Starting with the End in Mind: How Pharma Can Build a Smarter Path to Commercialization
To chart a clear path to commercialization, a manufacturer must begin with the end in mind. Early market research helps pharma companies understand which clinical endpoints and differentiators an asset will need to succeed at launch. Today, one-third of pharma companies start market access planning in Phase I, and 80%
Selling the Script: The Introduction of Private Equity in Retail Pharmacy
Over the past decade, health systems have seen a rapid influx of private equity, with a six-fold increase in acquisitions totaling $10 trillion. As private equity firms continue to explore new methods of investment in health care, the recent announcement that Walgreens Boots Alliance will be acquired by Sycamore Partners
Asembia Trends: IRA Operationalization and the Future of Specialty Therapies
At the end of April, more than 8,000 attendees visited Las Vegas for the Asembia Specialty Pharmacy Summit, otherwise known as AXS25. If you missed the conference, here’s an overview of some of the key areas covered this year: Keeping an Eye on Government Policies AXS25 featured quite a few presentations
What to Watch in Second Round of Medicare Drug Price Negotiations
Established by the Inflation Reduction Act in August 2022, the Medicare Drug Price Negotiation Program is still in its infancy, but is expected to impact a wide swath of stakeholders in the U.S. healthcare system. Last year, CMS negotiated prices for the first round of drugs, and in January, the
How Copay Accumulators and Maximizers Affect Pharma PAPs
In a recent post on specialty carve-out mechanisms, we examined how payers’ use of specialty benefit managers and alternative funding programs can impact manufacturers’ patient assistance programs (PAPs). Today’s post takes a look at another managed care trend: the rise of copay accumulators and maximizers, also known as copay adjustment
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Alzheimer’s Drugs Face Uncommon Market Access Challenges
Approximately 6.9 million Americans aged 65 and older have been diagnosed with Alzheimer’s disease (AD). By 2060, prevalence could reach 13.8 million if no therapies are approved to prevent or cure AD. For decades, Alzheimer’s treatment focused on symptom management, with stagnant progress in experimental breakthroughs. That changed recently with
© 2024 MMIT
Payers Prepare for 2025 Medicare Part D Changes
As of 2024, more than 54 million Medicare beneficiaries had prescription drug coverage through Medicare Part D. Of that total, 31 million had Part D coverage alongside a Medicare Advantage plan, and about 23 million had a Part D prescription drug plan. As a result of the Inflation Reduction Act
Growing Interest in Direct-to-Consumer Drug Programs
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.
Growth of Warranty-Based Contracts
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
Evaluating Payer Impact on Utilization with Claims and Coverage Data
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.
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