Our leading subject matter experts share their insightful analysis and points of view to help you stay abreast of industry trends
Copay accumulator and maximizer programs are now firmly embedded in the commercial market, and their influence on patient access and manufacturer strategy is becoming impossible to overlook. In the first installment of our two-part series on copay accumulators and maximizers, we shared recent Indices research on how payers are deploying and measuring these programs.
In this follow-up blog post, we look at the downstream effects of copay adjustment programs and suggest a few strategies for manufacturers trying to protect patient access…
As payers continue to refine their cost-containment strategies, copay accumulator and copay maximizer programs have quietly become standard tools in their playbook. As of March 2025, 21 states have enacted laws banning payer/PBM use of copay accumulator programs for state-regulated health plans, including the individual, fully insured large-group, and small-group markets.
Yet despite this legislation, the majority of payers are still using copay accumulators, not to mention copay maximizer programs. These copay adjustment programs limit the amount of money that payers…
As artificial intelligence (AI) transforms how life sciences organizations access and analyze real-world data (RWD), one challenge looms large: ensuring that these powerful tools are used appropriately.
RWD can illuminate patient outcomes, accelerate research, and guide better decision-making—but only when it’s handled ethically, transparently, and within the boundaries of contractual and regulatory use. Here are some ways to avoid the misuse of RWD with AI.
The Stakes of Responsible RWD Use Historically, RWD analysis was controlled by trained data specialists who knew how to…
The mental health treatment landscape is evolving rapidly, driven by new and innovative therapies. Recent approvals like KarXT (from Karuna Therapeutics, now part of Bristol Myers Squibb) for schizophrenia, as well as many promising pipeline drugs, such as MindMed’s MM-120 for generalized anxiety disorder, highlight this momentum.
Amid this progress, alcohol use disorder (AUD) remains an area of significant unmet need. Many individuals with AUD also experience co-occurring mental health conditions such as depression, PTSD, anxiety, schizophrenia, and bipolar disorder—underscoring the…
Transthyretin amyloidosis (ATTR) has rapidly shifted from a rarely recognized, fatal condition into one of the most closely watched rare-disease markets in biopharma.
With multiple therapeutic entrants, distinct scientific platforms, and increasingly sophisticated payer strategies, ATTR now serves as a template for how innovation, diagnosis expansion, pricing, and access come together to shape a complex specialty category.
This deep dive draws on recent research into the ATTR space, collected via MMIT’s Payer Message Monitor across 100 payers and 150 panelists.
Understanding…
The use of alternative funding programs (AFP) has been on the rise in recent years, in keeping with the growing number of self-funded employer health plans. Run by for-profit vendors, AFPs are a relatively new type of specialty carve-out program meant to save employers money by removing certain high-cost medications from their formularies.
Instead of filing with their health plan, AFP vendors encourage patients to apply for financial assistance through pharma patient assistance programs (PAPs) or charities. AFPs have serious consequences…
Our latest research at Norstella strongly suggests that a highly dynamic market access situation in the U.S. is feeding back into upstream decisions around R&D strategy. We explored this topic in detail in a recent white paper, Working Backwards: Patient Access Strategy Is Now Guiding R&D. This article briefly summarizes the first half of the report.
From compressed drug lifecycles to therapeutic area priorities, drug developers are resetting as the status quo shifts. Policymakers are looking to wield greater control over…
In today’s complex pharmaceutical landscape, a brand’s market access can no longer be judged solely by its coverage. Pharma leaders are under growing pressure not just to identify access barriers, but to prove their impact. They want the ability to link payer policy decisions to patient outcomes, as their payer strategies and competitive positioning depend upon this kind of actionable intelligence.
This shift in focus demands a new level of visibility across the healthcare ecosystem, as market access teams often struggle…
This article was originally published in BioPharma Dive.
Every day, patients are experiencing the life-changing impact of real-world data (RWD), and life sciences companies are feeling the business impact, too.
RWD is no doubt helping pharma companies better understand the patient journey and get life-saving therapies to market faster, according to Norstella’s recent survey of 200 life science executives. Over the next one to three years, RWD will play a key role for life sciences, with 40% of the executives we…
In July 2025, the 2025 Federal Budget Reconciliation bill, known colloquially as the One Big Beautiful Bill Act (OBBBA) and officially as H.R.1, was signed into law.
This act introduced major, immediate reforms to Medicaid, adding new administrative requirements and eligibility conditions (including work requirements) for patients seeking to enroll in or maintain Medicaid coverage. It also lowered the cap on state-directed payments—the supplemental payments states pay to increase reimbursement rates for specific providers that serve a large number of Medicaid…
