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2021 Spotlight on Market Access

Experts: Post-COVID Oncology Strategies Call for Regional Focus, Tactical Shift

August 2nd, 2021

  • U.S. Health Care System Is Recovering From Pandemic, but Concerns Remain
  • Infographic: Medicare ‘Overspent’ by 20% Compared With Costco Prices on Generic Drugs
  • Aduhelm Approval Prompts Backlash From Array of Sources

2021 Spotlight on Market Access

Offering Patients Financial Incentive to Switch Therapies May Become PBM Tool

July 19th, 2021

  • Pilot Program Targets Social Determinants Of Health Barriers for Members With MS
  • Magellan Rx Report Reveals That Medical Drug Spend Continues to Rise
  • Reality Check: Atopic Dermatitis

Pharma Industry Can Help With Employer Challenges in Covering Specialty Drugs

July 5th, 2021

  • Magellan Rx/Trapelo Precision Oncology Solution Aims to Improve Patient Outcomes
  • Moody’s Is Bullish on Pharma Industry for Next 18 Months
  • Infographic: Many Large Employers Want Government to Help Control Health Care Costs

Next-Best Omnichannel Programs Are Transforming Sales, Marketing Teams

June 21st, 2021

  • Multiple Myeloma Continues to Pose Management Challenges for Payers
  • Infographic: Small Business Owners Want Big Changes to Lower Drug Costs
  • Reality Check: Kidney Cancer

Pharma Is Stepping Up Focus on SDoH, Urging Use of Data-Driven Approach

May 3rd, 2021

  • Pharmaceutical Industry Should Undergo Various Steps to Help Rebuild Public Trust
  • Infographic: Health Care Spending Bounces Back but Still Falls 1% Year Over Year
  • CVS-CTCA Pilot Offers In-Home Infusion of Cancer Therapies

Development of COVID-19 Vaccines, Tests, Therapeutics Could Have Broader Impact

March 15th, 2021

  • FDA Approval Makes Breyanzi Third CAR-T Therapy in Non-Hodgkin’s Lymphoma
  • Chart: Oncologists’ Anticipated Site of Administration for CAR-T Therapies Assuming Approval of Liso-Cel
  • Reality Check: Triple-Negative Breast Cancer

Value-Based Pricing Interest Stays High, But Headwinds Could Hamper Uptake

February 1st, 2021

  • Survey Shows That Copay Accumulators And Maximizers Continue to Be Popular
  • Chart: Utilization and Coverage Under Copay Accumulator/ Maximizer Programs
  • Centene Boosts Specialty Drug Expertise With Pair of Deals

Medicaid, Medicare Drug Reimbursement Is Facing Significant Changes in Policy

June 7th, 2021

  • Uncertainties Swirl Around Management, Pricing of COVID Vaccines Post Pandemic
  • Specialty Drug Spending May Be Slowed by Biosimilars
  • Chart: Global Oncology Spending and Growth

People on Specialty Drugs May Need to Alter Dosing When Getting COVID Vaccine

April 19th, 2021

  • FDA Approves New Long-Acting HIV Regimen That Could Help Adherence
  • Infographic: One-Third of U.S. Adults Delayed or Skipped Health Care During Pandemic
  • Reality Check: Migraine Prevention

Pharma Manufacturers Face New Medicaid Landscape as States Carve Out Drug Benefit

March 1st, 2021

  • Medicine’s Evolution Has Brought Novel New Products, Opportunities for Pharma
  • Orgovyx Offers New Oral Option for Prostate Cancer
  • Chart: Oncologists’ Anticipated Prescribing Actions for Relugolix Assuming FDA Approval

Pharma Innovation Is Poised to Continue Beyond COVID Vaccines, Drugs This Year

January 18th, 2021

  • Biosimilars May Be at Risk Depending On Supreme Court’s Affordable Care Act Ruling
  • Infographic: Specialty Drug Spending Continues to Rise, Driven by Higher Utilization
  • Reality Check: Metastatic Prostate Cancer

