What to Watch in Second Round of Medicare Drug Price Negotiations
Established by the Inflation Reduction Act in August 2022, the Medicare Drug Price Negotiation Program is still in its infancy, but is expected to impact a wide swath of stakeholders in the U.S. healthcare system. Last year, CMS negotiated prices for the first round of drugs, and in January, the
Mining the Hidden Gems in Unstructured EMR Data
Pharma companies are increasingly turning to real-world data to answer their commercial business questions, but not all realize that unstructured EMR data is the unsung hero of most queries. Whether a manufacturer is struggling to find a niche patient population, conduct unbiased outcomes research, or generate persuasive proof points, unstructured
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
Expanding Molecular Testing: What Payers and Manufacturers Should Know
Medicine has been trending towards personalization for decades. The growth of individualized medicine and new diagnostic technologies has resulted in drugs that are tailored towards patients’ profile and condition—and are much more effective as a result. These therapies rely on the existence of molecular tests, including genetic testing, predictive and
Changing Payer Management Dynamics at Play in Oncology
When it comes to the degree of payer management within a therapeutic area, pharma companies are becoming the victim of their own successes. One prime example is the rapid growth of competitive therapies across tumor types, pharmacological classes, and mechanisms of action in oncology. Payers have responded to the launch
Unlocking the Pathway Puzzle: How Biopharma Can Navigate the Clinical Pathways Landscape
In the realm of oncology, the advent of clinical pathways has gained substantial traction in the past two decades as the increasing cost and complexity of cancer care demanded structured, multidisciplinary, and cost-effective approaches. Pathways have become a critical strategy for both physicians and payers to streamline treatment decision-making, standardize
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
Using Real-World Data to Improve Patient Access to Oncology Therapies
Many oncology manufacturers assume that a therapy’s inclusion on clinical pathways is more important than its coverage profile, but this isn’t always true. Across every oncology class, manufacturers need to know which organizations—IDNs, provider organizations, payers or PBMs—have the biggest positive and/or negative influence on their products’ utilization. Patient access
How Are Payers Responding to ADHD and Chemo Drug Shortages?
In the wake of the COVID-19 pandemic, drug shortages, caused by increased demand, supply chain difficulties, and supplier issues have plagued payers and patients alike, making it harder for patients to access the therapies they need and causing delays in treatment. Drug shortages hit a record five-year high in 2022,
How Much Does Medication Compliance Affect Site-of-Care Optimization?
In an effort to lower the cost of specialty drugs, many payers have initiated site-of-care optimization strategies. By encouraging patients to receive therapies in more cost-effective settings — such as physician offices, infusion clinics, or at home — payers can reduce unnecessary expenses while ensuring members receive clinically appropriate care.
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