Our leading subject matter experts share their insightful analysis and points of view to help you stay abreast of industry trends
In the past few years, it’s become more challenging for pharmaceutical companies to promote their products directly to healthcare providers (HCPs), and COVID only exacerbated this trend. Physicians are more selective in who they choose to meet with, and many no longer accept face-to-face meetings with pharmaceutical reps. According to 2023 research, more than 50% of physicians now meet with three or fewer pharma companies on a regular basis.
At the same time, physicians are still eager to know more about…
This has been a significant year for the Humira (adalimumab) biosimilar market. AbbVie's blockbuster drug Humira, an injectable used to treat a range of inflammatory conditions, saw the end of its 20-year, $200 billion monopoly in January. By the beginning of November, nine adalimumab biosimilars had made their market debut.
Pharma manufacturers have been closely following the adalimumab rollout, as this year serves as a case study for biosimilars yet to be approved. At the center of the discussion is a…
For decades, payers have used prior authorizations (PA) with the intent of curbing costs by preventing the unnecessary use of medical procedures or treatments. But in recent years, more and more physicians have contended that the practice impedes their ability to provide care.
Amid pushback from provider groups and a swell of state and federal legislation aimed at PA reform, payers are reevaluating the need for PA for certain drugs and services, particularly those with a high PA approval rate. Throughout…
This article was originally published on Drug Channels.
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, 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…
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…
This article was originally published in BioPharma Dive.
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. According to MMIT Pulse Analytics data, roughly 64% of U.S. oncologists are exposed to third-party clinical pathways developed either by an oncology group or a payer. However, a payer or PBM’s medical policies and formulary placement can also have a huge impact on a drug’s utilization.
Patient access can easily be blocked by…
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…