Research Shows COVID’s Impact on Health Care Has Lessened but Not Disappeared

May 17th, 2021

  • Fotivda Approval Provides New Option for Certain People With Renal Cell Carcinoma
  • Chart: Anticipated Prescribing Actions for Tivozanib Assuming FDA Approval
  • Reality Check: Hereditary Angioedema

FDA’s Evaluation of Certain Cancer Drugs Illustrates Risk/Reward Balance Needed

April 5th, 2021

  • Vaccine Rollout, Ensuing Commercialization Offer Lessons for Pharma, Experts Maintain
  • How Will Biden Administration Handle Copay Accumulators?
  • Infographic: Copay Accumulator Usage Is on the Rise

Shields’ Purchase of Excelera Highlights Integrated Specialty Pharmacy industry

February 15th, 2021

  • Administration Delays Implementation of Rebate Rule; Congress Is Likely to Repeal It
  • Infographic: Hike in Drug List Prices Has Downstream Effect on Patient, Payer Costs
  • Reality Check: Epilepsy

Unsurprisingly, COVID Pandemic and Race For Vaccine Led 2020 Pharma Headlines

January 4th, 2021

  • IDNs Are Spearheading Research Projects To Examine Specialty Pharmacy Outcomes
  • With Oxlumo FDA OK, Alnylam Unveils Value-Based Program
  • Infographic: By the Numbers: The National Health Insurance Market in 2020

2020 Spotlight on Market Access

Administration Issues Drug Pricing Rules That May Have Unintended Outcomes

December 21st, 2020

  • Anthem Oncology Pay-for-Performance Program Boosted Evidence-Based Care
  • Infographic: COVID-19 Causes Unprecedented Drop in Health Care Spending
  • Reality Check: Growth Hormone Deficiency

2020 Spotlight on Market Access

Oncology Care Faces Major Disruption, Changes in Wake of COVID-19 Pandemic

December 7th, 2020

  • Strategies Can Address Challenges With Follow-Up Studies for Cell, Gene Therapies
  • ‘Drug Super Spender’ Members Doubled Over Four-Year Span
  • Infographic: Part D, Private Plan Spending Rises on Retail Specialty Drugs

Start Early in Planning Variety of Payer And Provider Commercialization Tactics

November 16th, 2020

  • Study Finds Cancer-Related Services Have Dropped, Could Have Long-Lasting Impact
  • Infographic: Pharma Industry Spent Big on Lobbying Amid COVID-19, Election
  • Reality Check: Anemia — Chronic Kidney Disease

Pharma Industry’s Focus on High-Cost Drugs May Provoke More Access Barriers

November 2nd, 2020

  • Real-World Evidence Has Crucial Role To Play in Race to COVID-19 Approvals
  • FDA Approval of Sogroya May Change Prescribing in GH Class
  • Chart: Payers’ Anticipated Reaction to the Introduction of Long-Acting GHD Therapies

As COVID-19 Pandemic Persists, People Need to Access Essential Services Safely

September 21st, 2020

  • Anemia Due to Chronic Kidney Disease May See First-in-Class Drug This Year
  • Infographic: Health Services Utilization Index
  • Reality Check: Non-Small Cell Lung Cancer Systemic Therapy

COVID Emphasizes Collaborative Approach That’s Needed to Assess Health Care Value

August 3rd, 2020

  • COVID-19 Manufacturer Market Access Challenges Include Speed, Scale, Pricing
  • Infographic: How Close Are We to a Coronavirus Vaccine?
  • DOJ, Pharma Renew Disputes Over Charitable Foundations

Study: Pandemic May Result in Shift From Part B to Part D for Autoimmune Drugs

June 15th, 2020

  • With One Drug Supply Issue In Check, ‘Buy American’ May Prompt Another
  • Infographic: CVS Reports Lowest Drug Trend in Years
  • Reality Check: Bipolar Disorder

COVID-19 Pandemic Is Resulting in Array Of Changes That Will Transform Pharma

May 4th, 2020

  • Start Launch Planning, Contact Payers Early in Development for Best Results
  • Plan Will Cover Whole Genome Sequencing for Ill Children
  • Chart: Ranking of Meeting Formats for Remotely Working/Meetings With Pharma MSLs/Account Managers

