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 […]
For Manufacturers and Pharmacists, Patient Access Is a Team Sport
Getting a life-saving therapy into the hands of a patient who needs it is much easier said than done. While overcoming the numerous hurdles to adequate access typically falls to manufacturers, there are many stakeholders involved in this effort, from providers to payers to patients themselves. Pharmacists, too, play a key role in helping patients […]
The Push to Cover More Health Management Tools: A Shift From Acute Medicine to Health Management
Today’s healthcare world is seeing a shift from acute medicine to health management. A contributing factor to this has been the COVID-19 pandemic. A recent report shows that 66% of respondents with chronic conditions were more interested in taking a proactive approach to health than prior to the pandemic. People are taking a more vested […]
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 […]
Product Launch Success: Getting It Right In Rare Disease
As we wrote in our last article, “To Ace Your Product Launch, Don’t Fail At Market Access,” launching a drug into a crowded market without understanding the market access landscape is like failing to study for a make-or-break final. Yet while inadequate patient access to a life-saving treatment is much graver than a disappointing grade, […]
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 the emergence of biologics driving […]
How Pharma Companies Can Navigate the Medical Exception Process at Launch
There are many challenges that manufacturers face when launching a new drug: Will physicians prescribe the drug? Will they have any legal issues? Will patients request the drug? How should they market and distribute it? The list goes on and on, but one of the most critical questions to answer is this: Will patients be […]
Pathway or Perish: The Two-Pronged Hurdle to Ensuring Access in Oncology
While payers’ formulary decisions can make or break a drug’s success, manufacturers within oncology face an additional obstacle to gaining market access: clinical pathways, or guidelines that determine which treatments and procedures should be prescribed along the patient journey. While pathways were developed to help standardize treatment and ensure quality care, oftentimes they limit physicians’ […]
Why Pharma Companies Need a Strategy to Track Market Access in Real-Time
With payer coverage decisions around pharmaceuticals changing rapidly, simply being covered is no longer enough for getting patients on therapy quickly. Today, increasing market complexity and outsize payer influence have resulted in numerous hurdles to ensuring adequate access, from prior authorizations to step therapy to label restrictions. To succeed at launch amid these higher stakes […]
For Payers, Determining Aduhelm Coverage Is a Waiting Game
This article was originally published in FierceHealthcare. While it has been over a month since the FDA announced its controversial decision to approve Biogen’s Alzheimer’s drug, Aduhelm, payers have been slow to make any decisions—and for good reason. While the excitement around the approval is undeniable given the long-overdue unmet need for Alzheimer’s patients, there […]