Market Access Trends Impacting Your Patient Assistance Program
Payers tend to manage high-cost, high-complexity disease states quite differently than other indications. In recent years, payers’ growing reliance on managed care carveouts, in the form of specialty benefit managers (SBMs) and alternative funding programs (AFPs), has directly impacted pharma companies that offer patient assistance. This year, the downstream effects of the Inflation Reduction Act […]
Meet Your Launch Goals with Payer and HCP Insights
The weeks preceding a pharma product’s launch date are a critical window for market access teams. The ability to pivot and adjust to last-minute shifts can make all the difference between a successful first year and a disappointing launch trajectory. While much of your market access research may have already been completed by the time […]
Evaluating Payer Impact on Utilization with Claims and Coverage Data
To fully understand how payers impact patient access, pharma companies should be evaluating payers using multiple datasets, including both coverage/restriction data and claims data. While payer policies indicate how payers plan to manage a product or service, medical and pharmacy claims reveal how payers actually manage that product in reality. Taken together, claims and coverage […]
Acing Market Access: Six Steps to Take Before Launch
Our first post in this series discussed how early market access research, conducted in the 12-18 months before launch, helps pharma companies identify differentiators and establish accurate expectations. As your organization moves closer to launch, your market access team will need to establish a commercially focused definition for your patient population. You’ll need to identify […]
Tremendous Growth in 2024 Health Insurance Exchange Membership
For the past year, Medicaid has been the predominant topic of conversation for those who monitor insurance market share shifts. Medicaid enrollment peaked at 94.5 million in April 2023, when states resumed eligibility redeterminations after a multi-year pause. In the year that followed, Medicaid enrollment declined 10.4%, and has continued to plummet in recent quarters, with […]
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 prognostic biomarkers, and companion diagnostics. […]
Weight-Loss Mania: Coverage Trends for Obesity Drugs
We are in the midst of a weight-loss drug explosion. Mania for Novo Nordisk’s Wegovy/Ozempic has taken hold of both celebrities and everyday patients, leading to massive shortages and a surge of interest in all glucagon-like peptide 1 (GLP-1) agonists. Industry experts say that obesity has become a top five global market driver, and MMIT’s […]
The Rise of Specialty Benefit Managers: What Pharma Should Know
This article was originally published in Fierce Pharma. In the shift toward value-based care, more payers are outsourcing the management of specific therapeutic areas to third-party specialty benefit managers (SBMs). These companies help payers manage high-cost, high-complexity disease states by leveraging provider networks and making coverage recommendations intended to improve outcomes and lower cost. Unlike […]
Understanding Access Barriers in 2024 and Beyond
Navigating the landscape of patient access in the pharma industry has become increasingly complex, extending far beyond traditional channels. The challenges are multifaceted, influenced by evolving policies, innovative payer strategies, and shifts in provider dynamics. Recent market research conducted by MMIT and The Dedham Group, encompassing insights from more than 300 industry stakeholders, sheds light […]
Solving Access Barriers in Biomarker Testing: 5 Tips for Manufacturers
This article was originally published in Drug Channels. Despite the rapid evolution of personalized medicine, access to genetic testing and next-generation sequencing (NGS) is a challenge—due in no small part to coverage confusion. Physicians struggle to navigate poorly defined testing coverage policies and a fragmented payer and vendor ecosystem, resulting in delayed care for patients […]