Our leading subject matter experts share their insightful analysis and points of view to help you stay abreast of industry trends
As researchers continue to identify specific genetic markers within different diseases, more and more treatments targeting those markers are launching. In fact, more than 77,000 genetic tests currently are available. They can identify, for example, what type of breast cancer or non-small cell lung cancer a patient has. Some can determine a person’s risk for developing a disease, and others can predict the probability of a response to a drug. With so many tests available, it can be hard for payers…
This article was originally published in Drug Channels.
Next year’s staggered launch of adalimumab biosimilars will mark one of the largest losses of exclusivity for a pharmaceutical company in U.S. market history.
For years, Humira has been the top-selling drug worldwide, raking in more than $20 billion in revenue last year. Manufacturers of reference biologics will be monitoring the impending upheaval, while companies with biosimilars in the pipeline will be eagerly tracking utilization data. Which drugs will secure a place on payers’ formularies,…
Every consumer is familiar with the rebates one may get when purchasing a product or service. However, if the rebate was invalid or was not submitted properly, the money does not always get back to the consumer. A similar issue of ineligible rebates and incurred costs also consistently occurs in the pharmaceutical industry, but on a much larger scale. As a consumer, you would be angry if you didn’t get your money back from a rebate. Why should pharma companies let…
Could previously launched drugs that significantly missed sales expectations have met a different fate if their manufacturers had accounted for payer perspectives in their early stage development strategy?
Let’s start with some stats.
About half of the drugs launched in the last 15 years underperformed analysts' sales estimates by more than 20% Only one-fifth of new meds reached $1 billion in U.S. sales, and more than half failed to hit even $250 million The average cost to develop a drug is…
A patient's journey to accessing life-saving therapies is rarely linear, and while much of that is due to factors within the healthcare system, many external influences are also at work. Social determinants of health are an example of these outside forces that play a crucial role in patient care, for better or for worse.
Social determinants of health (SDoH), as defined by the CDC, “are conditions in the places where people live, learn, work and play that affect a wide range…
Given the spotlight that COVID-19 has shone on the glaring holes within the U.S. healthcare system, it’s not surprising that the current Biden administration has placed considerable importance on addressing key issues head-on. The focus on solving these issues has manifested as the Inflation Reduction Act (IRA), which passed along party lines in the Senate as well as the House of Representatives and was signed into law by President Biden on Aug. 16, 2022. The IRA attacks several major issues currently…
This article was originally published in FierceHealthcare.
With the continuation of the COVID-19 pandemic and resulting policy changes, the health plan landscape is facing some complex challenges ahead.
A key factor contributing to these challenges is the Public Health Emergency (PHE) that was declared in January 2020 and renewed on July 15. As a condition of receiving enhanced federal funds during the PHE, states have been required to ensure continuous Medicaid and CHIP coverage for most enrollees by pausing eligibility redeterminations—a process in…
This article was originally published in PharmExec.
At age 19, my stepson has run the gamut of therapeutic options—combination therapies, cognitive behavioral therapy, you name it—for treating his attention deficit hyperactivity disorder (ADHD). After 10 years of searching, we have yet to find a treatment that truly works for him.
However, there’s one option that we haven’t tried: prescription digital therapeutics (PDTs). More specifically, an app-based video game called EndeavorRx. The game, which was approved by FDA in June 2020, is…
In oncology, clinical pathways—recommendations of specific treatments for a specified group of patients—have long been used to help control costs and treatment variation while improving outcomes. Clinical pathways may be payer-driven or provider-driven based on the organization that develops and controls the pathways, and financial incentives and policing mechanisms encourage provider buy-in and adherence.
While clinical pathways are used mainly in oncology, we’re starting to see them in non-oncology treatment settings. Children’s Hospital of Philadelphia (CHOP) has adopted clinical pathways for…
Much has been said about healthcare’s shift from a fee-for-service model to a value-based care (VBC) model—and for good reason. With 50% of clinical interventions resulting in unknown effectiveness, and 20-40% of health expenditure wasted on unproven or unnecessary treatments, VBC models can help reduce costs and inefficiencies for patients, providers and manufacturers.
Yet while many industry stakeholders are quick to support the idea of tying compensation to a model that delivers more value and better outcomes for patients, the conversation…