Prior Authorization Can Be Challenging For MDs; Pharma Can Help With Process

March 16th, 2020

  • Drug Prices, Biosimilars and Gene Therapies Are Among Expected 2020 Industry Trends
  • Chart: Health Care Affordability Is Top of Mind for Voters
  • Reality Check: Chronic Lymphocytic Leukemia

New Orphan Drug Playing Field Requires Change in Tactics for Pharma Companies

February 3rd, 2020

  • Manufacturers May Employ Variety of Tactics to Ensure Favorable Drug Launch
  • Chart: The Preapproval Information Payers Value Most
  • HHS Importation Efforts Move Ahead, but Questions Remain
  • Chart: Share of Drugs Approved in 1998-2017 by Type
  • Chart: Annual Cost of Drugs at Launch: 1998-2017

Drugmakers Could Gain Market Share by Partnering With Calif. on New Initiative

October 19th, 2020

  • Allogeneic Process Might Help Make CAR-T Therapies Less Expensive, Easier to Make
  • Chart: Little Is Spent on Treating High-Cost Patients’ Behavioral Health Conditions
  • Reality Check: Sickle Cell Disease

Virtual FDA Meetings in COVID-19 Era Highlight Need for Revised Preparation

September 7th, 2020

  • Challenges Exist for Drugmakers in ‘Buy American’ Executive Order Implementation
  • Two PARP Inhibitors OK’d for New Prostate Cancer Indication
  • Infographic: Effectuated ACA Exchange Enrollment Rises Slightly in Early 2020

CMS Proposes Changes to Medicaid Best Price to Encourage VBP Arrangements

July 20th, 2020

  • CMS Reverses Stance, Will Allow Copay Accumulators for Drugs With No Generics
  • Chart: Payers’ Adoption of Copay Accumulator Programs
  • Reality Check: Duchenne Muscular Dystrophy

COVID Is Having Impact on Cancer Care, Will Transform It For Patients, Providers

June 1st, 2020

  • IDNs and Employers Are Seeking Savings By Cutting Out Health Insurer ‘Middlemen’
  • Report: Oncology Drives Rise in Medical Benefit Drug Spend
  • Source: Pandemic Poses ‘Major Disruption’ to My Cancer Care
  • Chart: Modeled Impact of Reduced Screening Tests Three Months Ending June 5, 2020

As COVID-19 Highlights Pharma Innovation, How Might It Impact Opinions of Industry?

April 20th, 2020

  • Providers Protest New Tennessee Blues Plan Policy Intended to Save Clients Money
  • Experts Vary on Challenges, Benefits of White Bagging
  • Infographic: Current/Anticipated Office-Administered Non-Oncology Therapy Per Distribution Channel
  • White Bagging Can Pose Array of Logistical, Contractual and Communication Issues
  • Reality Check: Type 2 Diabetes (GLP-1 and Combo)

Manufacturers Have Growing Interest in Getting Real-World Data, Dispelling Issues

March 2nd, 2020

  • Drugmakers Change Up Tactics to Leverage MD Relationships to Obtain Payer Coverage
  • Multiple Oncology Biosimilars Could Prompt Preferencing
  • Chart: Minimum Number of Available Biosimilars Required to Accept Preferred Contracts

Drug Prices, Health Technology, Novel New Products Will Be in 2020 Pharma Headlines

January 20th, 2020

  • Study Examines Adherence Rates, Out-Of-Pocket Costs for Cystic Fibrosis CFTR Drugs
  • Chart: What Impact on the Deal-Making Climate Do You Think Each of the Following Disruptors Will Have?
  • Reality Check: Migraine

Administration Continues With Drug Price Efforts, but Questions, Issues Remain

October 5th, 2020

  • GPOs Eye Branded, Specialty Products as Insurer-Owned PBMs Launch Competitors
  • Recently Approved Evrysdi May Have Big Impact on Class
  • Chart: Payers’ Likelihood of Taking Management Steps for Risdiplam for the Treatment of SMA

