Our leading subject matter experts share their insightful analysis and points of view to help you stay abreast of industry trends
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…
After the FDA called for additional warning labels on anti-inflammatory drugs known as JAK inhibitors this September, pharma companies in the immunology space have been waiting with bated breath to see how payers will react to this news. Will insurers start requiring step-edits or prior authorization? Will payers alter their management strategies for rheumatoid arthritis and ulcerative colitis? What will potential restrictions mean for newly diagnosed patients or those who are seeing success with JAK inhibitors? What will the impact be…
There are many challenges that manufacturers face when launching a new drug: Will physicians prescribe the drug? Will they have any legal issues? Will patients request the drug? How should they market and distribute it?
The list goes on and on, but one of the most critical questions to answer is this: Will patients be able to access the drug? A manufacturer can have all other elements of a product launch accounted for, but if there are tight restrictions in place…
While payers’ formulary decisions can make or break a drug’s success, manufacturers within oncology face an additional obstacle to gaining market access: clinical pathways, or guidelines that determine which treatments and procedures should be prescribed along the patient journey. While pathways were developed to help standardize treatment and ensure quality care, oftentimes they limit physicians’ prescribing decisions by restricting their choices to the products on the pathway.
Why is this important for oncology manufacturers?
Consider Martha, a 68-year-old who started experiencing…
