From Integration to AI: The Data-Driven Future of Market Access
This article was originally published in Drug Channels. In a competitive market, pharma companies are increasingly relying on various datasets to drive their decision-making. With so many disparate sources, however, data standardization presents a challenge, especially for companies eager to use predictive analytics tools. In a recent survey of 125 pharma executives, nearly half cited data integration […]
Growth of Warranty-Based Contracts
As payers grapple with their ever-increasing spend on healthcare services, many are entering into various arrangements with pharma manufacturers to help mitigate their risk when paying for cell, gene and specialty therapies—which often have price tags ranging from several hundred thousand to millions of dollars. A warranty-based agreement is one approach that can benefit both […]
Increased Competition Drives Biosimilar Market Shifts
For the past decade, biosimilar adoption in the U.S. has proceeded at a relatively slow pace, due in large part to limited financial rebates for payers and provider preferences for biologics. Recent research suggests that utilization is finally picking up steam as more health plans place both biosimilars and their reference biologics on preferred formulary […]
Using De-Identified Lab Data to Find Patients, Target Physicians and Expedite Treatment
Lab data has become an increasingly essential dataset for pharmaceutical companies at all stages of the product life cycle. A key use case for our MMIT clients is using lab data for commercial targeting. Since lab tests often represent one of the earliest data points in a patient’s diagnostic journey, pharma companies are using lab […]
Open vs. Closed Claims: Unlocking Opportunities for Healthcare Analytics
In the complex healthcare analytics landscape, understanding the nuances of open and closed claims is critical for researchers and analysts. Open and closed claims each offer unique insights into the patient journey. Open claims, sourced from various clearinghouses and warehouses across the U.S., present a vast collection of data, while closed claims, adjudicated by insurers, […]
Digital Best Practices for Communicating Drug Coverage to HCPs
Before physicians prescribe a new therapy, they need to trust that it is the most effective and appropriate treatment for an individual patient. They need education on the drug’s efficacy and safety, dosing and administration, and the clinical criteria that define eligibility. They also need to know if the drug is affordable and accessible for […]
Tremendous Growth in 2024 Health Insurance Exchange Membership
For the past year, Medicaid has been the predominant topic of conversation for those who monitor insurance market share shifts. Medicaid enrollment peaked at 94.5 million in April 2023, when states resumed eligibility redeterminations after a multi-year pause. In the year that followed, Medicaid enrollment declined 10.4%, and has continued to plummet in recent quarters, with […]
When Payers Become Producers: Inside the Private-Labeling Trend
This article was originally published in Drug Channels. Vertical integration between payers, PBMs, specialty pharmacies, and providers has grown in the last decade, with more negotiating power concentrated among a handful of major players. Now insurers are adding production arms into the mix, following CVS Health’s bid to cash in on the race for Humira […]
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. […]
Connecting the Dots: Part D Design, the IRA, and Biosimilar Uptake
Although the biosimilar market is expected to continue growing over the next few years, adoption thus far has been somewhat slow and uneven. Recent research published in Health Affairs takes a look at how upcoming provisions of the Inflation Reduction Act (IRA) are likely to impact biosimilar coverage, concluding that both Medicare beneficiaries and the […]