Our leading subject matter experts share their insightful analysis and points of view to help you stay abreast of industry trends
In pharma, every year seems to bring forth even more change than the year before, but 2023 just might take the cake. Stakeholders have had to adjust to new developments in the healthcare ecosystem such as the Inflation Reduction Act, the rise of immunology biosimilars and insulin price changes impacting payer rebate economics, and the recent ruling that insurers can no longer implement copay accumulator adjustor programs, among many others.
Over the next few years, several more trends are poised to redefine how manufacturers,…
When a pharma company secures expedited approval for a drug in development, everyone involved is usually thrilled. After all, a faster approval process means that patients in need will be able to access this critical treatment more quickly. Manufacturers also assume that expedited approval will lead to faster revenue recognition, but this isn’t always true.
Many payers are reluctant to cover drugs approved via an expedited process due to insufficient safety and efficacy data. For drugs granted conditional approval, payers are…
Due to the end of the public health emergency for COVID-19 and subsequent redeterminations for Medicaid, health plan enrollment data has become increasingly volatile.
As of this spring, states were able to resume Medicaid eligibility redeterminations, which were stopped during the pandemic. For three years, states couldn’t check members’ income to determine whether they were still under the income limits for Medicaid in their states, which caused Medicaid membership to increase steadily throughout the pandemic, particularly in the first year, when…
The explosion of real-world data (RWD) now available to pharma companies can be overwhelming. While many larger manufacturers with their own teams of data analysts have been using RWD for years, smaller manufacturers are just beginning to incorporate RWD into their clinical development and market access strategies. Which data sets do they need, and how can they use them most effectively?
As the majority of pharma companies don’t have the resources to invest millions in a data lake, they’re looking for…
Many oncology manufacturers assume that a therapy’s inclusion on clinical pathways is more important than its coverage profile, but this isn’t always true. Across every oncology class, manufacturers need to know which organizations—IDNs, provider organizations, payers or PBMs—have the biggest positive and/or negative influence on their products’ utilization.
Patient access can easily be blocked by a misalignment between pathway placement and coverage requirements, without manufacturers realizing the disconnect. Simply tracking clinical pathways and coverage restrictions in isolation is not sufficient. Real-world…
Recently, payers have started to use the phrase “member disruption” to refer to the potential impact of an impending formulary change on their members. This qualitative term is mentioned with increasing frequency during contracting discussions and P&T sessions, although the weight of these considerations varies between organizations.
Member disruption describes the impact of formulary changes across three spectrums: how a plan is perceived by both members and employers; the workload and logistics required for a payer to execute a change; and…
In the wake of the COVID-19 pandemic, drug shortages, caused by increased demand, supply chain difficulties, and supplier issues have plagued payers and patients alike, making it harder for patients to access the therapies they need and causing delays in treatment. Drug shortages hit a record five-year high in 2022, according to a U.S. Senate report.
To learn more, in August we asked payers about the impact and challenges they face due to drug shortages, focusing on ADHD therapy and chemotherapy…
Over the past two decades, skyrocketing list prices for insulin have threatened medication adherence for the estimated 7.4 million American diabetics who rely on insulin to manage their disease.
With the passing of the 2022 Inflation Reduction Act, Congress addressed the financial strain on nearly three million diabetics by capping insulin prices at $35 a month for Medicare beneficiaries. Eli Lilly, Novo Nordisk, and Sanofi—which together produce 90% of insulins on the market—subsequently reduced the costs of their products for all…
For manufacturers, building a static commercialization strategy will only take you so far. But infusing that strategy with real-world data (RWD)—consisting of medical claims, lab testing and pharmacy data, and electronic health records—provides a more holistic view of the patient journey.
RWD fills in crucial missing puzzle pieces, especially when it’s integrated alongside payer coverage data. It can show if a patient is unable to access a drug and why—insights that can help manufacturers improve their commercial strategies and increase access,…
Respiratory syncytial virus (RSV) can impact anyone, but infants and older adults are most at risk of illness. With multiple new immunizing agents gaining FDA approval in 2023—and more in the pipeline—manufacturers and payers have a role to play in educating patients and providers about the importance of immunizations to combat RSV.
RSV, a contagious virus that can cause severe illness or death, is a common cause of respiratory illness. According to the U.S. Centers for Disease Control and Prevention (CDC),…
