Market Access

MMIT Reality Check on Glaucoma (Mar 2019)

March 15, 2019

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

According to our recent payer coverage analysis for glaucoma 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 glaucoma treatments shows that under the pharmacy benefit, more than 58% of the lives under commercial formularies are covered without utilization management restrictions.

Trends: Prime Therapeutics LLC’s 2019 National NetResults Formulary excludes Rhopressa (netarsudil solution), a new mechanism of action for glaucoma. Via AIS Health.

MMIT Reality Check on Major Depressive Disorder (Mar 2019)

March 8, 2019

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

According to our recent payer coverage analysis for major depressive disorder 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 major depressive disorder treatments shows that under the pharamcy benefit, more than 47% of the covered lives in commercial formularies have utilization management restrictions.

Trends: In November 2018, CMS issued a proposed rule that would let Medicare Advantage and Part D plans limit coverage of certain drugs in the six “protected classes,” which include antidepressants and antipsychotics. Wall Street analysts viewed the proposal as good news for managed care firms . Via AIS Health.

Perspectives on Biosimilars Market in 2019

March 7, 2019

Biosimilars are one way that payers had hoped to bring down spending on pharmaceuticals, but as of yet, these products have had little impact in the United States. As of mid-January, the FDA had approved 17 biosimilars, but only a handful actually are available in the U.S. However, the products may pick up more traction in 2019, with some significant ones potentially coming to market, AIS Health reported.

Biosimilars are one way that payers had hoped to bring down spending on pharmaceuticals, but as of yet, these products have had little impact in the United States. As of mid-January, the FDA had approved 17 biosimilars, but only a handful actually are available in the U.S. However, the products may pick up more traction in 2019, with some significant ones potentially coming to market, AIS Health reported.

According to Lynn Nishida, R.Ph., vice president of clinical product at WithMe Health, “More biosimilars are in the pipeline, but, sadly, expect continued issues of patent litigations that delay marketing of biosimilars soon after their approval or force biosimilar manufacturers to consider launching products at risk” before a lawsuit has been settled, potentially setting themselves up to be responsible for paying damages if they lose the case.

“Biosimilars will face continued slow uptake in utilization; however, there will likely be additional biosimilar approvals with future potential for utilization,” says Amy Nash, Pharm.D., president of RelianceRx, the specialty pharmacy affiliate of Independent Health. “Oncology-related biosimilars will likely have increased utilization.”

Mesfin Tegenu, president of PerformRx, tells AIS Health that he expects “a slow but steady increase in the availability of marketed biosimilars.” Among the biosimilars his company is watching in 2019 are the following:

• Cyltezo (adalimumab-adbm) from Boehringer Ingelheim Pharmaceuticals, Inc.

• Erelzi (etanercept-szzs) from Sandoz Inc.

• Herzuma (trastuzumab-pkrb) from Celltrion Inc.

• Mvasi (bevacizumab-awwb) from Amgen

• Two biosimilar Neupogens (filgrastim)

“I think some doom-and-gloom statements about biosimilars were a bit premature,” Jeremy Schafer, Pharm.D., senior vice president, director, payer access solutions at Precision for Value, says. “Biosimilars have definitely had a challenging market entry, but we need to remember we are still in the early days of a very new industry. In addition, signs indicate that biosimilars in important categories are gaining more traction, and I expect them to continue to do so.”

MMIT Reality Check on Hereditary Angioedema (Mar 2018)

March 1, 2019

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

According to our recent payer coverage analysis for Hereditary Angioedema (HAE) 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: Under the pharmacy benefit, more than 63% of the covered lives under commercial formularies have utilization management restrictions.

Trends: Management of HAE cannot simply be a one-size-fits-all approach, as the condition is variable and patient specific. Via AIS Health.

MMIT Reality Check on HIV (Feb 2019)

February 22, 2019

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

According to our recent payer coverage analysis for HIV 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 HIV treatments shows that under the pharamcy benefit, more than 75% of the covered lives in commercial formularies have utilization management restrictions.

Trends: Contracting is prevalent for drugs in the same HIV grouping, with most activity focused on tiering preference. Patent expirations are expected for single agents. Via AIS Health.

Radar On Market Access: PBMs Prepare for Big Changes Tied to Part D Rebate Rule

February 21, 2019

Nearly two weeks after the Trump administration issued a proposed rule that would effectively overhaul the prescription drug rebate system, the dust has still not settled in the PBM sector as firms brace for a seismic shift in how they do business, AIS Health reported.

Nearly two weeks after the Trump administration issued a proposed rule that would effectively overhaul the prescription drug rebate system, the dust has still not settled in the PBM sector as firms brace for a seismic shift in how they do business, 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. It would also 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 rule is enacted, “the entire Part D and Managed Medicaid pharmacy management industry would have to change,” Mike Kolar, senior vice president and general counsel of Prime Therapeutics, LLC, tells AIS Health. “Prime, and other PBMs, will need to develop new tools and methods to continue to negotiate price on behalf of millions of members,” he adds.

What might these changes look like? In lieu of negotiating for rebates, PBMs might have to start negotiating up-front “discounts” with manufacturers that are reflected at the point of sale and begin working with pharmacies to ensure that these discounts are reflected in member transactions, Kolar says. “We would also need to adjust our relationships with manufacturers for services and data to fall under the requirements of the new safe harbor for PBM compensation.”

Kolar adds that Prime is “concerned about the adverse economic impacts of the proposal,” as it could raise Medicare Part D premiums and government program costs.

Dea Belazi, president and CEO of specialty-pharmacy-focused PBM AscellaHealth, says the new proposal, if enacted, “is going to be a revenue hit” for his company, “because it is dollars that come in that will no longer come in if this goes through.” But it’s certainly not going to put the PBM out of business, he adds.