In a move that industry analysts see as a positive development for the managed care sector, CMS issued new guidance that will allow Medicare Advantage (MA) plans to use step therapy for Part B drugs starting in 2019, AIS Health reported.

 

CMS is giving MA plans that offer a Part D benefit the ability to "cross-manage" drugs across Part B and Part D. In other words, plans could require patients to try alternatives covered within Part D before moving on to relatively expensive physician-administered drugs in Part B, Credit Suisse analyst A.J. Rice explained in a research note.

Topics: Specialty, Industry Trends, Market Access

According to our recent payer coverage analysis for tardive dyskinesia 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

For years, clinicians have mostly prescribed generic prescription drugs to treat migraines. But a new class of relatively high-cost specialty biologic products is threatening to upend payers' calm, AIS Health reported.

 

Current migraines treatments supported by clinical evidence "include beta blockers, tri-cyclic anti-depressants and some seizure medications," according to Mesfin Tegenu, R.Ph., president of PerformRx, LLC. The situation changed in mid-May, when Amgen, Inc and Novartis AG's Aimovig got the regulatory greenlight in the U.S., and two more calcitonin gene-related peptide (CGRP) inhibitors — Teva Pharmaceuticals' fremanezumab and Eli Lilly and Co.'s galcanezumab — are under FDA review, says an Institute for Clinical and Economic Review (ICER) report on migraine treatments.

 

Topics: Specialty, Industry Trends, Market Access, Payer

According to our recent payer coverage analysis for Crohn's disease 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

Continuing the Trump administration's spate of actions aimed at lowering prescription drug costs, the FDA recently unveiled the 11-step "Biosimilar Action Plan" designed to help get more biosimilar drugs to the market that can compete with pricey biologics, AIS Health reported. 

 

While the FDA has approved 11 biosimilars, only three are currently being marketed in the U.S., FDA Commissioner Scott Gottlieb said. "Competition is, for the most part, anemic," he concluded, adding that an FDA analysis showed Americans could have saved $4.5 billion in 2017 if all the approved biosimilars were available to consumers.

Topics: Specialty, Market Access, Product Release

According to our recent payer coverage analysis for immune globulin 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, Branding & Marketing

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.

 

Credit Suisse's A.J. Rice wrote in a research note, "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." 

 

Topics: Industry Trends, Market Access, Provider, Payer, Branding & Marketing

Although multiple myeloma is a relatively rare cancer, numerous therapies to treat it are available, AIS Health reported. Because of these products' efficacy, they have made the disease manageable — and, as a result, costly.

 

"The mainstays of treatment for multiple myeloma are considered specialty medications and therefore placed into a specialty tier," says Raechele McMahan, vice president and general manager, enterprise specialty pharmacy at Prime Therapeutics. "The therapies are also subject to utilization management, which primarily consists of prior approval."

 

Topics: Specialty, Industry Trends, Market Access, Payer

According to our recent payer coverage analysis for epilepsy 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

CMS recently denied a waiver request by Massachusetts to allow its Medicaid program, MassHealth, to use a closed formulary that excludes certain drugs. But the agency, in its June 27 decision, left the door open on the state's pursuit of tighter drug controls, AIS Health reported.

 

"The Massachusetts proposal brought to the table a new approach to increase its leverage to get lower drug prices, but an approach that left many unanswered questions," says Jack Hoadley, Ph.D., a research professor emeritus in Georgetown University’s Health Policy Institute. "Its rejection by CMS should not stop states from continuing to seek new ways to achieve lower prices. The key is how to balance maintaining access to needed drugs with tools to get lower prices."

Topics: Specialty, Market Access, Product Release