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MMIT Reality Check on Rheumatoid Arthritis (Feb 2019)

February 15, 2019

According to our recent payer coverage analysis for rheumatoid arthritis (RA) treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

According to our recent payer coverage analysis for rheumatoid arthritis (RA) treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT’s team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

Payer Coverage: A review of market access for RA treatments shows that about 73% of the covered lives under the commercial formularies are covered with utilization management restrictions.

Trends: With more biosimilars coming to market to compete against some of the older biologic-based drugs, an industry expert suggests that the RA market will see more competition. Via AIS Health.

Trends That Matter for M&A Activity in Specialty Pharmacy and Infusion Therapy Spaces

February 14, 2019

The specialty pharmacy and infusion therapy spaces have certainly seen their share of merger and acquisition (M&A) activity over the years. Some challenges within those industries may have helped slow down 2018 activity a bit, observes Reg Blackburn, managing director at The Braff Group. And for 2019, we may see more of the same, AIS Health reported.

The specialty pharmacy and infusion therapy spaces have certainly seen their share of merger and acquisition (M&A) activity over the years. Some challenges within those industries may have helped slow down 2018 activity a bit, observes Reg Blackburn, managing director at The Braff Group. And for 2019, we may see more of the same, AIS Health reported.

As far as specialty pharmacy trends in 2018, Blackburn points out that “the largest specialty pharmacies continue to get even larger. Payer- and chain-owned dominate. Most new entity growth is coming from large academic hospitals starting their own specialty pharmacies.”

Direct and indirect remuneration (DIR) fees in Medicare Part D that include rebates and price concessions occurring after the point of sale have been around since the start of that program more than a decade ago.

But they started really becoming an issue for specialty drugs around 2016, and it doesn’t look like that’s changing any time soon.

Within the specialty pharmacy space, M&A activity “was lower than in past years,” he explains. Through third-quarter 2018, The Braff Group recorded eight specialty pharmacy deals, compared with 18 for full-year 2017, 20 for 2016 and 10 for 2015.

Moving forward into 2019, Blackburn expects to see “continued consolidation at a measured pace.” In addition, he says, “smaller independents will remain under pressure for gross margin and closed networks. They will want to exit, but buyers will be limited.”

Within the infusion therapy space over the past year, observes Blackburn, intravenous immune globulin and other specialty infusion products continue to drive revenue growth.

Radar On Market Access: Novel Drugs, High Prices, Ways to Manage Them Remain Hot

February 14, 2019

With the FDA approving multiple novel new therapies over the past couple of years, we should expect to see more of the same moving forward. But that innovation is not cheap, and the pharmaceutical industry likely will continue to offer products at higher price points than ever before, AIS Health reported.

With the FDA approving multiple novel new therapies over the past couple of years, we should expect to see more of the same moving forward. But that innovation is not cheap, and the pharmaceutical industry likely will continue to offer products at higher price points than ever before, AIS Health reported.

As payers struggle to rein in high specialty drug prices, many have turned to copay accumulator programs, and this trend shows no signs of slowing. “There was an increased focus on copay accumulator programs in 2018,” comments Amy Nash, Pharm.D., president of RelianceRx, the specialty pharmacy affiliate of Independent Health. She tells AIS Health she expects to see “further refinement of copay accumulator programs from payers and additional strategies from pharma to prevent them.”

Moving forward, Nash tells AIS Health, “specialty drug price increases will likely continue to be less frequent and at a lower percentage increase than previous years. We will likely see newly approved products priced lower than competitors to drive utilization.”

The industry could see “a handful of novel gene therapies with curative intent,” says Mesfin Tegenu, president of PerformRx. However, as the prices of these drugs and other innovative treatments continue to grow, “The high prices will necessitate a paradigm shift in the way medicines are paid for….Unsustainable price increases [are] forcing new payment models and novel cost controls.”

“Gene therapies may experience the biggest paradigm shift we will see in the near future,” says Jeremy Schafer, Pharm.D., senior vice president, director, payer access solutions at Precision for Value.

In the oncology space, the FDA last year approved the second tissue-agnostic drug: Loxo Oncology, Inc. and Bayer Corp.’s Vitrakvi (larotrectinib).

In 2019, Tegenu tells AIS Health, “We may see many new agents with new mechanisms of action, particularly site-agnostic chemotherapeutic agents….Cancer continues to be the most targeted therapeutic area of focus in terms of drug development.”

Radar On Market Access: Part D Rebate Proposal Might Raise Premiums, Reshape PBMs’ Business Models

February 12, 2019

While a new federal proposal to overhaul the prescription drug rebate system may not be a significant threat to major managed care companies’ bottom lines, it will likely be disruptive for insurers and PBMs alike, AIS Health reported.

While a new federal proposal to overhaul the prescription drug rebate system may not be a significant threat to major managed care companies’ bottom lines, it will likely be disruptive for insurers and PBMs alike, AIS Health reported.

The proposed rule would remove safe-harbor protections under the federal anti-kickback statute for rebates paid by drug manufacturers to PBMs, Part D plans and Medicaid managed care organizations. Instead, it would create two new safe harbors: one for prescription drug discounts offered directly to patients, and one for fixed-fee service arrangements between drug manufacturers and PBMs.

If the proposed rule goes into effect, health insurers will likely have to raise Part D premiums, as they currently use the rebates they get from manufacturers to push premiums down, says Chris Sloan, a director at Avalere. That can be problematic for Part D plans, since one of the main factors they compete on are low premiums.

PBMs, meanwhile, are facing even more disruption, Sloan says. “Figuring out how to transition the revenue that they are receiving in the space now, from a percentage-of-a-rebate-type contract to a fixed-fee agreement with the health plans that [is] not tied to the cost of the drugs, is going to be a pretty monumental change.”

Still, multiple analysts pointed out that a very small piece of those companies’ earnings is likely to be affected by the new rebate rule if it goes into effect.

Based in part on company disclosures, “we estimate the big PBMs’…exposure to all-in rebate retention at [less than] 4% of earnings,” Citi analyst Ralph Giacobbe wrote.

MMIT Reality Check on Type 2 Diabetes (Feb 2019)

February 8, 2019

According to our recent payer coverage analysis for type 2 diabetes treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

According to our recent payer coverage analysis for type 2 diabetes treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT’s team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

Payer Coverage: A review of market access for type 2 diabetes treatments shows that almost half of the lives under the commercial and health exchange formularies have utilization management restrictions.

Trends: Health insurers are targeting diabetes via prevention programs and technology. Via AIS Health.