Our leading subject matter experts share their insightful analysis and points of view to help you stay abreast of industry trends
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…
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…
This article was originally published in Drug Channels.
While the U.S. has been frustratingly slow to embrace biosimilars, the next few years are poised to see a veritable boom in new market entrants. Only six biosimilars were available at the end of 2018. There are now around 40 biosimilars approved in the U.S. across multiple indications. Plus, enrollment in the FDA’s Biosimilar Development Program has increased nearly 60% since October 2015, with more than 90 proposed biosimilar products in the program.
As longstanding tensions…
While COVID-19 has left no industry untouched, it’s safe to say that healthcare has been hit the hardest. Yet despite this reality, there are plenty of exciting advancements happening within the industry, even amid the lingering effects of the global pandemic.
To get an idea of what’s to come in market access, I asked four of my colleagues to weigh in on upcoming challenges and opportunities within healthcare. Their answers—which cover topics from evolving payer strategies to gene therapies to digital…
This article was originally published in PharmExec.
Over the past decade, the life sciences industry has undergone transformative change that has disrupted everything from early drug discovery to post-launch treatment monitoring. Driven by the proliferation of real-world data (RWD) and technology like AI and machine learning, these innovations are changing our understanding of drug value and enabling life-saving medications to get into the hands of patients faster.
However, changing market dynamics and growing scrutiny around rising healthcare costs have resulted in…
When it comes to medical reimbursement, there are several challenges that both payers and providers face in today’s rapidly changing regulatory environment. With new drugs and generics entering the market at breakneck speed and supply chain issues continuing to plague manufacturers, it can be difficult for stakeholders to keep up with the Healthcare Common Procedure Coding System (HCPCS), especially considering that July will mark the eighth consecutive quarterly update to HCPCS codes. While HCPCS codes used to be updated on an…
