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Radar On Market Access: Clover Health Offers Pharmacogenomics Testing

Posted by Matt Breese on Jul 17, 2018

In-home primary care has become a de rigueur offering for Medicare Advantage (MA) organizations looking to avoid costly emergency room visits and hospital admissions. Clover Health aims to innovate the traditional multidisciplinary structure with pharmacogenomic testing that could lead to safer and more effective medication use, AIS Health reported. 
 
Clover currently serves about 600 frail, chronically ill members in its home care program, who on average have between six and 11 chronic conditions and are on 10 or more medications. The insurer in June began offering genetic testing capabilities provided by YouScript, a proprietary clinical decision support tool designed to assist in medication therapy management.
 
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Amazon/PillPack Deal Has Limited Effect

Posted by Matt Breese on Jul 12, 2018

Amazon recently unveiled its plan to purchase PillPack — a tech-enabled startup that offers pre-sorted dose packaging and home delivery of prescription drugs for those taking multiple medications — yet industry analysts do not appear convinced that the acquisition will have a significant effect on PBMs or health insurers, at least not in the short term, AIS Health reported.
 
"We do not expect any material impact on our financial expectations for the MCOs we cover and thus we make no change to our estimates or ratings," Credit Suisse's A.J. Rice wrote in a research note.
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Centene Highlights New PBM Asset

Posted by Matt Breese on Jul 10, 2018

Amid a flurry of recent deal-making in the PBM sector, Centene Corp. highlighted the capabilities of the tech-savvy PBM it recently invested in, RxAdvance, during its June 15 investor day presentation, AIS Health reported.
 
Centene's equity investment in RxAdvance, CEO Michael Neidorff said, was made to complement the insurer's internal PBM, US Script. RxAdvance's technology and PBM cloud platform "will enable us to drive change across the care continuum," he added.
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Topics: Industry Trends, Data & Analytics, Payer

Trends That Matter for Drug Cost

Posted by Matt Breese on Jul 5, 2018

IngenioRx, the PBM being developed by Anthem, Inc., released a drug trend report on May 31 that says Anthem's ability to manage both medical and pharmacy benefits kept the average drug cost increase at 2% for the insurer's affiliated employer-based health plans in 14 states in 2017, AIS Health reported. 

The report also found that inflation was the primary contributor to 2017 drug trends, pushing it up by 5.6%. In addition, specialty medical (21.1%) and specialty pharmacy (29.1%) accounted for 50.2% of drug spending in 2017, but by 2021 that share is expected to increase to 59.3%.

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Topics: Market Access, Data & Analytics

Perspectives on Outcomes-Based Drug Pricing

Posted by Matt Breese on Jun 28, 2018

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

Radar On Market Access: Prime's New Platform Targets Fraud, Waste and Abuse

Posted by Matt Breese on Jun 21, 2018

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.
 
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Topics: Specialty, Industry Trends, Data & Analytics

Radar on Market Access: Global Oncology Trends

Posted by Matt Breese on Jun 14, 2018

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.

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Topics: Specialty, Industry Trends, Data & Analytics

Radar on Market Access: IngenioRx Drug Trend Report

Posted by Matt Breese on Jun 12, 2018

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.

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Topics: Specialty, Industry Trends, Data & Analytics

Radar On Market Access: Value of Device-Gathered Data to Regulatory Agencies

Posted by Matt Breese on Jun 5, 2018

While physicians may be the obvious stakeholder to benefit from the data gathered from wearable and handheld drug-administration devices, regulatory bodies also are realizing their value, AIS Health reported.
 
In recent years, both FDA and the European Medicines Agency are warming to the use of real-world evidence (RWE) during the regulatory-approval process, according to John J. Doyle, senior vice president and general manager, real-world and analytic services, IQVIA.
 
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Topics: Industry Trends, Data & Analytics

Radar On Market Access: Drug Cost Transparency Service

Posted by Matt Breese on May 24, 2018

Blue Shield of California has unveiled a program designed to show doctors lower-cost alternative medications and enable them to compare prices and make prescribing changes while meeting with patients in their offices, AIS Health reported.
 
The new Gemini Drug-Cost Transparency Service, which is developed by Gemini Health, LLC, taps into providers' existing electronic health record (EHR) systems. 
 
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Topics: Data & Analytics, Payer