Our leading subject matter experts share their insightful analysis and points of view to help you stay abreast of industry trends
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…
In the complex healthcare analytics landscape, understanding the nuances of open and closed claims is critical for researchers and analysts. Open and closed claims each offer unique insights into the patient journey.
Open claims, sourced from various clearinghouses and warehouses across the U.S., present a vast collection of data, while closed claims, adjudicated by insurers, provide a detailed, individualized perspective. Open claims are rather like a wide-angle view of the forest, whereas closed claims are more like a view of the…
Our first post in this series discussed how early market access research, conducted in the 12-18 months before launch, helps pharma companies identify differentiators and establish accurate expectations.
As your organization moves closer to launch, your market access team will need to establish a commercially focused definition for your patient population. You’ll need to identify treating physicians, define the current standard of care, and establish how your brand will fit into the existing landscape. Critically, your team will also need to…
Before physicians prescribe a new therapy, they need to trust that it is the most effective and appropriate treatment for an individual patient. They need education on the drug’s efficacy and safety, dosing and administration, and the clinical criteria that define eligibility. They also need to know if the drug is affordable and accessible for their patients.
Although pharma sales reps typically convey all this information to HCPs during their in-person meetings, physicians have become much more selective about the companies…
According to our 2024 State of Patient Access survey, 81% of pharma companies are launching their market access planning much earlier than they did five years ago. By Phase I, one-third of pharma companies are already engaged in market access research, with most pharma companies (54%) engaged by Phase II – III.
What can manufacturers hope to learn about the competitive landscape so far in advance? From identifying a brand’s most valuable differentiators to establishing accurate expectations for launch, early market access…
For the past year, Medicaid has been the predominant topic of conversation for those who monitor insurance market share shifts. Medicaid enrollment peaked at 94.5 million in April 2023, when states resumed eligibility redeterminations after a multi-year pause. In the year that followed, Medicaid enrollment declined 10.4%, and has continued to plummet in recent quarters, with this channel losing nearly 4.9 million beneficiaries from Q3 to Q4 2023.
As a direct result of this decline, membership in health insurance exchange plans is…
This article was originally published in Drug Channels.
Vertical integration between payers, PBMs, specialty pharmacies, and providers has grown in the last decade, with more negotiating power concentrated among a handful of major players. Now insurers are adding production arms into the mix, following CVS Health’s bid to cash in on the race for Humira biosimilar market share.
Adding a manufacturing arm brings undeniable advantages for PBMs, from better cost control to smoother supply chain dynamics. Payer-production entities can align an…
For manufacturers of medical benefit drugs, ensuring accurate provider reimbursement is essential. If providers are unaware of how to appropriately bill for a particular drug, their errors will result in claims denials, which in turn may lead them to stop prescribing that drug in favor of another. Inadvertent underbilling for services rendered is also a top provider concern, especially given the popularity of buy-and-bill procurement.
In an attempt to manage medical drug spend, a majority of payers are now enforcing an…
