Market Access

MMIT Reality Check on Narcolepsy (May 2019)

May 10, 2019

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

According to our recent payer coverage analysis for narcolepsy 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 narcolepsy treatments shows that under the pharmacy benefit, more than 66% of the lives under commercial formularies are covered with utilization management restrictions.

Trends: In March 2019, the FDA approved Jazz Pharmaceuticals plc’s Sunosi (solriamfetol) to improve wakefulness in adults with excessive daytime sleepiness from narcolepsy or obstructive sleep apnea. Via AIS Health.

Radar On Market Access: Magellan Sees Success With Infliximab Biosimilars

May 7, 2019

Magellan Rx Management saw a significant shift in utilization from Janssen Biotech, Inc.’s Remicade (infliximab) to biosimilars after it implemented a comprehensive utilization management (UM) program, resulting in 34% drug cost savings, the PBM reported.

Magellan Rx Management saw a significant shift in utilization from Janssen Biotech, Inc.’s Remicade (infliximab) to biosimilars after it implemented a comprehensive utilization management (UM) program, resulting in 34% drug cost savings, the PBM reported.

The program, which began in late 2017, involves any patient prescribed an infliximab product for any indication, and is available to all payer clients as an opt-in option, Steve Cutts, senior vice president and general manager, tells AIS Health.

When Magellan Rx began the infliximab program in the fourth quarter of 2017, 100% of the PBM’s patients receiving an infliximab product received Remicade and none took biosimilars, the PBM said. In the third quarter of 2018, the last quarter for which Magellan has data, 86% of patients got the biosimilar and 14% took the brand-name drug.

The FDA approved the first infliximab biosimilar, Pfizer, Inc.’s Inflectra (infliximab-dyyb), in April 2016. The agency now lists three approved infliximab biosimilars: Inflectra; Merck & Co., Inc.’s Renflexis (infliximab-abda); and Pfizer’s Ixifi (infliximab-qbtx). Pfizer is not launching Ixifi in the U.S. since it already has Inflectra on the market, so only Inflectra and Renflexis are being sold in the U.S.

Magellan Rx works with both infliximab biosimilar manufacturers, Cutts says, and can “offer multiple options to our clients regarding which biosimilar or combination of biosimilars will work best for their unique situation.”

The Magellan Rx infliximab UM program aims to overcome reluctance on the part of physicians to prescribe biosimilars by emphasizing that they provide the same level of clinical efficacy and safety, with the added benefit of cost savings.

“Likely the most important factor [in the Magellan Rx utilization management program] is obtained provider acceptance that the biosimilar is going to deliver the same results as the innovator product,” says Daniel Malone, R.Ph., Ph.D., professor at the University of Arizona College of Pharmacy.

MMIT Reality Check on Low Testosterone (May 2019)

May 3, 2019

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

According to our recent payer coverage analysis for low testosterone 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 low testosterone treatments due to chronic kidney disease shows that under the pharmacy benefit, about 55% of the lives under commercial formularies are covered with utilization management restrictions.

Trends: In March 2019, the FDA approved Jatenzo (testosterone undecanoate) for the treatment of males with low testosterone levels because of specific genetic disorders or pituitary gland-damaging tumors. Via AIS Health.

MMIT Reality Check on Anemia — Chronic Kidney Disease (Apr 2019)

April 26, 2019

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

According to our recent payer coverage analysis for anemia treatments due to chronic kidney disease, 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 anemia treatments due to chronic kidney disease shows that under the pharmacy benefit, more than 56% of the lives under commercial formularies are covered with utilization management restrictions.

Trends: In October 2018, UnitedHealthcare said that starting Jan. 1, 2019, it would require step therapy prior authorization for Part B covered items that are not preferred for new starts. The plan will prefer biosimilar Retacrit (epoetin alfaepbx) over Procrit (epoetin alfa) and Aranesp (darbepoetin alfa). Via AIS Health.

Radar On Market Access: Copay Accumulators’ Use Rises; Virginia Passes Law Banning Such Programs

April 23, 2019

Payers are continuing to implement copay accumulators and copay maximizers in an effort to counter copay assistance from pharmaceutical manufacturers, according to a recent survey, AIS Health reported.

Payers are continuing to implement copay accumulators and copay maximizers in an effort to counter copay assistance from pharmaceutical manufacturers, according to a recent survey, AIS Health reported.

A Zitter Insights report shows that more than 90 million commercial lives are covered by payers that have a copay accumulator program — and it doesn’t look like these arrangements are going away any time soon.

It also explores the use of a similar kind of program: copay maximizers. Among 51 payer respondents covering 177.9 million lives, payers covering more than 50 million commercial lives have implemented a copay maximizer program. But payers representing 58% of covered lives say they do not have plans to incorporate maximizers within their benefits offerings.

Melinda Haren, a senior consultant at Zitter Insights, notes that accumulators and maximizers are focused on specialty drugs, particularly those products that are adjudicated through the pharmacy benefit.

The savings for payers — and the additional burden on manufacturers — are not insignificant. But drugmakers can do little to limit the use of these programs, at least in the short term, says Haren.

One recent effort may prove to be effective against accumulators: On March 21, Virginia Gov. Ralph Northam (D) signed a law that will go into effect Jan. 1, 2020, which states, in part, “When calculating an enrollee’s overall contribution to any out-of-pocket maximum, deductible, copayment, coinsurance, or other cost-sharing requirement under a health plan, a carrier shall include any amounts paid by the enrollee or paid on behalf of the enrollee by another person.”

This approach to counter accumulators “will likely be effective, at least in the near term,” maintains Jeremy Schafer, Pharm.D., senior vice president of payer access solutions at Precision for Value.

MMIT Reality Check on Ophthalmic Anti-Inflammatory (Apr 2019)

April 19, 2019

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

19

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 ophthalmic anti-Inflammatory treatments shows that under the pharmacy benefit, almost 64% and 42% of the lives under commercial formularies and Medicare formularies are covered without utilization management restrictions, respectively.

Trends: There are numerous products in the ophthalmic anti-inflammatory pipeline; many are new formulations or strengths of the same chemical entity, while only one is a new molecule. Via AIS Health.