Our leading subject matter experts share their insightful analysis and points of view to help you stay abreast of industry trends
Patients have expanding options for where to receive and take their medications. Both payers and manufacturers can capitalize on these options to improve patient access, adherence, and outcomes.
Within many therapeutic areas (TAs), medications that were previously covered by the medical benefit are now covered by the pharmacy benefit. To accommodate the new benefit designs, payer preferences regarding sites of care and routes of administration are also shifting. These changes have allowed payers to better control specialty drug spending.
Traditionally, patients…
The past few years saw the launch of several direct-to-consumer (DTC) programs, including Amazon One Medical and Mark Cuban’s Cost Plus Drugs. In 2024, several manufacturer-designed DTC programs, such as LillyDirect and PfizerForAll, have been added to the mix, demonstrating pharma’s continuing shift toward an integrated model of patient care.
While these programs can benefit multiple stakeholders, pharma companies should be aware of the existing and potential challenges before rolling out such a program.
Multiple Benefits for Stakeholders Patients stand to…
The weeks preceding a pharma product’s launch date are a critical window for market access teams. The ability to pivot and adjust to last-minute shifts can make all the difference between a successful first year and a disappointing launch trajectory. While much of your market access research may have already been completed by the time you go to market, there are several ways your team can continue impacting coverage and utilization.
Our first post in this series discussed the benefits of…
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…
This article was originally published in Drug Channels.
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…
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…
