Leaning into Real-World Evidence: Lessons from the IRA
Manufacturers are continuing to wrestle with the effects of the Inflation Reduction Act (IRA) on their business plans and revenue streams. Although some of the IRA’s impacts are still uncertain, real-world evidence (RWE) is an important tool for manufacturers navigating the road ahead, as it will help them demonstrate the value and
Treating Hemophilia: The Impact of New Gene Therapies
The CDC estimates that more than 33,000 Americans are living with hemophilia, an inherited bleeding disorder which affects primarily men. Patients with hemophilia have a deficiency of the blood proteins, known as coagulation or clotting factors, that help blood to clot properly. The two most common subtypes are hemophilia A
Navigating the Variances: Payer vs. Employer Coverage for Infertility and Obesity Drugs
As healthcare costs continue to climb, insurers are eager to control their spend. According to WTW’s Global Medical Trends Survey, 58% of insurers anticipate higher medical trend over the next three years. How stakeholders approach cost containment varies significantly depending on their priorities and incentives. Payers, pharmacy benefit managers (PBMs)
What Does Member Disruption Mean to Payers?
Recently, payers have started to use the phrase “member disruption” to refer to the potential impact of an impending formulary change on their members. This qualitative term is mentioned with increasing frequency during contracting discussions and P&T sessions, although the weight of these considerations varies between organizations. Member disruption describes
Spotlight on Vaccines: 2023’s RSV Immunization Approvals
Respiratory syncytial virus (RSV) can impact anyone, but infants and older adults are most at risk of illness. With multiple new immunizing agents gaining FDA approval in 2023—and more in the pipeline—manufacturers and payers have a role to play in educating patients and providers about the importance of immunizations to
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How to Leverage Real-World Data in Your Commercial Strategy
In the past few years, real-world data (RWD) has become an increasingly important element of a successful market access strategy. By blending claims and lab data with clinical pathway and payer coverage data, pharma companies can get full visibility into what’s happening in the market. But how, exactly? What can
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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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Industry Trends Medical Benefit Medical Billing and Coding Oncology Reimbursement and Rebates
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Case Study: Using Real-Time Market Access Data to Build a Strong Commercialization Strategy
Developing the first and only FDA-approved treatment for a particular indication is no longer a guarantee of market access. Before the launch of its first commercial product, one small biotech company was concerned about restrictive utilization management policies. How would its sales team combat barriers to patient access? The company
Market Access 101: Formulary and Medical Exceptions
Beginning with the basics, our Market Access 101 blog series has addressed how manufacturers can improve formulary placement for pharmacy benefit drugs, secure coverage and assess the need for contracting for medical benefit therapies. In this final post, we’ll explore what it means to request a formulary exception or medical
Market Access 101: Key Factors in Medical Benefit Contracting
Welcome back to our Market Access 101 blog series, which began with the basics of market access and covered how to improve formulary placement and secure coverage under the medical benefit. In this post, we’ll dive deeper into the medical benefit, explaining how payer/PBM contracting works—and why it’s increasingly necessary.