Impact, Feasibility, logistics of Executive Orders on Drug Pricing Are Questioned

August 17th, 2020

  • Banner Prepares to Launch Generic Novel Fumarate Bafiertam in Multiple Sclerosis
  • Infographic: Medicaid Pays Millions in Excess Costs Due to Delayed Generic Drug Entry
  • Reality Check: Ankylosing Spondylitis

Virtual Pharma-Payer Negotiations May Require More Persistence in COVID-19 Era

July 6th, 2020

  • As More Clinical Trial Services Shift To Alternate Sites, Changes May Stick
  • Study Shows High Adherence in People on CDK 4/6 Inhibitors
  • Chart: Prioritization of Making Decisions on Scheduling Meetings With Pharma MSLs/Account Managers

COVID-19 Is Causing Changes to Models, Entities Throughout Health Care Landscape

May 18th, 2020

  • Prime Studies Show High Costs Among Asthma, Hereditary Angioedema Biologics
  • Chart: Physician Interactions in Week Ending April 3, 2020
  • Reality Check: Multiple Sclerosis

Pharma Firms Face Numerous COVID-19 Challenges but Still Can Help Other Entities

April 6th, 2020

  • Learn How Payers Think, Solve Data Issues To Enact More Complex Value-Based Pacts
  • CVS Health Offers Genomic Testing for More Precise Care
  • Infographic: Pharma Companies Race to Tackle COVID-19
  • Pharma Manufacturers Can Take Multiple Steps to Protect On-Site Employees

Real-World Data Can Take on Multitude Of Forms and Offers Variety of Benefits

February 17th, 2020

  • Louisiana Touts Fast Start for New Five-Year Hepatitis C ‘Netflix’ Model With Asegua
  • Chart: People With Hepatitis C Treated in Louisiana Medicaid and State Corrections
  • Reality Check: Cystic Fibrosis

Innovative New Therapies, Uptick in M&A Activity Were Some 2019 Pharma Highlights

January 6th, 2020

  • Pharma Manufacturers Could See Better Adherence, Outcomes With Focus on SDOH
  • Highmark Unveils Hemophilia Effort Focused on Care, Costs
  • Chart: U.S. Spending on Retail Prescription Drugs Grows Moderately in 2018

2019 Spotlight on Market Access

NDC Mandates May Offer Medical Benefit Spend Clarity, but Payer Challenges Exist

December 16th, 2019

  • Alnylam Offers Value-Based Agreements, Prevalence-Based Adjustment for Givlaari
  • Chart: Future NDC Data Collection
  • Chart: Current NDC Data Collection
  • Chart: Payer NDC Data Collection
  • Reality Check: Parkinson’s Disease

2019 Spotlight on Market Access

ICER Will Take Different Approach to Assess Short-Term, High-Impact Products

December 2nd, 2019

  • As Health Care Consolidation Accelerates, New Entities Make Decisions on Therapies
  • Infographic: Generic Drug Approvals Hit Another Record in Fiscal Year 2019
  • Study: NSCLC EGFR-i May Be Fit for Value-Based Contracts

As Step Therapy Use Increases, Federal and State Bills Are Taking Aim at Payer Strategy

November 18th, 2019

  • ICER Releases Report on Drug Price Hikes; Opinions Vary on Its Usefulness, Impact
  • Chart: Influence of ICER’s Assessments on Payers’ Decision-Making Is Likely to Increase
  • Chart: ICER Reports Have Influenced Payers to Support Risk/Value-Based Contracting
  • Reality Check: Narcolepsy

Precision Medicine Hits N of 1 Milestone but Still Faces Many Cost, Regulatory Obstacles

November 4th, 2019

  • Health Systems Can Reap Multiple Benefits By Offering Specialty Pharmacy Capabilities
  • Source: Some Misconceptions Exist Around Health System Specialty Pharmacies
  • IL-17 Use in Psoriasis Grows as Adherence, Outcomes Rise
  • Chart: Personalized Medicines Top 30% of FDA Approvals for Second Year in a Row

