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Radar On Market Access: Express Scripts Reports Record Low Drug Trend Across Commercial Plans in 2018

Posted by Judy Packer Tursman on Feb 19, 2019

For its first annual drug trend report as a part of Cigna Corp., Express Scripts Holding Co. said it had achieved a record low drug trend of 0.4% across its clients' employer-sponsored commercial plans in 2018. Overall, the PBM reported savings of $45 billion for its clients last year, AIS Health reported.

The PBM cited "an unprecedented 0.3% decline" in per-beneficiary drug spending across Medicare plans. Overall, there was a 1.4% decrease in unit cost trend, which allowed clients to absorb a 1.1% increase in utilization, the PBM said. Oncology replaced diabetes as Medicare’s top therapy class by per member per year spend.
 
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Topics: Payer, Provider, Market Access, Data & Analytics, Industry Trends

MMIT Reality Check on Rheumatoid Arthritis (Feb 2019)

Posted by Matt Breese on Feb 15, 2019

According to our recent payer coverage analysis for rheumatoid arthritis (RA) 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.

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

Radar On Market Access: Part D Rebate Proposal Might Raise Premiums, Reshape PBMs' Business Models

Posted by Leslie Small on Feb 12, 2019

While a new federal proposal to overhaul the prescription drug rebate system may not be a significant threat to major managed care companies' bottom lines, it will likely be disruptive for insurers and PBMs alike, AIS Health reported.

The proposed rule would remove safe-harbor protections under the federal anti-kickback statute for rebates paid by drug manufacturers to PBMs, Part D plans and Medicaid managed care organizations. Instead, it would create two new safe harbors: one for prescription drug discounts offered directly to patients, and one for fixed-fee service arrangements between drug manufacturers and PBMs.
 
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Topics: Payer, Provider, Market Access, Industry Trends

MMIT Reality Check on Type 2 Diabetes (Feb 2019)

Posted by Matt Breese on Feb 8, 2019

According to our recent payer coverage analysis for type 2 diabetes 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.

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

Radar On Market Access: Anthem Hits the Gas on Launch of In-House PBM IngenioRx

Posted by Leslie Small on Feb 5, 2019

Anthem, Inc. caused its stock to surge and Wall Street analysts to raise their 2019 and 2020 earnings estimates by revealing during its quarterly earnings call on Jan. 30 that it's planning to launch its in-house PBM three quarters earlier than it originally projected, AIS Health reported.

In its earnings release for the fourth quarter of 2018, the insurer said it will terminate its contract with Express Scripts Holding Co. on March 1, 2019, rather than the original expiration date of Dec. 31, 2019, because of Cigna Corp.'s acquisition of the PBM. Thus, Anthem expects to begin transitioning members to the new PBM platform, IngenioRx, in the second quarter of 2019.
 
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Topics: Payer, Provider, Market Access

MMIT Reality Check on Neutropenia (Feb 2019)

Posted by Matt Breese on Feb 1, 2019

According to our recent payer coverage analysis for neutropenia 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.

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

Radar On Market Access: California Makes Waves With Pharma Benefits, Purchasing Plan

Posted by Leslie Small on Jan 31, 2019

Under the direction of its new governor, Democrat Gavin Newsom, California is planning to take control of the pharmacy benefit for all of the state's Medi-Cal beneficiaries — the vast majority of which currently have that part of their care administered by private insurers and their PBMs, AIS Health reported. What's more, the order directs state agencies to create bulk-purchasing arrangements for high-priority drugs and establish a framework for letting private businesses and insurers join the state’s buying pool.

The idea of the state's Medicaid program shifting to an entirely fee-for-service drug benefits system is already sparking worries about what it will do to PBMs' bottom lines.
 
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Topics: Payer, Provider, Market Access, Industry Trends

MMIT Reality Check on Hemophilia (Jan 2019)

Posted by Matt Breese on Jan 25, 2019

According to our recent payer coverage analysis for hemophilia 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.

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

MMIT Reality Check on PCSK9 (Jan 2019)

Posted by Matt Breese on Jan 18, 2019

According to our recent payer coverage analysis for PCSK9 inhibitors, 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.

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

Trends That Matter for FDA Orphan Label Application Reviews

Posted by Angela Maas on Jan 17, 2019

The Orphan Drug Act (ODA) offers multiple incentives to manufacturers that bring a drug to market with an orphan designation. A recently released U.S. Government Accountability Office (GAO) report revealed that while the number of applications both received and granted for this designation has grown, FDA reviewers were not consistently recording or evaluating required information that is mandated to consider granting this designation, AIS Health reported.

The report, titled Orphan Drugs: FDA Could Improve Designation Review Consistency; Rare Disease Drug Development Challenges Continue (GAO-19-83), shows that from 2008 to 2017, both orphan designation applications received as well as orphan designations granted rose.
 
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Topics: Payer, Specialty, Market Access, Product Release