Market Access

MMIT Reality Check on Urothelial/Bladder Cancer (Jun 2019)

June 7, 2019

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

According to our recent payer coverage analysis for urothelial/bladder cancer 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 urothelial/bladder cancer treatments shows that under the pharmacy benefit, about 24% of the lives under commercial formularies are covered with utilization management restrictions.

Trends: In April 2019, the FDA gave accelerated approval to the Janssen Pharmaceutical Companies of Johnson & Johnson’s Balversa (erdafitinib).

Radar On Market Access: Oncology Is Experiencing Surge Of Innovation — and Prices

June 6, 2019

The oncology space continued its trend of developing innovative therapies — both those launching and in the pipeline — in 2018. That’s according to a new report from the IQVIA Institute for Human Data Science titled Global Oncology Trends 2019: Therapeutics, Clinical Development and Health System Implications. And while the outlook continues to look promising in terms of the science, it may pose issues to the health care system that need to be resolved in order to take full advantage of next-generation oncology products, AIS Health reported.

The oncology space continued its trend of developing innovative therapies — both those launching and in the pipeline — in 2018. That’s according to a new report from the IQVIA Institute for Human Data Science titled Global Oncology Trends 2019: Therapeutics, Clinical Development and Health System Implications. And while the outlook continues to look promising in terms of the science, it may pose issues to the health care system that need to be resolved in order to take full advantage of next-generation oncology products, AIS Health reported.

The 15 new oncology drugs and one supportive care drug launched last year for 17 tumor types marked a record. “Importantly, one of the new drugs is tissue-agnostic” — Loxo Oncology, Inc. and Bayer Corp.’s Vitrakvi (larotrectinib) — noted Murray Aitken, executive director of the institute, during a May 23 media call to discuss the report’s findings. “Over half of the new drugs are oral therapies, continuing this trend toward more of the targeted, innovative therapies being available in an oral form. Two-thirds of the new drugs have an orphan indication, continuing this trend towards cancer being redefined into narrower segments.”

Among the new drugs, more than half have a predictive biomarker on their label.

“This is a trend, the movement towards precision medicine and the growing role that predictive biomarkers are having, both in the way in which the drugs are tested in the clinic, as well as used in practice, where patients can be tested for a biomarker in advance of being treated with a particular drug,” maintained Aitken.

This level of innovation, however, has meant a surge in spending for these treatments.

Total spending on all oncology drugs, both therapeutics and supportive care products, globally was almost $150 billion, up 12.9% for the year, which “marks the fifth consecutive year of double-digit growth,” said Aitken.

In the U.S., “spending on cancer drugs has doubled since 2013 and exceeded $56 billion in 2018,” he noted.

MMIT Reality Check on Endometriosis (May 2019)

May 31, 2019

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

According to our recent payer coverage analysis for endometriosis 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 endometriosis treatments shows that under the pharmacy benefit, around 46% of the lives under commercial formularies are covered with utilization management restrictions.

Trends: ObsEva SA announced in May 2019 that they initiated the Phase III development program of linzagolix, a novel, orally administered gonadotropin-releasing hormone receptor antagonist, to treat women with endometriosis-associated pain.

MMIT Reality Check on Pain Narcotic Opioid (May 2019)

May 24, 2019

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

According to our recent payer coverage analysis for pain narcotic opioid 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 pain narcotic opioid treatments shows that under the pharmacy benefit, around 43% of the lives under commercial formularies are covered with utilization management restrictions.

Trends: Many brand name products (Xtampza ER, Oxaydo) continue to enter this market despite the numerous generics. Via AIS Health.

Radar On Market Access: Generic Advair May Help Reduce COPD Costs

May 21, 2019

A new generic alternative for GlaxoSmithKline’s Advair Diskus (fluticasone/salmeterol) provides payers with the chance to better manage care in chronic obstructive pulmonary disease (COPD), a condition in which high out-of-pocket costs often lead to lower compliance and an increased risk of hospitalization, AIS Health reported.

A new generic alternative for GlaxoSmithKline’s Advair Diskus (fluticasone/salmeterol) provides payers with the chance to better manage care in chronic obstructive pulmonary disease (COPD), a condition in which high out-of-pocket costs often lead to lower compliance and an increased risk of hospitalization, AIS Health reported.

Advair Diskus, a combination long-acting beta-agonist and an inhaled corticosteroid, has been one of the most common drugs used for COPD, a condition largely dominated by brand products. The generic, marketed by Mylan and approved Jan. 30, joins generics for two additional COPD devices: a generic for Ventolin HFA (albuterol) and one for Proair HFA (albuterol).

All three have the potential to save payers and patients significant money. Charline Shan, R.Ph., vice president, access experience team at payer insights and strategy firm Precision for Value, says plans have multiple options for structuring their formularies with the amount of generic options available.

Generics are typically included, with brand drugs placed on preferred or nonpreferred tiers based on price, “but not all are required or have to be on the formulary since there are many branded and therapeutic equivalent options,” she says.

Most people with COPD are covered by Medicare, and CMS requires that a minimum of two products for each category or class be available on the formulary. However, Medicare Part D plans may also consider additional factors when structuring their formularies for COPD patients, including the total cost of care, and that may lead them to implement more selective branded choices on formularies than commercial plans, Shan says.

MMIT Reality Check on Chronic Idiopathic Constipation (May 2019)

May 17, 2019

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

According to our recent payer coverage analysis for chronic idiopathic constipation 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 chronic idiopathic constipation treatments shows that under the pharmacy benefit, around 41% of the covered lives in commercial formularies are covered without utilization management restrictions.

Trends: This class is heavily contracted, with some PBMs excluding Trulance in favor of the older therapies Linzess and Amitiza. Via AIS Health.