Apples to Apples: Stelara Biosimilars and the Fight for Market Share
Over the next five years, 88 biologics—including several blockbuster agents like Eliquis, Keytruda, Opdivo, and Darzalex—are facing a loss of exclusivity, representing an estimated market of more than $100 billion. After the fierce competition between Humira (adalimumab) biosimilars, manufacturers are keeping a close eye on adoption dynamics for biosimilars of Johnson & Johnson’s autoimmune drug, […]
Quantifying Value: Innovative Contracting for High-Cost Drugs
As high-cost specialty treatments become more common, manufacturers are turning to innovative contracting to boost coverage for their products. Many cell and gene therapies, orphan drugs, and oncology therapies are prohibitively expensive, with costs ranging from several hundred thousand to millions of dollars. Warranty-based agreements help mitigate the risk of paying for these therapies, as […]
Starting with the End in Mind: How Pharma Can Build a Smarter Path to Commercialization
To chart a clear path to commercialization, a manufacturer must begin with the end in mind. Early market research helps pharma companies understand which clinical endpoints and differentiators an asset will need to succeed at launch. Today, one-third of pharma companies start market access planning in Phase I, and 80% start by Phase III. Manufacturers […]
Push for Change in 340B Drug Pricing Program
As the 340B Drug Pricing Program continues to grow in size and importance, its operations are being scrutinized more than ever. Pharma manufacturers, who have long noted issues with this program, have made various attempts at reform. Their latest strategy — which would move away from up-front discounts to a rebate model — is currently […]
Selling the Script: The Introduction of Private Equity in Retail Pharmacy
Over the past decade, health systems have seen a rapid influx of private equity, with a six-fold increase in acquisitions totaling $10 trillion. As private equity firms continue to explore new methods of investment in health care, the recent announcement that Walgreens Boots Alliance will be acquired by Sycamore Partners seems to be a natural […]
Asembia Trends: IRA Operationalization and the Future of Specialty Therapies
At the end of April, more than 8,000 attendees visited Las Vegas for the Asembia Specialty Pharmacy Summit, otherwise known as AXS25. If you missed the conference, here’s an overview of some of the key areas covered this year: Keeping an Eye on Government Policies AXS25 featured quite a few presentations on the impact of the […]
How Copay Accumulators and Maximizers Affect Pharma PAPs
In a recent post on specialty carve-out mechanisms, we examined how payers’ use of specialty benefit managers and alternative funding programs can impact manufacturers’ patient assistance programs (PAPs). Today’s post takes a look at another managed care trend: the rise of copay accumulators and maximizers, also known as copay adjustment programs. In 2025, copay accumulator […]
Alzheimer’s Drugs Face Uncommon Market Access Challenges
Approximately 6.9 million Americans aged 65 and older have been diagnosed with Alzheimer’s disease (AD). By 2060, prevalence could reach 13.8 million if no therapies are approved to prevent or cure AD. For decades, Alzheimer’s treatment focused on symptom management, with stagnant progress in experimental breakthroughs. That changed recently with the development of beta-amyloid targeting […]
Payers Prepare for 2025 Medicare Part D Changes
As of 2024, more than 54 million Medicare beneficiaries had prescription drug coverage through Medicare Part D. Of that total, 31 million had Part D coverage alongside a Medicare Advantage plan, and about 23 million had a Part D prescription drug plan. As a result of the Inflation Reduction Act (IRA), significant changes to the […]
Growing Interest in Direct-to-Consumer Drug Programs
The past few years saw the launch of several direct-to-consumer (DTC) programs, including Amazon One Medical and Mark Cuban’s Cost Plus Drugs. In 2024, several manufacturer-designed DTC programs, such as LillyDirect and PfizerForAll, have been added to the mix, demonstrating pharma’s continuing shift toward an integrated model of patient care. While these programs can benefit […]