What Role Do Social Determinants of Health Play in Market Access?
A patient’s journey to accessing life-saving therapies is rarely linear, and while much of that is due to factors within the healthcare system, many external influences are also at work. Social determinants of health are an example of these outside forces that play a crucial role in patient care, for better or for worse. Social […]
When Will Payers Improve Coverage of Prescription Digital Therapeutics?
This article was originally published in PharmExec. At age 19, my stepson has run the gamut of therapeutic options—combination therapies, cognitive behavioral therapy, you name it—for treating his attention deficit hyperactivity disorder (ADHD). After 10 years of searching, we have yet to find a treatment that truly works for him. However, there’s one option that […]
Are Clinical Pathways Expanding Beyond Oncology?
In oncology, clinical pathways—recommendations of specific treatments for a specified group of patients—have long been used to help control costs and treatment variation while improving outcomes. Clinical pathways may be payer-driven or provider-driven based on the organization that develops and controls the pathways, and financial incentives and policing mechanisms encourage provider buy-in and adherence. While […]
What Manufacturers Need to Know About Alternative Payment Models
Much has been said about healthcare’s shift from a fee-for-service model to a value-based care (VBC) model—and for good reason. With 50% of clinical interventions resulting in unknown effectiveness, and 20-40% of health expenditure wasted on unproven or unnecessary treatments, VBC models can help reduce costs and inefficiencies for patients, providers and manufacturers. Yet while […]
Three Hot Topics at AHIP 2022
From drug pricing to health equity to digital therapeutics, the healthcare industry had a lot to talk about at this year’s America’s Health Insurance Plans (AHIP) conference, held June 21-23 in Las Vegas—the first in-person AHIP event since the start of the COVID-19 pandemic. While the keynote speakers, panel sessions and individual presentations covered a […]
Why Oncology Manufacturers Need a Clinical Pathway Strategy
As a society, we have made great strides in improving cancer care and outcomes in recent years. There are now more treatment options across more tumor types than ever before. There are targeted therapies designed for specific genetic mutations, which carry fewer side effects than traditional chemotherapy and lead to higher rates of remission and […]
Manufacturers and the Mental Health Crisis: How Data and Education Can Improve Patient Access
According to the National Institutes of Health (NIH), nearly one in five U.S. adults (approximately 52 million) live with some form of mental illness. Unfortunately, those struggling with a mental health disorder often aren’t getting the treatment they need, and when undertreated, can have considerable economic impact on national healthcare budgets due to the cost […]
PBM GPOs: An Uncertain Shift
While vertical integration and consolidation within the U.S. health system has been a steady trend over the years, now we’re seeing it go even further with the creation of pharmacy benefit manager group purchasing organizations (PBM GPOs), which create yet another tollgate requiring payment in the drug therapy supply chain. Approximately 80% of all prescription […]
PrEP Therapy Can End the HIV Epidemic, but Equitable Access Is Key
Amid a global pandemic that has been the foreground of thought and development in medicine the past two years, another epidemic has been lingering for decades: HIV and AIDS were first recorded in the early 1980s, and their presence has grown exponentially over the last 40 years. In that time, HIV has fostered significant innovations […]
The Evolution of Patient Assistance Programs
It’s no secret that copay maximizer and accumulator programs have come under fire since their inception, and for good reason: In theory, these programs aim to help manage costs, but oftentimes accumulators can end up shifting the cost of medications to patients while maximizers can shift the cost of care from the patient to the […]