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Radar On Market Access: Biosimilars' Change in Part D

Posted by Matt Breese on Jun 19, 2018

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

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: In Value-Based Deals, Idea of Value Differs Among Firms

Posted by Matt Breese on Jun 7, 2018

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

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: Pharma Faces Limits When Providing Payers Drug Information

Posted by Matt Breese on May 31, 2018

Payers increasingly are looking to pharma to provide evidence that a drug will provide value, yet some restrictions still limit what information manufacturers actually can provide to payers, AIS Health reported.
 
"Generally, drug companies cannot talk to stakeholders about unapproved products outside of 'coming soon' ads and scientific exchange," says Ernest Voyard, a director in Avalere Health’s regulatory strategy practice. "However, FDA issued a draft guidance last year that included direction for conversations with payers that included safe harbors for conversations about investigational products, recognizing a need for payors to plan for the future."  
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Express Scripts Inks Deal with Praluent Manufacturers

Posted by Matt Breese on May 29, 2018

Express Scripts Holding Co. has struck a deal with the manufacturers of Praluent (alirocumab), one of two pricey PCSK9 inhibitors on the market, that will give the PBM a lower net price on the drug in exchange for streamlined patient access and an exclusive spot on the Express Scripts national formulary, AIS Health reported.
 
The pact, unveiled May 1, comes after Regeneron and Sanofi announced in March that they would lower the net price of Praluent for payers willing to reduce access barriers for appropriate patients.
 
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Topics: Industry Trends, Market Access, Provider

Radar On Market Access: Managed Care Strategies for Specialty Pharmaceuticals

Posted by Matt Breese on May 22, 2018

A survey by EMD Serono, Inc. revealed that managing oncology drugs and services remains the top challenge for health plans, tied with determining the value of specialty drugs and ensuring clinically appropriate use of specialty therapies.
 
Released at the end of April, the 14th edition of the EMD Serono Specialty Digest: Managed Care Strategies for Specialty Pharmaceuticals is based on survey responses from 59 commercial health plans representing more than 76 million covered lives. 
 
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Topics: Industry Trends, Market Access, Data & Analytics

Radar On Market Access: American Patients First Blueprint

Posted by Matt Breese on May 17, 2018

After more than a year of promising action to counter the high costs of prescription drugs, the Trump administration on May 11 unveiled its American Patients First blueprint aimed at lowering medication prices and reducing costs for consumers, AIS Health reported.
 
Steve Wojcik, vice president, public policy, National Business Group on Health, says the blueprint "generally followed what was in the Administration’s proposal budget, by and large."
 
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Topics: Industry Trends, Provider

Radar On Market Access: Outcomes-Based Drug Pricing

Posted by Matt Breese on May 15, 2018

While outcomes-based contracts for prescription drugs are a continual hot topic in the health care industry, experts who spoke on a panel May 1 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, Market Access, Payer