Increased Competition Drives Biosimilar Market Shifts
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 […]
How Costs Impact Utilization for Hemophilia CGTs
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 […]
When Payers Become Producers: Inside the Private-Labeling Trend
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 […]
Coding Chaos: How Pharma Can Help Providers Get Paid
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 […]
The Rise of Specialty Benefit Managers: What Pharma Should Know
This article was originally published in Fierce Pharma. 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. Unlike […]
Communication Trends: How to Prepare for Effective Pharma/Payer Meetings
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 […]
Treating Hemophilia: The Impact of New Gene Therapies
The CDC estimates that more than 33,000 Americans are living with hemophilia, an inherited bleeding disorder which affects primarily men. Patients with hemophilia have a deficiency of the blood proteins, known as coagulation or clotting factors, that help blood to clot properly. The two most common subtypes are hemophilia A (factor VIII deficiency) and hemophilia […]
Humira Biosimilars: Pricing, Contracting and Interchangeability
This has been a significant year for the Humira (adalimumab) biosimilar market. AbbVie’s blockbuster drug Humira, an injectable used to treat a range of inflammatory conditions, saw the end of its 20-year, $200 billion monopoly in January. By the beginning of November, nine adalimumab biosimilars had made their market debut. Pharma manufacturers have been closely […]
Four Trends That Are Shaping the Future of Market Access
This article was originally published on Drug Channels. In pharma, every year seems to bring forth even more change than the year before, but 2023 just might take the cake. Stakeholders have had to adjust to new developments in the healthcare ecosystem such as the Inflation Reduction Act, the rise of immunology biosimilars, insulin price […]
Using Real-World Data to Improve Patient Access to Oncology Therapies
This article was originally published in BioPharma Dive. Many oncology manufacturers assume that a therapy’s inclusion on clinical pathways is more important than its coverage profile, but this isn’t always true. According to MMIT Pulse Analytics data, roughly 64% of U.S. oncologists are exposed to third-party clinical pathways developed either by an oncology group or a payer. However, […]