Our leading subject matter experts share their insightful analysis and points of view to help you stay abreast of industry trends
As the pharma industry continues to adjust to the provisions of the Inflation Reduction Act (IRA), the country will soon be ushering in a new presidential administration—leaving the future of the IRA in question. Despite ongoing regulatory uncertainty, manufacturers will still be focused on the same concerns: drug development, pipeline performance and ensuring patient access to their therapies.
To better understand what 2025 might bring, I asked three of my colleagues to share their perspectives on upcoming market shifts. Their answers…
Initially developed to manage type 2 diabetes, glucagon-like peptide-1 (GLP-1) agonist medications have become exceptionally popular for weight loss. High-profile celebrity endorsements and widespread media coverage has led to an overwhelming spike in demand.
By any estimation, the American market for weight-loss GLP-1s is enormous. According to a Kaiser Family Foundation analysis, more than 40% of privately insured adults under 65 are clinically eligible for a GLP-1 drug to treat obesity. Although there are several GLP-1 agonists on the market, only…
In recent years, pharma companies have begun to embrace lab data as a richly rewarding dataset for a whole host of purposes, including trial enrollment and site identification, patient monitoring and disease progression, and commercial targeting and market access insights. Along with test orders, values, and results, deidentified lab data includes a wealth of information, such as a patient’s demographic information, diagnosis codes, and ordering provider and facility details.
In addition to providing a deep understanding of a specific patient's clinical…
During the pandemic, the number of individuals in the U.S. enrolled in both fee-for-service and managed Medicaid programs increased dramatically. This increase was tied to a provision in the Families First Coronavirus Response Act, which boosted federal dollars to the states in exchange for keeping individuals covered through Medicaid, even if their eligibility changed since they enrolled.
In April 2023, states resumed eligibility redeterminations, leading to a steep and continuing decline in Medicaid enrollment. In the last few years, Medicaid unwinding…
In a competitive market, pharma companies are increasingly relying on various datasets to drive their decision-making. With so many disparate sources, however, data standardization presents a challenge, especially for companies eager to use predictive analytics tools. In a recent survey of 125 pharma executives, nearly half cited data integration and cleanliness as the primary roadblocks to adopting technologies like AI.
Harmonized data is a prerequisite for generating actionable insights, with or without sophisticated data science engines. For pharma companies, integrating internal…
As payers grapple with their ever-increasing spend on healthcare services, many are entering into various arrangements with pharma manufacturers to help mitigate their risk when paying for cell, gene and specialty therapies—which often have price tags ranging from several hundred thousand to millions of dollars. A warranty-based agreement is one approach that can benefit both stakeholders. These agreements can potentially boost the uptake of high-cost treatments by increasing the likelihood that payers will cover products, particularly those with unclear efficacy or…
To fully understand how payers impact patient access, pharma companies should be evaluating payers using multiple datasets, including both coverage/restriction data and claims data. While payer policies indicate how payers plan to manage a product or service, medical and pharmacy claims reveal how payers actually manage that product in reality.
Taken together, claims and coverage data generates a wealth of information about how patients move through the healthcare system—and how payer behavior impacts their access to treatment. What’s driving rejections of…
For the past decade, biosimilar adoption in the U.S. has proceeded at a relatively slow pace, due in large part to limited financial rebates for payers and provider preferences for biologics. Recent research suggests that utilization is finally picking up steam as more health plans place both biosimilars and their reference biologics on preferred formulary tiers.
A Health Affairs study found that preferred coverage of a single biologic declined by 47% between 2017 and 2022, while preferred coverage of multiple drugs…
When the FDA approved the first cell and gene therapy (CGT) for hemophilia almost two years ago, it represented a massive leap forward in treating the bleeding disorder. The one-and-done agents offer the promise of a cure, giving patients the prospect of freedom from the disease without regular treatments.
Although three hemophilia CGTs are now on the U.S. market, access has not yet met expectations, and only a handful of patients have received treatment to date. These therapies have been slow…
Lab data has become an increasingly essential dataset for pharmaceutical companies at all stages of the product life cycle. A key use case for our MMIT clients is using lab data for commercial targeting. Since lab tests often represent one of the earliest data points in a patient’s diagnostic journey, pharma companies are using lab results to identify potential patients and their physicians in time to directly impact the patient’s treatment plan. By coupling lab data with clinical expertise, pharma companies…
