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

Radar On Market Access: Vaccine Race, Regulatory Risk, Robust M&A Will Impact Drugmakers in 2021

Posted by Leslie Small on Feb 2, 2021

In the year ahead, the three main "developments to watch" in the branded pharmaceuticals sector will include COVID-19 vaccine scale-up and distribution, continued legislative and regulatory pushback against high drug prices, and robust levels of merger and acquisition activity, according to a new report from Moody's Investors Service.

Regarding vaccines, Moody's noted that Moderna Inc. as well as Pfizer Inc. and its partner BioNTech will continue to ramp up production of their COVID-19 vaccines and distribute them widely throughout 2021.

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Topics: Industry Trends, Data & Analytics

Trends That Matter for Epilepsy Medications' Market Access

Posted by Jane Anderson on Jan 28, 2021

Pharmaceutical treatment for different types of epilepsy generally still relies on tried-and-true generics, despite recent efforts by drug manufacturers to introduce new branded medications into the mix, PBM insiders tell AIS Health.

Xcopri (cenobamate tablets), manufactured by SK Biopharmaceuticals Co., Ltd.'s subsidiary SK Life Science, Inc., launched in May for the treatment of partial-onset seizures. However, many plans haven't jumped to add Xcopri to their formularies, says Mesfin Tegenu, R.Ph., president of PerformRx.
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Topics: Market Access, Product Release, Data & Analytics

Radar On Market Access: Though Care Utilization Rebounds, Insurers Still Face Uncertainty in 2021

Posted by Peter Johnson on Jan 28, 2021

Since the start of the COVID-19 pandemic, the managed care industry has wrestled with how to project utilization of normal care and assess the risk of funding care related to the virus. While insurers generally seem to be in good financial shape, experts say that plans face continuing uncertainty, AIS Health reported.

In the early days of 2021, the U.S. confronted a grim milestone when the tally of Americans who died from COVID-19 reached 400,000.

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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: UnitedHealth: Health Care Spending Returned to Normal in 4Q

Posted by Leslie Small on Jan 26, 2021

In the fourth quarter of 2020, health care spending patterns experienced by the country's largest health insurer "returned to seasonal baselines" even as COVID-19 cases surged all over the U.S, AIS Health reported.

During a Jan. 20 conference call, UnitedHealth Group Chief Financial Officer John Rex explained that two opposing forces caused spending to align with historical levels. While the amount that UnitedHealth spent on COVID-19-related care increased compared with the third quarter, overall outpatient activity dipped below baseline as the end of the year drew closer, reflecting the fact that more people started deferring routine and elective care as coronavirus cases rose.

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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Centene to Bolster Pharmacy Services with Magellan Deal

Posted by Leslie Small on Jan 19, 2021

In addition to creating "one of the nation's largest behavioral health platforms," Centene Corp. will add another pharmacy-related asset to its portfolio with its recently announced $2.2 billion proposed purchase of Magellan Health, Inc, AIS Health reported.

The deal, unveiled on Jan. 4, will deliver 2 million PBM members and 16 million medical pharmacy lives to Centene. The transaction creates "additional value across our pharmacy capabilities," Centene Chief Financial Officer Jeff Schwaneke said during a Jan. 4 conference call. "This is a large and significant market….We have invested in this area in recent years given its attractive growth opportunities, most recently with the addition of PANTHERx."

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Topics: Industry Trends, Data & Analytics, Payer

Trends That Matter for MCO's Role in COVID Vaccine Rollout

Posted by Lauren Flynn Kelly on Jan 14, 2021

States and the federal government recently began rolling out the COVID-19 vaccine to health care workers across the country. Health plans, particularly those that serve high-risk individuals, may be ideally situated to coordinate care and update members on vaccination opportunities, experts tell AIS Health.

The FDA on Dec. 11 authorized emergency use of the COVID-19 vaccine made by Pfizer Inc. and BioNTech in individuals age 16 and older. Then the agency on Dec. 18 authorized Moderna’s vaccine for emergency use in people 18 years or older.
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Topics: Market Access, Product Release, Data & Analytics, Payer

Perspectives on New-to-Market Oral Drugs

Posted by Leslie Small on Jan 7, 2021

In its latest quarterly Drug Pipeline Insights Report, OptumRx includes a diverse array of medications that the UnitedHealth Group-owned PBM believes are likely to make a market impact when they're approved by the FDA, AIS Health reported. One interesting trend that applies to three of the five highlighted drugs is the fact that each is the first oral option in its respective category.

While oral medications tend to be thought of as more convenient than injectable or IV-administered therapies, that factor alone may not confer as much of a competitive advantage as one might think, according to one OptumRx executive.
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Topics: Industry Trends, Product Release, Data & Analytics

Trends That Matter for COVID Vaccine Distribution

Posted by Brian Eastwood on Dec 31, 2020

As details continue to emerge about the availability of COVID-19 vaccines and how they will be administered, the role that payers will play in the process is becoming clearer, AIS Health reported.

It's imperative for health plans to do two key things at the same time, according to Katherine Dallow, M.D., the vice president of clinical programs and strategy at Blue Cross Blue Shield of Massachusetts. Payers need to help the entities that will be distributing the vaccine to identify the individuals who should be first in line to be vaccinated, and they need to use their resources to help educate the community.
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Topics: Market Access, Product Release, Data & Analytics, Payer

Radar On Market Access: PBMs Continue Integration, Face More Regulatory Challenges in 2020

Posted by Peter Johnson on Dec 29, 2020

In 2020, the PBM industry continued to deepen its integration with other industry players, a trend that experts say is likely to continue in coming years. The PBM space has consolidated to the point that five firms — UnitedHealth Group's OptumRx, CVS Health Corp.'s Caremark, Cigna Corp.'s Express Scripts, Anthem Inc.'s IngenioRx, Humana Inc.'s Humana Pharmacy Solutions, and the Blue Cross and Blue Shield affiliate-owned Prime Therapeutics LLC — manage the lion's share of the pharmacy benefits offered to U.S. health plan members.

Beyond their deepening integration with the payers that own them, these firms are working to expand their data and direct-to-consumer operations, AIS Health reported.

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

Perspectives on Amazon Pharmacy

Posted by Leslie Small on Dec 24, 2020, Inc. made a splash in the health care world on Nov. 17 when the online retail powerhouse unveiled new pharmacy offerings that aim to disrupt the prescription drug market with increased convenience and savings, AIS Health reported.

In addition to setting up its own online pharmacy, Amazon is partnering with one of the three largest PBMs — Cigna Corp.'s Express Scripts — to offer a prescription-savings benefit that will be available to Amazon Prime members. "It can be used for discounts up to 80% off generic and 40% off brand name medications at over 50,000 participating pharmacies nationwide," according to a press release.
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Topics: Industry Trends, Data & Analytics, Payer