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.
Growth of Warranty-Based Contracts
As payers grapple with their ever-increasing spend on healthcare services, many are entering into various arrangements with pharma manufacturers to help mitigate their risk when paying for cell, gene and specialty therapies—which often have price tags ranging from several hundred thousand to millions of dollars. A warranty-based agreement is one
Evaluating Payer Impact on Utilization with Claims and Coverage Data
To fully understand how payers impact patient access, pharma companies should be evaluating payers using multiple datasets, including both coverage/restriction data and claims data. While payer policies indicate how payers plan to manage a product or service, medical and pharmacy claims reveal how payers actually manage that product in reality.
© 2024 MMIT
How Costs Impact Utilization for Hemophilia CGTs
When the FDA approved the first cell and gene therapy (CGT) for hemophilia almost two years ago, it represented a massive leap forward in treating the bleeding disorder. The one-and-done agents offer the promise of a cure, giving patients the prospect of freedom from the disease without regular treatments. Although
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
© 2024 MMIT