Payer Response to the Great Medicaid Unwinding
During the pandemic, the number of individuals in the U.S. enrolled in both fee-for-service and managed Medicaid programs increased dramatically. This increase was tied to a provision in the Families First Coronavirus Response Act, which boosted federal dollars to the states in exchange for keeping individuals covered through Medicaid, even if their eligibility changed since […]
Weight-Loss Mania: Coverage Trends for Obesity Drugs
We are in the midst of a weight-loss drug explosion. Mania for Novo Nordisk’s Wegovy/Ozempic has taken hold of both celebrities and everyday patients, leading to massive shortages and a surge of interest in all glucagon-like peptide 1 (GLP-1) agonists. Industry experts say that obesity has become a top five global market driver, and MMIT’s […]
New Program Combats Drug Shortages by Strengthening Generics
According to the American Society of Health-System Pharmacists (ASHP), U.S. drug shortages are the highest they’ve been in more than two decades. As of the end of 2024’s first quarter, 323 drugs were in short supply, including many chemotherapy, ADHD, and pain and sedation medications. These drugs run the gamut from basic drugs to life-saving […]
Asembia Trends: The IRA, High-Cost Drugs and Personalized Care
At the beginning of May, almost 8,000 attendees descended on Las Vegas for Asembia’s AXS24 Summit. While all of the session speakers discussed the future of healthcare in one way or another, MMIT noticed a few common trends about the state of the industry today. If you missed the conference, read on for an overview […]
Understanding Access Barriers in 2024 and Beyond
Navigating the landscape of patient access in the pharma industry has become increasingly complex, extending far beyond traditional channels. The challenges are multifaceted, influenced by evolving policies, innovative payer strategies, and shifts in provider dynamics. Recent market research conducted by MMIT and The Dedham Group, encompassing insights from more than 300 industry stakeholders, sheds light […]
Cordavis Could Benefit U.S. Biosimilars Market
It has now been over a year since the first Humira biosimilar, Amgen’s Amjevita, entered the U.S. market. Eight additional adalimumab biosimilars followed suit, offering lower-cost alternatives to AbbVie’s blockbuster drug via a variety of dual-pricing and discounting strategies. Some PBMs, including Express Scripts and Optum Rx, were quick to add some biosimilars to their […]
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. […]
What’s Ahead for Market Access in 2024?
Last year was a period of adjustment for the U.S. pharma industry, as the combination of increased financial pressures and the Inflation Reduction Act (IRA) meant adjustments to resource allocation. While concerns about macro trends like inflation and interest rates are still top of mind for manufacturers, we expect a renewed focus on efficient pipeline […]
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 swell of state and federal […]
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 insulin prices at $35 a […]