Preparing for the Inflation Reduction Act’s Impact on Medicare Plans
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. […]
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 […]
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 of more innovative and highly […]
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 comparative effectiveness of their treatments. […]
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 […]
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) and employer benefit managers (EBMs) […]
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 the impact of formulary changes […]
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 combat RSV. RSV, a contagious […]
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 a unified source of RWD […]
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 identified payer coverage monitoring and […]