Responding to 2024’s Volatile Insurance Market
From the spring of 2020 to March 2023, Medicaid gained approximately 20 million new members, thanks in large part to the provision for continuous enrollment during the pandemic. Once Medicaid eligibility redeterminations were officially back in play in April 2023, states were allowed to begin the process of disenrolling beneficiaries who failed to meet their […]
How Claims and Lab Data Helps Pharma Generate Real-World Evidence
In our last blog on this subject, we asked three clinical experts to explain how integrated real-world and market access data helps pharma companies go to market. In this blog, our experts weigh in on how integrated data helps pharma brands identify patients, correct payer/IDN misalignment, and make better predictions to improve patient care. We […]
How Claims and Lab Data Helps Pharma Go to Market
When a manufacturer is at least a year out from a drug’s PDUFA date, the market access team begins to make informed decisions about what data is necessary for a successful launch. Many are using claims, lab, and other real-world data sets to access the right patient population at the right time to drive utilization […]
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 […]
Navigating the Variances: Payer vs. Employer Coverage for Infertility and Obesity Drugs
As healthcare costs continue to climb, insurers are eager to control their spend. According to WTW’s Global Medical Trends Survey, 58% of insurers anticipate higher medical trend over the next three years. How stakeholders approach cost containment varies significantly depending on their priorities and incentives. Payers, pharmacy benefit managers (PBMs) and employer benefit managers (EBMs) […]
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 […]
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 rebate economics, and the […]
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, but this isn’t always true. […]
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 to determine whether they were […]
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 do they need, and how […]