Market Access 101: Securing Coverage Under the Medical Benefit
Welcome back to MMIT’s Market Access 101 blog series. Our first post, Understanding the Basics, covered the difference between the pharmacy and medical benefit structure, while our second, Improving Your Drug’s Formulary Placement, discussed how to overcome access barriers. In this post, we’ll discuss what manufacturers should know about drugs covered under the medical benefit. […]
Spotlight on Vaccines: The Path to Commercial Plan Coverage
Following a severe season of respiratory syncytial virus, or RSV, in the U.S., multiple companies have reported that they have promising vaccine candidates for various patient populations in the late-stage clinical trial pipeline. The FDA could approve some of them as early as this year, for what is estimated to be a market worth more […]
Market Access 101: Improving Your Drug’s Formulary Placement
Welcome back to MMIT’s Market Access 101 series, in which we unpack the complexities of market access via a series of blog posts. In our first post, Understanding the Basics, we covered the difference between the pharmacy and medical benefit structure, the typical timeline for drug review, and why it’s critical to determine which entity […]
The Evolution of Medical Benefit Contracting: How Pharma Can Prepare
This article was originally published in Drug Channels. Given the growth of specialty pharmaceuticals, manufacturers will need to develop more aggressive contracting strategies to secure optimal market access for their medical benefit drugs. Shifting market dynamics, driven in part by the influx of lower cost biosimilars on the pharmacy benefit, will require pharma companies to […]
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 phases of the drug development […]
Payers and PBMs Are Excluding Cancer Drugs at a Growing Rate. How Can Manufacturers Prepare?
With rebates now a common pharma practice, and generics and biosimilars launching in oncology, payer management of once-untouchable cancer drugs is growing. As the FDA continues to approve a large number of cancer drugs, resulting in increased competition in various tumor types, and spending on these agents continues to rise, PBM and payer formularies are […]
Will Interchangeability Status Truly Move the Needle With Biosimilars?
When it comes to biosimilars, there seem to be far more questions than answers, specifically when it comes to interchangeability. Now that the FDA has granted three biosimilar products “interchangeable” status—with more to come, surely—how will this development affect the biosimilars market? What do pharma manufacturers, payers and physicians need to know about this designation? […]
Manufacturers: Are You Familiar With Payers’ Genetic Testing Coverage Procedures?
As researchers continue to identify specific genetic markers within different diseases, more and more treatments targeting those markers are launching. In fact, more than 77,000 genetic tests currently are available. They can identify, for example, what type of breast cancer or non-small cell lung cancer a patient has. Some can determine a person’s risk for […]
What the Inflation Reduction Act Means for Manufacturers and Health Plans
Given the spotlight that COVID-19 has shone on the glaring holes within the U.S. healthcare system, it’s not surprising that the current Biden administration has placed considerable importance on addressing key issues head-on. The focus on solving these issues has manifested as the Inflation Reduction Act (IRA), which passed along party lines in the Senate […]
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 […]