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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…
With payer coverage decisions around pharmaceuticals changing rapidly, simply being covered is no longer enough for getting patients on therapy quickly. Today, increasing market complexity and outsize payer influence have resulted in numerous hurdles to ensuring adequate access, from prior authorizations to step therapy to label restrictions.
To succeed at launch amid these higher stakes and ever-evolving market dynamics, pharma companies—especially those within the oncology or rare disease spaces—need a go-to-market strategy that tracks market access in real time.
Why timely…
John Griggs co-authored this article with Dinesh Kabaleeswaran. This article was originally published on Drug Channels.
Large healthcare conglomerates, or integrated delivery networks (IDNs), have long been fixtures in the market access landscape—a dynamic that has gone unchanged despite the disruption caused by COVID-19. While M&A activity slowed down during 2020, IDNs are seeing a bout of positive recognition: Many have received accolades on their ability to deliver quality coordinated care during a year of upheaval for healthcare. Partly thanks to this…
People often ask me how MMIT fits into the healthcare ecosystem. MMIT’s mission is to smooth and simplify access to therapies, affecting every part of the continuum from the pharmaceutical company to the payer, provider and patient.
Everyone knows someone who has had trouble accessing a life-saving or life-changing therapy because of communication problems between the pharma company, PBM, payer and provider. Sometimes providers prescribe a medication that isn’t covered by the payer, and other times may not prescribe a medication…
This article was originally published in FierceHealthcare.
While it has been over a month since the FDA announced its controversial decision to approve Biogen’s Alzheimer’s drug, Aduhelm, payers have been slow to make any decisions—and for good reason.
While the excitement around the approval is undeniable given the long-overdue unmet need for Alzheimer’s patients, there are still many questions stemming from the therapy’s stated efficacy and the FDA’s waffling over the label’s indication and usage section. With CMS’s recent move to open a…
