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Radar On Market Access: Can Louisiana’s Hepatitis C Drug Payment Model Be Replicated?

Posted by Leslie Small on Aug 1, 2019

Beginning last month, Louisiana has been able to treat hundreds of patients who were waiting to receive a pricey cure for hepatitis C thanks to after hammering out an innovative payment model with a drug manufacturer, AIS Health reported.

But the road to get there was long and difficult, according to Rebekah Gee, M.D., secretary of the Louisiana Dept. of Health, who, during a July 22 event hosted by the Brookings Institution, detailed the challenges she faced in trying to get a costly curative therapy to more people while facing down a $2 billion budget deficit. "We were told 'No' at least 50 times from a variety of people, whether it was the industry, or policymakers or individuals at the CDC…because it had never been done before," she said.
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Will Blockchain Transform Relationships Industry Wide?

Posted by Judy Packer Tursman on Jul 30, 2019

Industry consultants from Milliman Inc. assert in a July 11 report that blockchain — which is described as a real-time digital ledger for building secure networks — "could potentially transform the relationship between payers, pharmaceutical manufacturers, wholesalers, and pharmacies by offering an alternative, transparent mechanism for processing, pricing, and validating prescription transactions."

Using blockchain technology, payers and pharmacies would reduce the time they spend validating insurance coverage, making phone calls and managing data, Milliman explains. The firm is urging PBMs to work to "evaluate a blockchain alternative now with an eye toward a more efficient drug financing system" capable of handling additional technology improvements, AIS Health reported.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

MMIT Reality Check on Parkinson's Disease (Jul 2019)

Posted by Matt Breese on Jul 26, 2019

According to our recent payer coverage analysis for Parkinson's disease 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 New York's Pricing Transparency Bill

Posted by Jane Anderson on Jul 25, 2019

Lawmakers in New York in June approved wide-ranging legislation designed to require pricing transparency from PBMs and to eliminate key PBM practices. But the bill could potentially limit plans' ability to respond to pricing moves by manufacturers, one consultant tells AIS Health.

The New York bill (S.B. 6531) would require that PBMs disclose key pricing and rebate information and pass through all rebates and discounts to the plans and payers, and that they act in the best interests of the covered individual and the health plan or provider.
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Post-Rebate Rule, Trump Administration Mulls 'Any and All Tools'

Posted by Lauren Flynn Kelly on Jul 25, 2019

With only six months to go until a planned implementation date of Jan. 1, 2020, HHS on July 11 pulled its controversial rule that would have eliminated pharmaceutical manufacturer rebates in Medicare and Medicaid, leaving Part D stakeholders to ponder the Trump administration's next moves on lowering prescription drug pricing.

Although news of its withdrawal appeared to surprise the investment community, the rebate rule had too much stacked against it to become final, Larry Kocot, a principal at KPMG, LLP, tells AIS Health. "[T]here were a lot of challenges," starting with the Congressional Budget Office's (CBO) estimate that the rule as proposed would have increased federal spending by about $177 billion over the next decade.
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Plans Offer More $0 Copay Drugs to Boost Adherence

Posted by Leslie Small on Jul 23, 2019

As various players in the health care industry sharpen their focus on disease prevention, some experts tell AIS Health they’re seeing health plans offering more and more "preventive" drugs at no cost to members.

Dean Health Plan recently said it’s "adding even more preventive drugs to our list of drugs available to [members] for $0." Additions to the list, which total more than 200, include Advair inhalers (fluticasone propionate and salmeterol) for asthma, the diabetes drug Januvia (sitagliptin), and Alendronate for osteoporosis, says Kevin Engelien, manager of large group product and market research at the Wisconsin-based insurer.
 
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Topics: Industry Trends, Market Access, Provider, Payer

MMIT Reality Check on Kidney Cancer (Jul 2019)

Posted by Matt Breese on Jul 19, 2019

According to our recent payer coverage analysis for kidney 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 Oncology Biosimilars Management

Posted by Judy Packer Tursman on Jul 18, 2019

Magellan Rx Management, the PBM division of Magellan Health, Inc., on June 4 announced its launch of an oncology biosimilars program, preparing its health plan customers for the expected market entry of biosimilars for three cancer-fighting drugs — Herceptin, Rituxan and Avastin — later this year, AIS Health reported.

"Oncology is by far the largest therapeutic area for drug spend on the medical benefit, and it is even higher in Medicare," Steve Cutts, senior vice president and general manager for Magellan Rx's specialty drug unit, tells AIS Health. Thus, he says, the PBM will be focusing the oncology biosimilars program "on all lines of business for our clients."
 
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Topics: Industry Trends, Product Release, Data & Analytics

Radar On Market Access: In Win for Managed Care, Trump Administration Drops Rebate Rule

Posted by Leslie Small and Judy Packer-Tursman on Jul 18, 2019

In a move that Wall Street analysts deemed a win for the managed care industry, the Trump administration decided to withdraw a proposed rule that would have overhauled the prescription drug rebate system in Medicare Part D, AIS Health reported.

The proposed rule, first released in February, would have removed safe-harbor protections under the federal anti-kickback statute for rebates paid by drug manufacturers to PBMs, Part D plans and Medicaid managed care organizations, and it would have created a new safe-harbor protection for point-of-sale drug discounts.
 
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Topics: Industry Trends, Market Access, Provider, Payer

Radar On Market Access: In Medicare Part D, Generic Drugs May Not Always Be Cheaper

Posted by Leslie Small on Jul 16, 2019

A recently published study in Health Affairs shines a light on a peculiar quirk of the Medicare Part D benefit structure: For some high-priced specialty medications, seniors might pay less out-of-pocket for brand-name drugs than their generic counterparts.

The study found that, assuming a 61% discount between brand-name and generic drugs, Part D beneficiaries with prescriptions costing between $22,000 and $80,000 per year would have lower out-of-pocket spending if they use brand-name drugs over a generic, AIS Health reported.
 
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Topics: Specialty, Industry Trends, Market Access, Data & Analytics, Provider, Payer