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Radar On Market Access: Despite Threatening to Halt Integration, Judge Is Likely to Sign Off on CVS/Aetna Deal

Posted by Leslie Small on Dec 11, 2018

According to CVS Health Corp., its acquisition of Aetna Inc. closed on Nov. 28 after receiving the last required approval from a state regulator. But a federal judge appears to have other ideas.

In a hearing on Dec. 3, Judge Richard Leon of the U.S. District Court for the District of Columbia said he might halt CVS and Aetna’s integration efforts while he reviews the $69 billion deal, according to The Wall Street Journal.

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Topics: Industry Trends, Payer, Provider

MMIT Reality Check on Cystic Fibrosis (Dec 2018)

Posted by Matt Breese on Dec 7, 2018

According to our recent payer coverage analysis for cystic fibrosis (CF) 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: Market Access, Branding & Marketing, Specialty, Payer

Trends That Matter for HIV Treatments

Posted by Leslie Small on Dec 6, 2018

At the annual Medicaid Health Plans of America conference, Express Scripts Holding Co. Senior Vice President and Chief Medical Officer Steve Miller, M.D., had a simple message for health plan leaders: "You have to think long term if you're going to have better outcomes," AIS Health reported.

One area in which Medicaid is not heeding that call, Miller said, is how it approaches treating and preventing HIV.

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Topics: Specialty, Market Access, Payer

Radar On Market Access: Future of Potential Humana/ Walgreens Tie-Up Is Murky

Posted by Leslie Small on Dec 6, 2018

Just days before CVS Health Corp. said it closed its $69 billion acquisition of Aetna Inc., reports emerged that another retail pharmacy giant and health insurer— Walgreen Co. and Humana Inc. — are in preliminary talks to take equity stakes in each other.

Walgreens and Humana are already collaborating on a pilot project in which the insurer opened senior- focused primary care clinics in two Walgreens stores in the Kansas City, Mo., region. Now the companies are in “wide-ranging” talks about either expanding that venture or taking stakes in each other, according to The Wall Street Journal.

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Topics: Industry Trends, Payer, Provider

Radar On Market Access: CMS's Second Swing at Part D Protected Classes Might Work

Posted by Leslie Small on Dec 4, 2018

On Nov. 26, CMS issued a proposed rule that would let Medicare Advantage and Part D plans limit coverage of certain drugs in the six "protected classes," which include antidepressants, antipsychotics, anticonvulsants, immunosuppressants for treatment of transplant rejection, antiretrovirals and antineoplastics, AIS Health reported.

Under CMS's Contract Year 2020 Medicare Advantage and Part D Drug Pricing Proposed Rule, plans would be able to:
 
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Topics: Industry Trends, Provider, Payer

MMIT Reality Check on Growth Hormones (Nov 2018)

Posted by Matt Breese on Nov 30, 2018

According to our recent payer coverage analysis for growth hormone 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: Market Access, Branding & Marketing, Specialty, Payer

Perspectives on Proposed Part D Change

Posted by Leslie Small on Nov 29, 2018

If the Trump administration gets its way, Medicare Part D plan sponsors may at some point be on the hook for a greater share of costs once beneficiaries reach the catastrophic phase of coverage for prescription drugs. While America's Health Insurance Plans (AHIP) is opposed to the idea, experts tell AIS Health that the time may be ripe for such a change.

Beneficiaries enter the catastrophic coverage phase when, as of 2018, their "true out-of-pocket costs" exceed $5,000. Once in that phase, beneficiaries pay no more than 5% of the total cost for their drugs, while the federal government pays 80% and the Part D plan pays 15%.

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Topics: Payer, Industry Trends, Data & Analytics, Provider

Radar On Market Access: New Migraine Drugs Could Spark Value-Based Contracting

Posted by Jane Anderson on Nov 29, 2018

Therapy for chronic migraine — a condition that's been notoriously difficult to treat and which often leads to significant direct and indirect health care costs — has been upended with the recent approval of three injectable monoclonal antibody products in a new preventive medication class that’s significantly more effective than older preventive migraine drugs, a researcher says.

These new calcitonin gene-related peptide (CGRP) inhibitors — Amgen, Inc. and Novartis AG’s Aimovig (erenumab), Teva Pharmaceuticals’ Ajovy (fremanezumab) and Eli Lilly and Co.’s Emgality (galcanezumab) — also may usher in an era of value-based contracting for migraine products, with plan sponsors willing to pay more to get better results, Machaon Bonafede, Ph.D., outcomes research practice leader at IBM Watson Health, told attendees Oct. 23 at the Academy of Managed Care Pharmacy Nexus annual meeting, AIS Health reported.
 
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Topics: Payer, Specialty, Market Access, Product Release

Radar On Market Access: New Biosimilars Help Crohn’s Cost, but Boost Oversight Needs

Posted by Jane Anderson on Nov 27, 2018

New biosimilars for Janssen Biotech, Inc.'s Remicade (infliximab) have helped to moderate costs for Crohn's disease as they’ve launched over the last two years, but plans still rely on utilization management strategies, including site-of-service programs, to keep the cost of treating the condition under control, experts tell AIS Health.

Additional biosimilars — notably, three biosimilars for AbbVie Inc.'s Humira (adalimumab) — eventually will enter the marketplace as well, but the Humira biosimilars currently are mired in patent litigation and likely won't launch until 2023, says April Kunze, Pharm.D., senior director, clinical formulary development and trend management strategy at Prime Therapeutics LLC.
 
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Topics: Payer, Specialty, Market Access, Product Release

MMIT Reality Check on Ovarian Cancer (Nov 2018)

Posted by Matt Breese on Nov 23, 2018

According to our recent payer coverage analysis for ovarian cancer 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: Market Access, Branding & Marketing, Specialty, Payer