Recent Situations Stress That Data Is More Important Than Ever to FDA, Drug Uptake

September 16th, 2019

  • Report Reveals That Almost 100 RM/AT Products Are in Phase III Clinical Trials
  • Clinical Trials by Indication: Q2 2019
  • Reality Check: PCSK9 Inhibitors

Drug Pricing Proposals Have Undergone Flurry of Increased Activity Recently

August 5th, 2019

  • Stakeholders Want Data on Value of New Oncolytics, Place in Treatment Algorithms
  • Will Blockchain Transform Relationships Industrywide?
  • AARP Report Shows Prices for Specialty Medications Continue to Increase
  • Average Annual Price of Specialty Drugs Almost Tripled Between 2006 and 2017

How Much Impact Will Interchangeability Guidance Have on Biosimilars’ Uptake?

June 17th, 2019

  • Oncology Is Seeing Surge of Innovation, As Well as Double-Digit Spending Growth
  • Top 25 Cancers and the Number of Mechanisms Targeting Each, Phase I Through Pre-Registration Within Immuno-Oncology Pipeline
  • Reality Check: Multiple Sclerosis

Stakeholders Skeptical of Major Potential Effect From Amazon’s Health Care Plays

May 6th, 2019

  • In Burgeoning Oncology Space, Payers Are Looking to Pharma for Data to Assess Value
  • Companies Partner Up to Offer First Digital Oncology Medicine

As Use of Copay Accumulators Increases, Pharma Tactics Can Help Blunt Their Effects

March 18th, 2019

  • ANPRM Reportedly Prompts PhRMA to Mull Limiting Members’ Price Increases
  • Charts: Payers’ Current and Anticipated Status of Copay Accumulator Programs
  • Reality Check: Growth Hormones

2018 Trends of Innovative Therapies, Focus On Drug Prices Are Likely to Continue in ’19

February 4th, 2019

  • Biomarkers Are Helping Drive Research, Commercialization of New Treatments
  • Drug Importation Could Offer Savings for Vermont Payers
  • Chart: What to watch in 2019 — biopharma’s most valuable R&D projects

Manufacturers Must Address Challenges in Paying for, Showing Value of New Therapies

October 21st, 2019

  • Louisiana Took Long Path to Modified Subscription Model for Hepatitis C Drugs
  • Number of Next-Generation Biotherapeutic Pipeline Products in Late-Stage Pipeline, 2014–2018
  • What Are Other Reimbursement Models for Novel New Therapies?
  • Reality Check: Acute Myeloid Leukemia

FDA Guidance Encourages New Focus on Alzheimer’s Biomarkers, Early Detection

September 2nd, 2019

  • Conveying Value of Accelerated Approval Drugs May Be Challenge for Pharma Firms
  • FDA’s Project Facilitate Aims to Improve Access to Unapproved Therapies
  • Large Employers Are Worried About Pipeline of Costly Drugs
  • Chart: 102 Drugs to Treat Alzheimer’s Are in Clinical Trials

IDNs, Pharma Manufacturers Can Both Reap Benefits From Direct Contracting

July 15th, 2019

  • Some Practices Now Are Taking Two-Sided Risk in CMS’s Oncology Care Model Pilot
  • Study: Expensive Novel Drugs Launched After OCM Baseline Period Are Hamstringing MDs
  • Chart: Top 7 Unaided Reasons Why IDNs Want to Direct Contract With Pharma
  • Chart: Aided Reasons for IDN Direct Contracting With Pharma
  • Chart: IDN Decision Makers Explain Why Manufacturers Should Direct Contract
  • Reality Check: Glaucoma

Final Rule Requiring Drug Prices’ Inclusion In DTC Ads May Have Unplanned Outcomes

June 3rd, 2019

  • Pharma Data, Patient Support Are Critical In Engaging MDs and Winning Their Trust
  • Prime Analyzed Current, Future Costs for SMA and CF Therapies
  • Infographic: Pharmaceutical Industry, PBMs Spend Near Record-Breaking Sum on Lobbying Under Pressure on Drug Prices

