Under Pressure, Payers Are Reevaluating Prior Authorizations
For decades, payers have used prior authorizations (PA) with the intent of curbing costs by preventing the unnecessary use of medical procedures or treatments. But in recent years, more and more physicians have contended that the practice impedes their ability to provide care. Amid pushback from provider groups and a
How Are Payers Reacting to Insulin Price Caps?
Over the past two decades, skyrocketing list prices for insulin have threatened medication adherence for the estimated 7.4 million American diabetics who rely on insulin to manage their disease. With the passing of the 2022 Inflation Reduction Act, Congress addressed the financial strain on nearly three million diabetics by capping
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
What Pharma Wants to Know About the Inflation Reduction Act
Ever since the Inflation Reduction Act (IRA) became law, pharma companies have struggled to identify how these changes will affect their business. In many ways, the IRA is forcing a marriage of necessity between product development and market access, as manufacturers must now be more focused on anticipating future market
What Pharma Wants to Know About the Medicare Drug Price Negotiation Program
Since the passing of the Inflation Reduction Act (IRA) last fall, pharma companies have been bracing for the impact of its provisions. The main healthcare-related IRA policies are the out-of-pocket spending cap, the Medicare Drug Price Negotiation Program, and the penalty for increasing drug prices faster than inflation. To get
Why Payers Are Split on Working With Mark Cuban’s Cost Plus Drug Company
Dallas Mavericks owner and venture capitalist Mark Cuban is taking aim at drug prices with his discount prescription drugs startup, Mark Cuban Cost Plus Drug Company. However, payers are divided on whether they want to work with the company, according to new MMIT research. By leveraging direct sourcing, Cost Plus
10 Questions Oncology Manufacturers Should Be Asking About the Stark Law
Even though we knew it was coming, the end of the COVID public health emergency (PHE) on May 11, 2023, still took the healthcare industry by surprise. While the end of the PHE resulted in the rollback of many COVID-19 programs, it also changed the ways that Medicare patients can
Prepping for the Inflation Reduction Act: Why Manufacturers Need a Plan for Rapid RWE Generation
Since the passing of the Inflation Reduction Act (IRA) in August 2022, the healthcare industry has been bracing for the impact of several key provisions. Three of these policies—price negotiations, inflation-adjusted rebates, and the out-of-pocket spending cap—will be at least partially in place by the close of 2023. As manufacturers
Coping With Drug Shortages: How Payers and Manufacturers Can Support Continued Patient Access
The COVID-19 pandemic illuminated a challenge to the U.S. healthcare system that continues to undermine effective patient care: medication shortages. A Senate report found that drug shortages increased nearly 30% last year, with a record five-year high of 295 active drug shortages by the end of 2022. Most recently, these
Spotlight on Vaccines: The Inflation Reduction Act’s Impact on Coverage
While the Inflation Reduction Act (IRA) may best be known for mandating Medicare drug price negotiation, the act did much more than that. Among its other accomplishments are the elimination of cost sharing for vaccines under Medicare Part D, as well as improved access to adult vaccines for Medicaid and