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Formulary guidance and transparency from P&T to point of care

MMIT Reality Check on Acute Lymphoblastic Leukemia (July 2020)

Posted by Matt Breese on Jul 10, 2020

According to our recent payer coverage analysis for acute lymphoblastic leukemia 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 MedImpact’s New Program to Accelerate Pharmacogenomics

Posted by Leslie Small on Jul 9, 2020

With precision medicine an increasingly hot topic in health care, MedImpact is betting that a newly launched program — which reviews every drug prescribed to patients against their genetic profile — will simultaneously give the PBM a competitive edge and improve care, AIS Health reported.

In a Feb. 26 press release, MedImpact describes its new program as the industry's first "any drug, any time, any prescriber" approach to pharmacogenomics (PGx).
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Upheld Transparency Rule Is Slated to Reshape Payer-Provider Negotiations

Posted by Leslie Small on Jul 9, 2020

In another blow to an industry already beleaguered by the COVID-19 pandemic, a federal judge recently upheld a federal rule that requires hospitals to engage in unprecedented price transparency measures, AIS Health reported.

The rule would require hospitals to disclose the rates they negotiate with payers for all items and services they offer. It is slated to go into effect on Jan. 1, 2021, but the American Hospital Association (AHA) and other trade groups and health systems sued to block it.

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Topics: Market Access, Provider, Payer

Radar On Market Access: Reports Show Medicaid MCOs Are 'Dominant,' Increase Affordability

Posted by Peter Johnson on Jul 7, 2020

Two recent reports found that Medicaid managed care plans now enroll most Medicaid members, help keep costs and premiums low in the markets where they participate, and are competitive with commercial plans at the low end of the individual market in areas including network quality and benefit design, AIS Health reported.

One white paper was prepared by consultancy The Menges Group for America's Health Insurance Plans (AHIP), and the other was authored by researchers at the Robert Wood Johnson Foundation (RWJF) and Urban Institute.

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Topics: Industry Trends, Data & Analytics, Payer

MMIT Reality Check on Hemophilia A or B With Inhibitors (July 2020)

Posted by Matt Breese on Jul 3, 2020

According to our recent payer coverage analysis for hemophilia A or B with inhibitors 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 DMD Therapies

Posted by Angela Maas on Jul 2, 2020

Since 2016, the FDA has approved a handful of therapies to treat Duchenne muscular dystrophy (DMD). But some uncertainty exists over their effectiveness, in addition to concerns about their costs.

When DMD is suspected, a blood test that measures creatine kinase (CK) levels is performed. "CK is an enzyme found in abnormally high levels when muscle is damaged," Mesfin Tegenu, R.Ph., president of PerformRx, LLC., tells AIS Health. "The detection of an elevated CK level leads to molecular genetic testing to confirm a definitive diagnosis of DMD."
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Topics: Industry Trends, Market Access, Data & Analytics

Radar On Market Access: Insurers Are Required to Cover Only 'Medically Necessary' COVID-19 Tests

Posted by Jane Anderson on Jul 2, 2020

As more employers turn to COVID-19 testing to see if employees are safe to return to the workplace, the Trump administration has clarified that insurers must cover only physician-ordered "medically necessary" diagnostic and antibody tests, AIS Health reported.

The guidance, released jointly on June 23 by HHS, the Dept. of Labor and the Dept. of the Treasury, also says self-funded employer plans must pay for COVID-19 testing that’s medically appropriate.

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

Radar On Market Access: CMS Proposes New Medicaid Best Price Rules for Pricey Therapies

Posted by Peter Johnson on Jun 30, 2020

In an effort to boost adoption and lower costs for curative therapies, CMS proposed a new rule that the agency says would allow state Medicaid plans to enter into value-based, outcome-dependent purchasing agreements with drug manufacturers using a new interpretation of best price rules, AIS Health reported.

CMS proposed an updated interpretation of Medicaid "best price" rules by clarifying best price reporting requirements and enabling new structures including year-to-year scheduled prices that could change in relation to patient outcomes.

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Topics: Market Access, Provider, Payer

MMIT Reality Check on Ankylosing Spondylitis (June 2020)

Posted by Matt Breese on Jun 26, 2020

According to our recent payer coverage analysis for ankylosing spondylitis 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

Perspectives on COVID-19 Vaccine Rollout

Posted by Peter Johnson on Jun 25, 2020

The rollout of a vaccine for SARS-CoV-2, the virus that causes COVID-19, is an unprecedented logistical challenge. So will be deciding who gets it: experts say that the initial vaccine supply will not be large enough to dose everyone who wants it — and payers and PBMs will have a large role to play in distributing the medicine to the right people quickly.

David Simchi-Levi, Ph.D., a systems engineer who studies manufacturing and supply chain at MIT, tells AIS Health that it's inevitable that vaccine supply will not meet demand when it is available. "The question will be, who gets it?" he says.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer