Unintended Consequences of the IRA: Will the CPI Penalty Increase the Price of Drugs?
The Inflation Reduction Act (IRA), signed into law in August 2022, was intended in part to lower healthcare costs for families and small businesses. The IRA contains several provisions aimed at prescription drug costs which will roll out over the next few years, with the earliest taking effect this year. As of 2023, CMS will […]
Staying Competitive in an Expanding Medicare Advantage Market
Over the past year, the health plan landscape has seen significant enrollment shifts, especially within government-sponsored plans. According to MMIT’s Directory of Health Plans, the top 10 Medicare Advantage insurers accounted for 77.2% of the national market at the close of 2022. Nine of the top 10 organizations reported year-over-year growth ranging from 2.8% to […]
Market Access 101: Securing Coverage Under the Medical Benefit
Welcome back to MMIT’s Market Access 101 blog series. Our first post, Understanding the Basics, covered the difference between the pharmacy and medical benefit structure, while our second, Improving Your Drug’s Formulary Placement, discussed how to overcome access barriers. In this post, we’ll discuss what manufacturers should know about drugs covered under the medical benefit. […]
The Problem with Copay Adjustment and Alternate Funding Programs
Payers’ use of copay adjustment programs has exploded over the past few years, and interest in them remains high. In addition, payers are now looking to bring down their drug spend by adopting newer strategies offered by companies with alternate funding programs. While many manufacturers are pushing back against these copay adjustment and specialty carve-out […]
Market Access 101: Improving Your Drug’s Formulary Placement
Welcome back to MMIT’s Market Access 101 series, in which we unpack the complexities of market access via a series of blog posts. In our first post, Understanding the Basics, we covered the difference between the pharmacy and medical benefit structure, the typical timeline for drug review, and why it’s critical to determine which entity […]
The Evolution of Medical Benefit Contracting: How Pharma Can Prepare
Given the growth of specialty pharmaceuticals, manufacturers will need to develop more aggressive contracting strategies to secure optimal market access for their medical benefit drugs. Shifting market dynamics, driven in part by the influx of lower cost biosimilars on the pharmacy benefit, will require pharma companies to focus more on rebating and cost minimization. As […]
What Payers Want: Understanding Payer Preferences When Evaluating Therapies
Many manufacturers are interested in which factors can give them an edge on obtaining preferred coverage with payers. This is especially true given the increasing competition in saturated categories such as immunology, diabetes care and breast cancer. We scoured recent MMIT research to gain a better grasp on the factors that are top of mind […]
Rebate Leakage: How Pharma Companies Can Prevent a Multimillion-Dollar Problem
Every consumer is familiar with the rebates one may get when purchasing a product or service. However, if the rebate was invalid or was not submitted properly, the money does not always get back to the consumer. A similar issue of ineligible rebates and incurred costs also consistently occurs in the pharmaceutical industry, but on […]
From Buy-and-Bill to White Bagging: The Future of Reimbursement Under the Medical Benefit
Pharmaceutical manufacturers that are nearing the commercialization stage of pre-approval planning are faced with a lot of realities about managed markets. Manufacturers are so engrossed in the details of a clinical trial, and its eventual success, that beginning to plan for commercialization can be daunting. However, for physician-administered therapies or IV therapies, understanding and navigating […]