Thought Leadership

Since its passage in 2022, many have speculated on the impact of the Inflation Reduction Act (IRA) on providers, manufacturers and payers—especially those with Medicare Advantage plans. Just over half of all Medicare beneficiaries are currently enrolled in a Medicare Advantage plan, and enrollment is projected to reach 60% of the eligible population by 2029.

Although the biosimilar market is expected to continue growing over the next few years, adoption thus far has been somewhat slow and uneven. Recent research published in Health Affairs takes a look at how upcoming provisions of the Inflation Reduction Act (IRA) are likely to impact biosimilar coverage, concluding that both Medicare beneficiaries and the government could realize substantial savings if Part D formularies resembled those of employer-sponsored plans.

Medicine has been trending towards personalization for decades. The growth of individualized medicine and new diagnostic technologies has resulted in drugs that are tailored towards patients’ profile and condition—and are much more effective as a result. These therapies rely on the existence of molecular tests, including genetic testing, predictive and prognostic biomarkers, and companion diagnostics.

We are in the midst of a weight-loss drug explosion. Mania for Novo Nordisk’s Wegovy/Ozempic has taken hold of both celebrities and everyday patients, leading to massive shortages and a surge of interest in all glucagon-like peptide 1 (GLP-1) agonists. Industry experts say that obesity has become a top five global market driver, and MMIT’s sister company, Evaluate, estimates the obesity opportunity as exceeding $35 billion by 2028.

According to the American Society of Health-System Pharmacists (ASHP), U.S. drug shortages are the highest they’ve been in more than two decades. As of the end of 2024’s first quarter, 323 drugs were in short supply, including many chemotherapy, ADHD, and pain and sedation medications. These drugs run the gamut from basic drugs to life-saving therapies, and are predominantly generics, with 46% of the quarter’s new shortages being injectables.

In the shift toward value-based care, more payers are outsourcing the management of specific therapeutic areas to third-party specialty benefit managers (SBMs). These companies help payers manage high-cost, high-complexity disease states by leveraging provider networks and making coverage recommendations intended to improve outcomes and lower cost.

Manufacturers engage with managed care organizations (MCOs) in a number of ways, from deep conversations regarding clinical indications and brand coverage to general sessions focused on product portfolios and overall business. Although pharma companies have historically engaged with payers in phase III of the drug development lifecycle, pharma/payer meetings are now shifting to earlier in the timeline, during phase I and phase II. 

At the beginning of May, almost 8,000 attendees descended on Las Vegas for Asembia’s AXS24 Summit. While all of the session speakers discussed the future of healthcare in one way or another, MMIT noticed a few common trends about the state of the industry today.

At the beginning of May, almost 8,000 attendees descended on Las Vegas for Asembia’s AXS24 Summit. While all of the session speakers discussed the future of healthcare in one way or another, MMIT noticed a few common trends about the state of the industry today.

Navigating the landscape of patient access in the pharma industry has become increasingly complex, extending far beyond traditional channels. The challenges are multifaceted, influenced by evolving policies, innovative payer strategies, and shifts in provider dynamics.

Recent market research conducted by MMIT and The Dedham Group, encompassing insights from more than 300 industry stakeholders, sheds light on the critical barriers to patient access that are top of mind for pharma executives.