Market access

MMIT Reality Check on Multiple Myeloma (October 2022)

A review of market access for multiple myeloma treatments shows that under the pharmacy benefit, about 49% of the lives under commercial formularies are covered with utilization management restrictions. Around 27% of the lives under Medicare formularies are not covered for at least one of the drugs.

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© 2024 MMIT

Companies Should Focus on Patients for Successful Digital Strategies

While the pharmaceutical industry has accepted the importance of digital, implementing it in patient solutions remains a challenge. Manufacturers should prioritize patients’ needs and understand how they can evolve over the course of their treatment journey to offer them accessible and useful solutions, according to industry experts at a recent webinar sponsored by Reuters Events.

One trend within the digital space is tied to the change within the health care landscape and its digital support methods. Most would agree that this is a positive development. But according to Paul Fu, M.D., chief medical information officer at City of Hope, a cancer research and treatment organization, as well as a research center for diabetes and life-threatening diseases, “I think that one of the challenges of being a health care system is that the technology is moving faster than our ability to handle that rate of change. We see that with our patients.”

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MMIT Reality Check on Sickle Cell Disease (September 2022)

A review of market access for sickle cell disease treatments shows that under the pharmacy benefit, about 44% of the lives under commercial formularies are covered with utilization management restrictions. Around 37% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Schizophrenia (September 2022)

A review of market access for schizophrenia treatments shows that under the pharmacy benefit, about 26% of the lives under commercial formularies are covered with utilization management restrictions. Around 17% of the lives under Medicare formularies are not covered for at least one of the drugs.

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Study: Pharma Companies Often Profit From Donations to Patient Assistance Charities

Pharmaceutical companies often profit from their donations to non-profit patient assistance charities that are intended to help people afford high-cost medications, according to a study published in this month’s edition of the journal Health Affairs.

HHS’s Office of Inspector General (OIG) has provided guidance on the charities and cracked down in recent years on several charities and drug manufacturers. However, the authors noted that “the current regulations or enforcement permit donations that violate the spirit of Medicare’s Anti-Kickback Statute,” which prohibits pharma companies from covering Medicare Advantage enrollees’ out-of-pocket drug spending for the drugs they manufacture.

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MMIT Reality Check on Acute Migraine (September 2022)

A review of market access for acute migraine treatments shows that under the pharmacy benefit, about 47% of the lives under commercial formularies are covered with utilization management restrictions. Around 49% of the lives under health exchange formularies are not covered for at least one of the drugs.

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TennCare Acquiesces to CMS’s Demands for Demo Revisions

Bowing to CMS’s request after another public comment period, Tennessee is reluctantly pursuing a series of changes to the pending TennCare III demonstration that had been approved by the Trump administration for a start date of Jan. 8, 2021. In what one source says is an unusual back-and-forth on public display, the state will abandon its notorious plans to implement a closed Medicaid formulary and adopt a fixed funding mechanism.

Shortly before President Joe Biden took office, the Trump administration in January 2021 approved Tennessee’s request to use an “aggregate cap” for Medicaid funding that many industry observers had likened to a block grant. Through that approach, Tennessee would have received federal Medicaid funds based on a fixed budget target that is determined by CMS and the state using historical enrollment and costs data. If spending fell below that target cap but certain quality goals were met, the state would earn up to 55% of annual savings to reinvest back into other state health programs.

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MMIT Reality Check on Breast Cancer HR+/HER2- (September 2022)

A review of market access for treatments of adults with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) shows that under the pharmacy benefit, about 44% of the lives under commercial formularies are covered with utilization management restrictions. Around 33% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Non-Small Cell Lung Cancer Systemic Therapy (August 2022)

A review of market access for non-small cell lung cancer systemic therapy treatments shows that under the pharmacy benefit, about 38% of the lives under commercial formularies are covered with utilization management restrictions. Around 38% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MMIT Reality Check on Ulcerative Colitis (August 2022)

A review of market access for ulcerative colitis treatments shows that under the pharmacy benefit, about 64% of the lives under commercial formularies are covered with utilization management restrictions. Around 34% of the lives under Medicare formularies are not covered for at least one of the drugs.

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© 2024 MMIT