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Thought Leadership

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Medical Benefit

Market Access 101: Understanding the Basics

For many pharmaceutical companies, planning for commercialization only begins in earnest when a drug has been submitted for FDA approval—which is far too late. Ideally, a company’s commercial and market access teams should be fully functional long before the approval stage, as many decisions must be made in the early

New HCPCS Codes for Generics: What Payers and Manufacturers Should Know to Ensure Accurate Reimbursement

As if medical billing and coding wasn’t challenging enough, 2023 brings a new layer of complexity: the establishment of unique HCPCS codes for generic drugs. Specifically, the new codes affect generics approved under the FDA’s 505(b)(2) new drug application (NDA) and biologics license application (BLA) pathways. In its Q3 2022

From Buy-and-Bill to White Bagging: The Future of Reimbursement Under the Medical Benefit

Pharmaceutical manufacturers that are nearing the commercialization stage of pre-approval planning are faced with a lot of realities about managed markets. Manufacturers are so engrossed in the details of a clinical trial, and its eventual success, that beginning to plan for commercialization can be daunting. However, for physician-administered therapies or

Will New Approaches to Medical Benefit Contracting Help Control Specialty Drug Spend?

Pharmacy benefit contracting has always been a mechanism for payers to offset the cost of small-molecule therapeutic areas. Payers have looked to manufacturers to negotiate contracts that would prevent their products from being placed on a restrictive tier, or subject them to step edits or an NDC block. But with
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