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Radar On Market Access: CMS Denies Massachusetts' Medicaid Drug Pricing Plan

Posted by Matt Breese on Jul 19, 2018

CMS recently denied a waiver request by Massachusetts to allow its Medicaid program, MassHealth, to use a closed formulary that excludes certain drugs. But the agency, in its June 27 decision, left the door open on the state's pursuit of tighter drug controls, AIS Health reported.
 
"The Massachusetts proposal brought to the table a new approach to increase its leverage to get lower drug prices, but an approach that left many unanswered questions," says Jack Hoadley, Ph.D., a research professor emeritus in Georgetown University’s Health Policy Institute. "Its rejection by CMS should not stop states from continuing to seek new ways to achieve lower prices. The key is how to balance maintaining access to needed drugs with tools to get lower prices."
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Topics: Specialty, Market Access, Product Release

Trends That Matter for Specialty Pharmaceuticals' Managed Care Strategies

Posted by Matt Breese on Jul 19, 2018

A survey by EMD Serono, Inc. revealed that managing oncology drugs and services remains the top challenge for health plans, tied with determining the value of specialty drugs and ensuring clinically appropriate use of specialty therapies. 

Site-of-care programs continue to rise in use, with a 135% increase. Intravenous immune globulin (89%), rheumatoid arthritis/Crohn's (86%) and multiple sclerosis (67%) were the top therapeutic categories for site-of-care strategies.

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Topics: Specialty, Market Access, Data & Analytics, Payer

Radar On Market Access: Clover Health Offers Pharmacogenomics Testing

Posted by Matt Breese on Jul 17, 2018

In-home primary care has become a de rigueur offering for Medicare Advantage (MA) organizations looking to avoid costly emergency room visits and hospital admissions. Clover Health aims to innovate the traditional multidisciplinary structure with pharmacogenomic testing that could lead to safer and more effective medication use, AIS Health reported. 
 
Clover currently serves about 600 frail, chronically ill members in its home care program, who on average have between six and 11 chronic conditions and are on 10 or more medications. The insurer in June began offering genetic testing capabilities provided by YouScript, a proprietary clinical decision support tool designed to assist in medication therapy management.
 
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Topics: Industry Trends, Data & Analytics, Payer

MMIT Reality Check on Alpha-1 Antitrypsin Deficiency (Jul 2018)

Posted by Matt Breese on Jul 13, 2018

According to our recent payer coverage analysis for alpha-1 antitrypsin deficiency 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 Value-Based Contracts

Posted by Matt Breese on Jul 12, 2018

As pharma manufacturers strive to demonstrate to payers their products' efficacy in the face of backlash against rising drug prices, one effective tactic may be to enter into value-based contracts. It's crucial for manufacturers to understand how other entities they wish to partner with approach value and to start preparing that value proposition early in the drug development process, AIS Health reported.
 
Different payers will come at value from different perspectives. "A standalone Medicare Part D plan has very different priorities than an integrated health system," says Larry Blandford, Pharm.D., an executive vice president at Precision for Value.  
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Amazon/PillPack Deal Has Limited Effect

Posted by Matt Breese on Jul 12, 2018

Amazon recently unveiled its plan to purchase PillPack — a tech-enabled startup that offers pre-sorted dose packaging and home delivery of prescription drugs for those taking multiple medications — yet industry analysts do not appear convinced that the acquisition will have a significant effect on PBMs or health insurers, at least not in the short term, AIS Health reported.
 
"We do not expect any material impact on our financial expectations for the MCOs we cover and thus we make no change to our estimates or ratings," Credit Suisse's A.J. Rice wrote in a research note.
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Centene Highlights New PBM Asset

Posted by Matt Breese on Jul 10, 2018

Amid a flurry of recent deal-making in the PBM sector, Centene Corp. highlighted the capabilities of the tech-savvy PBM it recently invested in, RxAdvance, during its June 15 investor day presentation, AIS Health reported.
 
Centene's equity investment in RxAdvance, CEO Michael Neidorff said, was made to complement the insurer's internal PBM, US Script. RxAdvance's technology and PBM cloud platform "will enable us to drive change across the care continuum," he added.
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Topics: Industry Trends, Data & Analytics, Payer

MMIT Reality Check on Advanced Prostate Cancer (Jul 2018)

Posted by Matt Breese on Jul 6, 2018

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

Trends That Matter for Drug Cost

Posted by Matt Breese on Jul 5, 2018

IngenioRx, the PBM being developed by Anthem, Inc., released a drug trend report on May 31 that says Anthem's ability to manage both medical and pharmacy benefits kept the average drug cost increase at 2% for the insurer's affiliated employer-based health plans in 14 states in 2017, AIS Health reported. 

The report also found that inflation was the primary contributor to 2017 drug trends, pushing it up by 5.6%. In addition, specialty medical (21.1%) and specialty pharmacy (29.1%) accounted for 50.2% of drug spending in 2017, but by 2021 that share is expected to increase to 59.3%.

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Topics: Market Access, Data & Analytics

Radar On Market Access: Pharma Can Use REMS Programs to its Advantage

Posted by Matt Breese on Jul 5, 2018

For safety concerns, the FDA can require pharmacy manufacturers to have a Risk Evaluation and Mitigation Strategy (REMS) for a therapy in order to manage those risks while still allowing people to have access to it. Although the programs may present challenges to many stakeholders, manufacturers in particular may use them to their advantage, AIS Health reported.
 
One of the top challenges that manufacturers may grapple with is the "increasing complexity of developing and administering" REMS, says Glenn Carroll, principal at Deloitte. "Many of the REMS being developed today are more rigorous to implement than what we’ve seen in the past."
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Topics: Specialty, Industry Trends, Market Access, Product Release