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
Key Benefits of Early Market Access Planning
According to our 2024 State of Patient Access survey, 81% of pharma companies are launching their market access planning much earlier than they did five years ago. By Phase I, one-third of pharma companies are already engaged in market access research, with most pharma companies (54%) engaged by Phase II
When Payers Become Producers: Inside the Private-Labeling Trend
Vertical integration between payers, PBMs, specialty pharmacies, and providers has grown in the last decade, with more negotiating power concentrated among a handful of major players. Now insurers are adding production arms into the mix, following CVS Health’s bid to cash in on the race for Humira biosimilar market share.
Coding Chaos: How Pharma Can Help Providers Get Paid
For manufacturers of medical benefit drugs, ensuring accurate provider reimbursement is essential. If providers are unaware of how to appropriately bill for a particular drug, their errors will result in claims denials, which in turn may lead them to stop prescribing that drug in favor of another. Inadvertent underbilling for
Preparing for the Inflation Reduction Act’s Impact on Medicare Plans
Since its passage in 2022, many have speculated on the impact of the Inflation Reduction Act (IRA) on providers, manufacturers and payers—especially those with Medicare Advantage plans. Just over half of all Medicare beneficiaries are currently enrolled in a Medicare Advantage plan, and enrollment is projected to reach 60% of
Communication Trends: How to Prepare for Effective Pharma/Payer Meetings
Manufacturers engage with managed care organizations (MCOs) in a number of ways, from deep conversations regarding clinical indications and brand coverage to general sessions focused on product portfolios and overall business. Although pharma companies have historically engaged with payers in phase III of the drug development lifecycle, pharma/payer meetings are
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Changing Payer Management Dynamics at Play in Oncology
When it comes to the degree of payer management within a therapeutic area, pharma companies are becoming the victim of their own successes. One prime example is the rapid growth of competitive therapies across tumor types, pharmacological classes, and mechanisms of action in oncology. Payers have responded to the launch
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)