Our leading subject matter experts share their insightful analysis and points of view to help you stay abreast of industry trends
Imagine that it’s senior year of high school, and you show up to chemistry class completely unprepared for the midterm exam—a midterm that’s worth half of your grade. Instead of studying the periodic table, you spent the previous evening rehearsing your choir solo. And while extracurriculars are important, messing up a few lyrics during the fall recital won’t have the same ramifications on your GPA and college opportunities as bombing that chemistry test.
Luckily, we’re far removed from the days of…
According to the National Institutes of Health (NIH), nearly one in five U.S. adults (approximately 52 million) live with some form of mental illness. Unfortunately, those struggling with a mental health disorder often aren’t getting the treatment they need, and when undertreated, can have considerable economic impact on national healthcare budgets due to the cost of hospitalization for patients with worsening conditions.
Barriers to Mental Healthcare Despite the prevalence of mental health disorders, recent data from the Substance Abuse and Mental…
While vertical integration and consolidation within the U.S. health system has been a steady trend over the years, now we’re seeing it go even further with the creation of pharmacy benefit manager group purchasing organizations (PBM GPOs), which create yet another tollgate requiring payment in the drug therapy supply chain.
Approximately 80% of all prescription drug claims are managed by the top three PBMs: Express Scripts’ Ascent Health, OptumRx’s Emisar Pharmacy Solutions and CVS Caremark’s Zinc Health Services. Express Scripts, owned…
Pharmaceutical manufacturers that are nearing the commercialization stage of pre-approval planning are faced with a lot of realities about managed markets. Manufacturers are so engrossed in the details of a clinical trial, and its eventual success, that beginning to plan for commercialization can be daunting. However, for physician-administered therapies or IV therapies, understanding and navigating the nuances at play in the medical benefit landscape of payer organizations can significantly impact a product’s success.
Historically, access for medical benefit therapies was largely…
The drug development pipeline is dominated by specialty therapies, more and more of which are being managed under the medical benefit. Therefore, payers will increasingly need to manage those drugs themselves, given that the PBMs they’d normally rely on don’t process these sorts of claims.
As a result, payers are looking to better manage medical drugs, and one way of doing that is by implementing an NDC mandate—a trend that has been on the rise over the last five years. According…
Amid a global pandemic that has been the foreground of thought and development in medicine the past two years, another epidemic has been lingering for decades: HIV and AIDS were first recorded in the early 1980s, and their presence has grown exponentially over the last 40 years. In that time, HIV has fostered significant innovations and advancements across various fields including pharmaceuticals, access to care, public health education, and legislation, yet the U.S. still can’t seem to get control on the…
For B-to-B companies, turning to a vendor can be a valuable lifeline when it comes to meeting client needs—so long as that vendor doesn’t delay the project or lead to missed deadlines.
When business development firm MarketLauncher was tasked with generating leads in the payer space for a new medtech client, the company needed a vendor that could not only provide the right data, but do so at speed.
“When we have a client who has very specific parameters that our…
Pharmacy benefit contracting has always been a mechanism for payers to offset the cost of small-molecule therapeutic areas. Payers have looked to manufacturers to negotiate contracts that would prevent their products from being placed on a restrictive tier, or subject them to step edits or an NDC block.
But with the emergence of biologics driving the cost of specialty drugs managed under the medical benefit, more payers are looking for ways to implement tighter controls. This has now forced manufacturers to…
Two years of adapting to the constraints of a global pandemic has resulted in major changes to pharma companies’ commercial strategies. Now, as pandemic-related changes have started to become permanent fixtures, sales leaders are asking themselves key questions amid the shifting commercial landscape: How does my strategy need to evolve? How will it affect my field team’s workload and processes? What do HCPs expect from this new normal?
To get the most out of your sales team’s efforts in a world…
It’s no secret that copay maximizer and accumulator programs have come under fire since their inception, and for good reason: In theory, these programs aim to help manage costs, but oftentimes accumulators can end up shifting the cost of medications to patients while maximizers can shift the cost of care from the patient to the manufacturer.
Now, amid the relentless tug of war between payers and pharmaceutical manufacturers, a relatively new type of patient assistance program has emerged. These programs—such as…
