Contact

Payer

Pharma

Provider

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

Radar On Market Access: IL-17 Inhibitors Becoming More Popular as a First-Line Therapy, Study Finds

Posted by Angela Maas on Oct 25, 2018

The autoimmune therapy class boasts one of the broadest arrays of options within specialty drug classes. And while many physicians in general may tend to prescribe older medications that they have more familiarity with, a recent study shows that this may not necessarily be the case within this therapeutic class, AIS Health reported. The study, led by AllianceRx Walgreens Prime, found that among 5,547 analyzed psoriasis patients, providers may be comfortable with prescribing a newer type of autoimmune biologic as a first-line treatment.

The study assessed the use of two third-generation biologics, Novartis Pharmaceuticals Corp.’s Cosentyx (secukinumab) and Eli Lilly and Co.’s Taltz (ixekizumab), in the treatment of psoriasis. The FDA approved Cosentyx in January 2015, with Taltz’s approval coming about a year later, in March 2016.

Read More

Topics: Industry Trends, Market Access, Provider, Specialty

Trends That Matter for Epilepsy Medications

Posted by Leslie Small on Oct 25, 2018

This June, the FDA approved Epidiolex (cannabidiol), the first-ever agency-approved treatment that contains a purified drug substance derived from marijuana, AIS Health reported. The oral solution, produced by GW Pharmaceuticals plc, is indicated for the treatment of seizures associated with two rare forms of childhood-onset epilepsy, Lennox-Gastaut syndrome (LGS) and Dravet syndrome, for patients ages two and older.

The average gross price for Epidiolex will be $32,500 per year, Julian Gangolli, North America president of GW Pharmaceuticals, said during the company's Aug. 7 earnings call.

Read More

Topics: Specialty, Market Access, Payer

Radar On Market Access: UnitedHealth Bolsters OptumRx With Genoa Buy

Posted by Leslie Small on Oct 23, 2018

UnitedHealth Group’s acquisition of Genoa Healthcare — the fifth largest pharmacy chain in the country — gives OptumRx an edge in a competitive PBM space where companies are racing to innovate, one expert tells AIS Health.

Ashraf Shehata, a principal in KPMG’s health care and life sciences advisory practice, says not only does the purchase add to UnitedHealth’s ever-growing size — “and bigger is always better” — but it also helps give the company a boost in a highly competitive environment where the CVS Health Corp./Aetna Inc. and Cigna Corp./Express Scripts Holding Co. deals are changing the game.

Read More

Topics: Industry Trends, Payer, Market Access

MMIT Reality Check on Respiratory (Asthma/COPD) (Oct 2018)

Posted by Matt Breese on Oct 19, 2018

According to our recent payer coverage analysis for asthma and COPD 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: Market Access, Branding & Marketing, Specialty

Radar On Market Access: Drug Prices Increases Are Expected to Slow

Posted by Angela Maas on Oct 18, 2018

Pharmaceuticals are expected to undergo a 4.92% price increase from 2018 to 2019, according to the recently released July-August 2018 Drug Price Forecast from Vizient. That’s actually a slowing from the 7.61% increase for 2018, AIS Health reported.

The company conducted its analysis using price and volume data from hospital and non-acute facilities participating in its Vizient Pharmacy Program. Among Vizient members, therapeutic classes with the highest spend include many with specialty drugs.

Read More

Topics: Industry Trends, Specialty, Market Access, Data & Analytics

Perspectives on Indication-Based Formularies in Part D

Posted by Angela Maas on Oct 18, 2018

The Trump administration continues to take steps aimed at bringing down drug prices. CMS Administrator Seema Verma said in an Aug. 29 memo to Medicare Part D plan sponsors that they can begin using indication-based formularies in contract year 2020, AIS Health reported.

Starting in 2020, "Part D sponsors may utilize step therapy-like requirements within their [prior authorization] to promote cost-effective drug therapy by requiring the use of one formulary drug for a certain indication prior to authorizing coverage of a second drug for that indication," explains the memo.

Read More

Topics: Payer, Specialty, Market Access, Industry Trends

Radar On Market Access: Opinions Vary on MA Plans’ Use of Step Therapy in Part B

Posted by Angela Maas on Oct 16, 2018

While many stakeholders have praised CMS’s move to allow Medicare Advantage (MA) plans to apply step therapy to drugs covered under Part B, others have cautioned that it could result in delays or restrictions in patients accessing much-needed medications, AIS Health reported.

On Aug. 7, CMS issued new guidance allowing MA plans to use step therapy for Part B drugs as of Jan. 1, 2019. The letter also states that those MA plans that also offer prescription drug coverage may use step therapy to have a beneficiary use a drug under Part D before stepping to one under Part B.

Read More

Topics: Industry Trends, Payer, Specialty, Market Access, Provider

MMIT Reality Check on Hepatitis C (Oct 2018)

Posted by Matt Breese on Oct 12, 2018

According to our recent payer coverage analysis for Hepatitis C 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: Market Access, Branding & Marketing, Specialty

Trends That Matter for Specialty Drug Management

Posted by Matt Breese on Oct 11, 2018

Specialty drugs continue to be a concern for large employers, according to The Large Employers' 2019 Health Care Strategy and Plan Design Survey by the National Business Group on Health (NBGH), AIS Health reported.

NBGH surveyed its corporate members in May and June on what they are doing for 2019. When NBGH asked employers about specialty pharmacy benefit management techniques, respondents selected more aggressive utilization management protocols as the top strategy, with 64% citing this, followed by having employees get specialty drugs through a specialty pharmacy or the specialty department of the health plan or PBM, cited by 58%. At 44%, site-of-care management notched the third top technique.

Read More

Topics: Specialty, Industry Trends, Branding & Marketing, Data & Analytics

Radar On Market Access: Prime’s New Formulary Excludes Many Drugs Just Added in 2018

Posted by Judy Packer Tursman on Oct 11, 2018

Against the backdrop of giant PBMs' megadeals, mid-sized PBMs such as Prime Therapeutics LLC are strategizing to remain competitive. As part of its effort, Prime tells AIS Health it intends to exclude dozens of drugs from its formulary effective Jan. 1 — and most of the drugs being eliminated only entered the market in 2018.
 
Prime's national NetResults Formulary is eliminating 30 to 35 drugs, for a total of 303 exclusions, for 2019, says David Lassen, Pharm.D., chief clinical officer of the PBM, which is collectively owned by 18 Blue Cross and Blue Shield plans.
Read More

Topics: Industry Trends, Payer, Specialty, Market Access