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
Four Trends That Are Shaping the Future of Market Access
In pharma, every year seems to bring forth even more change than the year before, but 2023 just might take the cake. Stakeholders have had to adjust to new developments in the healthcare ecosystem such as the Inflation Reduction Act, the rise of immunology biosimilars and insulin price changes impacting
Payer Coverage of Fast-Tracked Therapies: A Cautionary Tale
When a pharma company secures expedited approval for a drug in development, everyone involved is usually thrilled. After all, a faster approval process means that patients in need will be able to access this critical treatment more quickly. Manufacturers also assume that expedited approval will lead to faster revenue recognition,
Why Updated Health Plan Enrollment Data Is Crucial in the Wake of Medicaid Changes
Due to the end of the public health emergency for COVID-19 and subsequent redeterminations for Medicaid, health plan enrollment data has become increasingly volatile. As of this spring, states were able to resume Medicaid eligibility redeterminations, which were stopped during the pandemic. For three years, states couldn’t check members’ income
What Pharma Needs From RWD: Top 5 Trends
The explosion of real-world data (RWD) now available to pharma companies can be overwhelming. While many larger manufacturers with their own teams of data analysts have been using RWD for years, smaller manufacturers are just beginning to incorporate RWD into their clinical development and market access strategies. Which data sets
Using Real-World Data to Improve Patient Access to Oncology Therapies
Many oncology manufacturers assume that a therapy’s inclusion on clinical pathways is more important than its coverage profile, but this isn’t always true. Across every oncology class, manufacturers need to know which organizations—IDNs, provider organizations, payers or PBMs—have the biggest positive and/or negative influence on their products’ utilization. Patient access
How Are Payers Responding to ADHD and Chemo Drug Shortages?
In the wake of the COVID-19 pandemic, drug shortages, caused by increased demand, supply chain difficulties, and supplier issues have plagued payers and patients alike, making it harder for patients to access the therapies they need and causing delays in treatment. Drug shortages hit a record five-year high in 2022,
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