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Thought Leadership

Our leading subject matter experts share their insightful analysis and points of view to help you stay abreast of industry trends

Contracting

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

Changing Payer Management Dynamics at Play in Oncology

When it comes to the degree of payer management within a therapeutic area, pharma companies are becoming the victim of their own successes. One prime example is the rapid growth of competitive therapies across tumor types, pharmacological classes, and mechanisms of action in oncology. Payers have responded to the launch

Leaning into Real-World Evidence: Lessons from the IRA

Manufacturers are continuing to wrestle with the effects of the Inflation Reduction Act (IRA) on their business plans and revenue streams. Although some of the IRA’s impacts are still uncertain, real-world evidence (RWE) is an important tool for manufacturers navigating the road ahead, as it will help them demonstrate the value and

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

Navigating the Variances: Payer vs. Employer Coverage for Infertility and Obesity Drugs

As healthcare costs continue to climb, insurers are eager to control their spend. According to WTW’s Global Medical Trends Survey, 58% of insurers anticipate higher medical trend over the next three years. How stakeholders approach cost containment varies significantly depending on their priorities and incentives. Payers, pharmacy benefit managers (PBMs)

What Does Member Disruption Mean to Payers?

Recently, payers have started to use the phrase “member disruption” to refer to the potential impact of an impending formulary change on their members. This qualitative term is mentioned with increasing frequency during contracting discussions and P&T sessions, although the weight of these considerations varies between organizations. Member disruption describes

Spotlight on Vaccines: 2023’s RSV Immunization Approvals

Respiratory syncytial virus (RSV) can impact anyone, but infants and older adults are most at risk of illness. With multiple new immunizing agents gaining FDA approval in 2023—and more in the pipeline—manufacturers and payers have a role to play in educating patients and providers about the importance of immunizations to

How to Leverage Real-World Data in Your Commercial Strategy

In the past few years, real-world data (RWD) has become an increasingly important element of a successful market access strategy. By blending claims and lab data with clinical pathway and payer coverage data, pharma companies can get full visibility into what’s happening in the market. But how, exactly? What can

Case Study: Using Real-Time Market Access Data to Build a Strong Commercialization Strategy

Developing the first and only FDA-approved treatment for a particular indication is no longer a guarantee of market access. Before the launch of its first commercial product, one small biotech company was concerned about restrictive utilization management policies. How would its sales team combat barriers to patient access? The company

Market Access 101: Formulary and Medical Exceptions

Beginning with the basics, our Market Access 101 blog series has addressed how manufacturers can improve formulary placement for pharmacy benefit drugs, secure coverage and assess the need for contracting for medical benefit therapies. In this final post, we’ll explore what it means to request a formulary exception or medical