2019 Starts Out Strong in M&A Activity, With Focus on Oncology, Gene Therapies

April 15th, 2019

  • Payers Are Specifying Duration of Steps Required for Inflammatory Class Biologics
  • Indication-Based Formularies Are Growing in Use for Inflammatory Conditions
  • Will Payers Prefer Biologic Anti-Inflammatories Within Certain Mechanisms of Action?
  • Gene Therapies, Payer Mix Present Challenges for Pharmaceutical Company Acquirers
  • Reality Check: Immune Globulin (PID)

Pharma and Payers Should Collaborate on Novel Payment Models for Costly Therapies

March 4th, 2019

  • PBMs Are Looking to Pharma Industry Data, Analytics to Manage Medical Benefit Drugs
  • Drugs With Unsupported Price Increases Are in ICER Crosshairs
  • Chart: Invoice Spending on Medications Is Expected to Hit $600 Billion by 2023

Oncology Drugs, CGRP Agents, Biosimilars Were Among Impactful Approvals in 2018

January 21st, 2019

  • GAO Report Maintains FDA Could Improve Orphan Designation Application Reviews
  • Chart: Therapeutic Areas of Orphan Drug Marketing Approvals from 2008 to 2017
  • Reality Check: Cystic Fibrosis

Will Various Drug Pricing Efforts Endanger Innovation Within Pharma? Opinions Vary

October 7th, 2019

  • Visibility Into Cost, Coverage Information Is Key for Providers, but Progress Is Slow
  • Medicare Part D Drug Rebates Reduced Drug Spending, OIG Report Shows
  • Payers’ Coverage Factors for Rozlytrek Will Go Beyond Cost

HHS and FDA Outline Importation Plan, but Savings and Timing of Actions Are Unclear

August 19th, 2019

  • Senate Drug Pricing Bill Takes Expansive Approach, Could Provide Huge Savings
  • More Than 1M Medicare Part D Enrollees Had High Out-of-Pocket Drug Spending in 2017
  • Reality Check: Major Depressive Disorder

Natural Language Processing Has Promise In Drug Discovery, Patient Identification

July 1st, 2019

  • IDN-Owned Specialty Pharmacies May Face Challenges but Can Offer Distinct Benefits
  • Infographic: Integrated Delivery Networks’ Impact Extends to PBM, Specialty Pharmacy Sectors
  • New Gene Therapy to Treat SMA Comes With Unknowns
  • Various Management Tactics Are Expected for Zolgensma
  • What Forms of SMA Will Payers Approve Zolgensma Use for?

CBO Says Proposed Rule to Kill Rebates Will Increase Spending by $177 Billion

May 20th, 2019

  • Program Helped Biosimilar Infliximabs Capture Market Share, Producing Savings
  • IQVIA Institute Report Shows Biosimilar Uptake Continues to Rise
  • Reality Check: COPD

Administration Calls for Eradication of HIV, But Could HHS Proposal Undermine Effort?

April 1st, 2019

  • Drugmakers Get Good PR Via Authorized Generics, but Other Effects Are Less Clear
  • Medical Benefit Drug Spend, Efforts to Manage It Increase
  • Infographic: Magellan Rx Report Shows Increases in Commercial, Medicare Drug Spending

HHS Takes Aim at Rebates With Proposed Rule That Could Transform Pharma Industry

February 18th, 2019

  • California’s Plan to Take Over Medi-Cal Pharmacy Benefit, Purchasing Makes Waves
  • Infographic: California Medicaid Could Shift to Fee-for-Service Drug Benefit
  • Reality Check: Crohn’s Disease

HHS Proposes Loosening Restrictions on Protected Drug Classes, Other Changes

January 7th, 2019

  • Payers Prepare for Cellular and Genetic Therapies’ Push Into Commercial Arena
  • Global gene therapy market size, by indication, 2014-2026 (USD Million)
  • FDA Approves Tissue-Agnostic Drug That Targets Rare Fusion