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

Perspectives on New Postpartum Depression Drug

Posted by Judy Packer Tursman on May 2, 2019

The FDA's recent approval of the first medication specifically aimed at treating postpartum depression is drawing a favorable response from clinicians, while payers could face challenges.

PBM executives tell AIS Health that the postpartum depression drug, Zulresso (brexanolone) injection, is likely to be covered under the medical, not the pharmacy, side of the benefit.
 
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Topics: Specialty, Industry Trends, Product Release, Provider, Payer

Radar On Market Access: Calif. Insurers Fear lll Effects if Medicaid Pharmacy Is Carved Out

Posted by Judy Packer Tursman on May 2, 2019

California is quietly plowing ahead on plans by Gov. Gavin Newsom, a Democrat, to create a statewide bulk purchasing system for prescription drugs — and to transition pharmacy services for Medi-Cal, the state's Medicaid program, from managed care to fee-for-service (FFS) by January 2021, AIS Health reported.

In the latest development related to the initiatives, Los Angeles County tentatively has agreed "to sit at the same bargaining table" with Newsom’s administration to negotiate prices with drug manufacturers, the Los Angeles Times reported April 17.
 
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Topics: Specialty, Industry Trends, Provider, Payer

Radar On Market Access: Diabetic Drug’s Kidney Benefit May Not Be Game-Changer

Posted by Judy Packer Tursman on Apr 30, 2019

The potential use of Invokana (canagliflozin) for chronic kidney disease as well as type 2 diabetes, its current indicated use, recently attracted national headlines. If Janssen Pharmaceuticals, Inc.'s supplemental indication for its medication is approved by the FDA, "it would be the first new treatment for diabetic kidney disease in decades," the National Kidney Foundation said.

The kidney foundation points out that diabetes is a key risk factor for chronic kidney disease. The group says it anticipates strong uptake of Invokana by clinicians and payers facing "high costs and management challenges" in treating advanced kidney disease in people with type 2 diabetes, AIS Health reported.
 
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Topics: Product Release, Provider, Payer

MMIT Reality Check on Anemia — Chronic Kidney Disease (Apr 2019)

Posted by Matt Breese on Apr 26, 2019

According to our recent payer coverage analysis for anemia treatments due to chronic kidney disease, 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 Insulin

Posted by Leslie Small on Apr 25, 2019

Amid increasing public scrutiny of rising insulin prices, some health insurers are taking matters into their own hands to help their diabetic members afford the lifesaving medications, AIS Health reported.
 
Leading PBMs, such as CVS Health Corp., Express Scripts and Prime Therapeutics, also applied formulary strategies to keep insulin affordable. CVS Health reported a -1.7% trend for antidiabetic drugs in 2018, despite increasing utilization and 5.6% average wholesale price inflation for brand drugs, according to its 2018 drug trend report
 
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Topics: Industry Trends, Data & Analytics

Radar On Market Access: CMS Guidance on Rebate Shift Offers Transition for Part D Plans

Posted by Leslie Small on Apr 25, 2019

As insurers and PBMs prepared to submit their comments about a proposed overhaul of the prescription drug rebate system, CMS on April 5 issued a guidance document aimed at mitigating at least some of their concerns, AIS Health reported.

The proposed rule would remove 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 create a new safe-harbor protection for point-of-sale drug discounts.
 
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Topics: Specialty, Industry Trends, Provider, Payer

Radar On Market Access: Copay Accumulators’ Use Rises; Virginia Passes Law Banning Such Programs

Posted by Angela Maas on Apr 23, 2019

Payers are continuing to implement copay accumulators and copay maximizers in an effort to counter copay assistance from pharmaceutical manufacturers, according to a recent survey, AIS Health reported.

A Zitter Insights report shows that more than 90 million commercial lives are covered by payers that have a copay accumulator program — and it doesn't look like these arrangements are going away any time soon.
 
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Topics: Industry Trends, Market Access, Provider, Payer

2019 Specialty Pharmacy Patient Choice Awards Finalists Announced

Posted by Matt Breese on Apr 23, 2019

 

The Specialty Pharmacy Patient Choice Award was created to recognize specialty pharmacies and their commitment to patient satisfaction. The criteria for this award were formulated by a committee comprised of individuals representing pharmaceutical manufacturers, health plans, pharmacy benefit managers (PBMs), trade organizations, consultants and equity research firms.

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Topics: Industry Trends, Market Access, Data & Analytics, Provider, Payer, Branding & Marketing

MMIT Reality Check on Ophthalmic Anti-Inflammatory (Apr 2019)

Posted by Matt Breese on Apr 19, 2019

According to our recent payer coverage analysis for ophthalmic anti-Inflammatory 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 Insulin Management

Posted by Leslie Small on Apr 18, 2019

Amid increasing public scrutiny of rising insulin prices, some health insurers are taking matters into their own hands to help their diabetic members afford the lifesaving medications, AIS Health reported.

At the integrated health system HealthPartners, the members who are hardest hit by rising insulin prices are those in high-deductible health plans, says Young Fried, vice president of pharmacy plan services. But she says insulin affordability is also an issue for Medicare members who are in the Part D "doughnut hole." 
 
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Topics: Industry Trends, Market Access, Data & Analytics, Provider, Payer