Focusing on Social Determinants of Health: How to Make an Impact
Consideration of patients’ social determinants of health (SDoH) has been a facet of healthcare delivery in the United States for decades. The CDC defines SDoH as the nonmedical factors that influence a patient’s health outcomes, such as access to care services and medication, housing and food stability, education levels, and employment. During the COVID-19 pandemic, […]
Are We at a Tipping Point for Prescription Digital Therapeutics?
The category of treatments known as ‘digital therapeutics’ is widely misunderstood. Though the term is often conflated with ‘digital health’ tools, such as fitness trackers or meditation apps, digital therapeutics (DTx) are distinguished by their reliance on clinical evidence. DTx products use evidence-based, clinically evaluated software to deliver medical interventions directly to patients to prevent, […]
Payers Troubled by Rise of Alternative Funding Programs
For the past few years, the industry has grappled with the rise of a controversial new pharmacy benefits strategy: alternative funding. Alternative funding programs (AFPs), also known as specialty carve-out programs, are intended to reduce the cost of specialty drugs for both patients and payers. According to proponents, AFPs can help employers improve access while […]
Exploring the Role of AI in Managed Care Organizations
Artificial Intelligence (AI) technology and ChatGPT are disrupting countless industries around the world. For healthcare, the possibilities appear promising, with organizations striving to improve patient outcomes and the overall quality of care. According to Precedence Research, AI in healthcare is expected to surpass $187.95 billion dollars by 2030, growing at a CAGR of 37% during […]
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 […]