part D redesign shifted liability toward plans and manufacturers and capped beneficiary out-of-pocket spending, reshaping formulary incentives. Inflation rebates penalize price increases above CPI. Each provision interacts with the others—and with your commercial book—in ways that simple rules of thumb miss.

We build IRA impact models that quantify your exposure: negotiation-eligibility timelines by asset, revenue-at-risk scenarios under plausible maximum fair prices, Part D liability shifts, and the strategic implications for launch sequencing and indication strategy. Because our AI-enhanced HEOR workflow compresses the modeling cycle, you get defensible scenario analysis in weeks—in time to inform the decision, not to document it afterward.

Results That Reach the Decision

Policy analysis matters only if it reaches the people deciding. Roebuck-authored research has a documented record of doing exactly that.

Federal Rulemaking Evidence

Roebuck-authored research has been cited in five Federal Register rulemaking documents: the 2024 proposed and 2025 final HHS health-information-technology rules, the 2023 proposed and 2024 final Mental Health Parity and Addiction Equity Act rules, and the Department of Labor's 2018 proposed Association Health Plans rule.

Congressional Testimony

Dr. Roebuck's medication-adherence and Medicare medical-offset findings were cited in witness testimony submitted to the U.S. Senate HELP Committee, and his EBRI site-of-care research was cited in 2026 written witness testimony before the House Energy and Commerce Subcommittee on Health addressing hospital outpatient pricing and site-neutral payment reform.

Hepatitis C Policy Modeling

RxEconomics has built hepatitis C policy and budget-impact models for Medicaid and federal-policy questions—including published Medicaid burden-of-illness and direct-acting antiviral cost-offset research in The American Journal of Managed Care with a subsequent economic model update, and a confidential policy-analysis model addressing the Cure Hepatitis C Act.

These examples document use of the research. They do not imply that any single study was the sole basis for a regulation, recommendation, policy, or product.

Why RxEconomics

RxEconomics was founded in 2011 by Dr. M. Christopher Roebuck, PhD, MBA, President & CEO, who brings 28+ years of experience spanning pharmaceutical, payer, and policy sectors—including service as Director of Strategic Research at CVS Caremark, where payer evidence strategy was the day job, not a slide in a capabilities deck. His research is widely cited and published in the field's leading journals, with a verified Google Scholar profile and ORCID record behind every citation.

As a boutique firm based in Miami—serving 50+ clients and institutional partners nationally since 2011—we offer what larger consultancies cannot: the senior economist who scopes your engagement is the one who does the work. You get direct, expert-level guidance, exceptional accuracy, and a response within one business day. And when market access disputes escalate into litigation—pricing challenges, coverage disputes, or regulatory matters—our healthcare economic expert witness services carry the same analysis into the courtroom.

Frequently Asked Questions

A health technology assessment is a structured evaluation of a health technology’s clinical effectiveness, safety, and economic value, used by payers and government bodies to inform coverage, reimbursement, and pricing decisions. HTA bodies typically weigh evidence from clinical trials, real-world studies, cost-effectiveness analyses, and budget impact models. In the U.S., organizations such as ICER perform value assessments that increasingly influence payer negotiations, while formal HTA agencies drive national reimbursement decisions in many other markets. We support HTA engagement end to end—building the economic models, assembling the evidence package, and developing response strategy when an assessment challenges your product’s value.

A value dossier is the organized evidence package that supports your product’s value proposition to payers. A strong dossier typically includes the disease burden and unmet need, the clinical evidence base, economic evidence (cost-effectiveness and budget impact analyses), real-world evidence, and the product value messages each element supports. In the U.S., the AMCP Format is the standard structure payers expect. We develop dossiers with the economic sections built by the economists who created the underlying models—so the evidence is coherent, current, and defensible rather than assembled from disconnected vendor deliverables.

HEOR evidence gives negotiations an objective anchor. Cost-effectiveness analysis frames price against health gained; budget impact modeling answers the payer’s first question—what this costs the plan over the next one to three years; and real-world evidence demonstrates that trial results hold up in the payer’s own population. Well-built evidence converts a price discussion into a value discussion, supports outcomes-based contract terms, and pre-empts the objections utilization management committees raise. Our advantage is speed with rigor: because our AI-enhanced workflow typically delivers results 3× faster, your evidence is ready when the negotiation happens, not a quarter later.

The IRA affects pricing strategy through three main channels. Medicare Drug Price Negotiation sets maximum fair prices for selected high-spend drugs, compressing revenue in the years after selection and changing the calculus on launch price, indication sequencing, and lifecycle planning. Inflation rebates penalize list-price increases above inflation, constraining the traditional price-escalation playbook. And the Part D redesign shifts financial liability toward plans and manufacturers, altering formulary incentives and rebate dynamics. Manufacturers now need quantitative negotiation-exposure modeling from early development onward—we build those models, with scenario analysis your leadership can act on.

Typically 3× faster than traditional consultancies. A focused economic model that would take 12-18 weeks elsewhere is usually complete in 4-6 weeks, and comprehensive real-world evidence generation takes 3-4 months rather than 9-12. For fast-moving policy questions—an executive order, a negotiation announcement, a proposed rule—we can often deliver an initial quantitative assessment within the comment or decision window. Every engagement begins with a scoping conversation, and you will always receive a response within one business day.

Put Payer-Ready Evidence Behind Your Strategy

Whether you are pricing a launch, answering an HTA, or modeling your IRA exposure, the evidence you bring determines the access you get. Tell us the decision you are facing, and we will scope the analysis that wins it—with senior-level attention from day one.

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