While outcomes-based contracts for prescription drugs are a continual hot topic in the health care industry, experts who spoke on a panel at the World Health Care Congress cited several barriers that are keeping these contracts from proliferating widely: chiefly, not enough reliable data and regulatory issues such as the federal antikickback statute.

 

"The beautiful thing about value-based contracts is we are basically putting the patient at the center of everything," said Enrique A. Conterno, senior vice president of Eli Lilly and Co.  

 

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

The Trump administration has touted competition as one way to bring down drug prices. With this goal in mind, the FDA recently released a pair of draft guidance documents aimed at helping generics get onto the market sooner while still upholding the focus on safety, AIS Health reported. 

 

One of the documents, titled Development of a Shared System Risk Evaluation and Mitigation Strategy (REMS) (83 Fed. Reg. 25468, June 1, 2018), offers recommendations for developing a shared system REMS for multiple drug products. The other, titled Waivers of the Single, Shared System REMS Requirement (83 Fed. Reg. 25465, June 1, 2018), describes situations in which the agency will waive the requirement that a generic drug and its reference product use a single, shared system (SSS) REMS with Elements to Assure Safe Use.

Topics: Specialty, Industry Trends, Market Access, Product Release

The FDA recently issued final guidance that seems likely to pave the way for smoother negotiations between pharmaceutical manufacturers and health plans over agreements tying payment to a drug's performance on cost-effectiveness and quality measures, AIS Health reported.

 

In it, the FDA clarifies that drugmakers and medical device manufacturers may provide "health care economic information," which may not be found in the medical product's labeling, to payers and other "sophisticated" entities — and offers recommendations on how to disseminate it properly.

Topics: Industry Trends, Market Access, Provider, Payer

According to our recent payer coverage analysis for growth hormone 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.

Topics: Specialty, Market Access, Payer, Branding & Marketing

Prime Therapeutics LLC has rolled out a new analytics platform to help identify and weed out fraud, waste and abuse. The tool takes a comprehensive look across both pharmacy and medical claims, giving a complete picture of a member's situation. Its fraud framework also builds out scenarios in order to help predict where the new area of fraud is going to be, AIS Health reported. 

 

Last year alone, Prime identified more than $211 million in fraud, waste and abuse within its network. The new tool is estimated to save the company's clients "more than $250 million in the next year," according to Prime.

 

Topics: Specialty, Industry Trends, Data & Analytics

In just a little more than six months, biosimilars reimbursed in Medicare Part D will get a boost from legislation passed earlier this year. Plans and patients also stand to win, but manufacturers, not so much, industry experts told AIS Health.

 

In Part D, beneficiaries consistently pay a 25% cost share until they hit the catastrophic phase, when their responsibility decreases to 5% of the drug. During the initial coverage period, plan sponsors are responsible for 75% of a drug's cost; during the "donut hole" coverage gap, brand-name drugs' manufacturers must pay 50% of the drugs' cost, while plan sponsors' responsibility drops to 25%. Biosimilar manufacturers, by contrast, are excluded from having to provide this discount, leaving plan sponsors' responsibility at 75%. Yet as of 2019, biosimilars will be treated the same as brand-name drugs rather than as generics in the coverage gap.

Topics: Industry Trends, Market Access, Provider, Payer

According to our recent payer coverage analysis for multiple myeloma 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.

Topics: Specialty, Market Access, Payer, Branding & Marketing

The field of oncology continues to see increasingly innovative treatments and increasingly higher prices, according to IQVIA Institute for Human Data Science’s recent report Global Oncology Trends: Innovation, Expansion and Disruption.

Murray Aitken, IQVIA senior vice president and executive director of the IQVIA Institute for Human Data Science, called 2018 "a banner year of new drugs being launched" during a May 22 media call. 2017 saw 14 cancer therapies launch, all of which targeted therapies and 11 with breakthrough therapy status.

Topics: Specialty, Industry Trends, Data & Analytics

IngenioRx, the PBM being developed by Anthem, Inc., released a drug trend report on May 31 that illustrates how it plans to stand out in a rapidly changing PBM landscape: by analyzing and managing the cost of drugs prescribed to consumers through both their medical and pharmacy benefits, AIS Health reported.

"That’s a key differential in our report that you're not going to see anywhere else, and the numbers aren't going to match up and compare, because those competitors aren’t considering medical drug spend," says Colleen Haines, Anthem's president of clinical and specialty pharmacy.

Topics: Specialty, Industry Trends, Data & Analytics

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.

Topics: Industry Trends, Market Access, Provider, Payer