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Radar On Market Access: New Financing Strategies for Innovative Therapies

Posted by Matt Breese on Apr 17, 2018

While breakthrough clinical treatments have the potential to change patients’ lives, their high upfront costs raise tricky questions for payers. A recent webinar hosted by the National Pharmaceutical Council explored some potential solutions to these financing challenges, AIS Health reported.
 
Finding a realistic and workable financing mechanism is important for patients, as the price tag for some new therapies is indeed steep. 
 
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Topics: Specialty, Industry Trends, Market Access, Payer

Radar On Market Access: Managing Specialty Drug Costs as Top Employer Concern

Posted by Matt Breese on Apr 12, 2018

As costs for specialty drugs continue to rise, managing those costs remains employers’ top concern, according to a recent Pharmacy Benefit Management Institute (PBMI) study.
 
Since 2011, medical benefit spending has risen 55%, and “double-digit average specialty trend under the pharmacy benefit has been the norm since 2007,” notes PBMI’s 2018 Trends in Specialty Drug Benefits
 
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Senate Seeks to Bar "Gag Clauses"

Posted by Matt Breese on Apr 3, 2018

Two newly introduced Senate bills are aiming to bar health insurers and PBMs from using so-called “pharmacy gag clauses,” AIS Health reported.
 
On March 15, Sen. Susan Collins (R-Maine) and Sen. Claire McCaskill (D-Mo.) introduced the “Patient Right to Know Drug Prices Act” and the “Know the Lowest Price Act” that would prohibit an insurer or PBM from restricting a pharmacy’s ability to tell a patient when there is a difference between the cost of the drug under their insurance plan and the out-of-pocket cost of the drug. 
 
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Topics: Industry Trends, Market Access, Payer

Radar On Market Access: Copay Accumulator Programs

Posted by Matt Breese on Mar 27, 2018

While copay accumulator programs operated by payers are growing, they risk having a negative impact on patient adherence, AIS Health reported.
 
Under copay accumulator programs, members’ payments will start counting toward their deductible and out-of-pocket costs after they have used all of the copay assistance provided by manufacturers. 
 
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Topics: Industry Trends, Payer

Radar On Market Access: Changes to Medicare Part D Coverage Gap

Posted by Matt Breese on Mar 22, 2018

The Bipartisan Budget Act of 2018, passed Feb. 9, could make some pharmaceutical companies take a multibillion dollar hit, industry experts told AIS Health.
 
The legislation closes the Part D coverage gap discount program in 2019 as opposed to 2020. It reduces beneficiaries’ coinsurance while they are in the so-called donut hole from 30% to 25% next year and increases brand-name manufacturers’ discounts provided to patients from 50% to 70%. 
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Rebates for Specialty Drugs

Posted by Matt Breese on Mar 20, 2018

UnitedHealthcare’s plan to apply point-of-sale rebates for more than 7 million members might be a game changer, industry experts told AIS Health.
 
Amid a lot of finger pointing among stakeholders over who benefits from rebates, United unveiled the approach to provide insured group patients with estimated point-of-sale discounts, beginning Jan. 1, 2019. Members can log in to myuhc.com or use the UHC mobile app to find out the discounted price. 
 
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Topics: Industry Trends, Payer

MMIT Reality Check on HIV (Feb 2018)

Posted by Matt Breese on Feb 2, 2018

According to our recent payer coverage analysis for HIV treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT's team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

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Topics: Specialty, Market Access, Payer, Branding & Marketing

Perspectives on Payer Priorities in 2018

Posted by Matt Breese on Jan 23, 2018

 
The past year has been eventful for payers and payer organizations. Looking ahead to 2018, Thomas Beaton, editor at HealthPayer Intelligence, wrote:
 
"2018 is a year in which payers are likely to implement strategies aimed at improving growth in Medicare Advantage markets, increasing the use of the social determinants of health to improve outcomes, and expanding member engagement with health plans."
 
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Topics: Industry Trends, Provider, Payer

Trends That Matter for Pain Relief

Posted by Matt Breese on Jan 4, 2018

In our weekly Trends that Matter series, we provide infographics, articles and recent news from influencers to highlight general trends affecting the pharmaceutical and healthcare industries. This week's featured topic is pain relief treatments. 

Neighborhood Health Plan (NHP) will soon begin broadly offering certain prevention, rehabilitation and drug-free pain relief treatments and prescriptions cost-free to members.

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Topics: Industry Trends, Payer

MMIT Reality Check on Hemophilia (Dec 2017)

Posted by Matt Breese on Dec 20, 2017

According to our recent payer coverage analysis for hemophilia treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT's team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

Read More

Topics: Specialty, Market Access, Payer, Branding & Marketing