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Trends That Matter: The Future of Value-Based Agreements

Posted by Dinesh Kabaleeswaran and Ritupriya Yamujala on Jun 4, 2020

The challenge of improving patient access while reducing treatment costs has led the healthcare sector to explore innovative contract arrangements. Using value-based agreements (also referred to as risk-sharing or outcomes-based contracts) biopharmaceutical manufacturers and payers agree to link coverage and reimbursement levels to a drug’s effectiveness and usage. These agreements have been a necessity in providing patients access to high-cost and high-value gene therapies. However, in chronic disease states like diabetes and cardiovascular disease, value-based contracts have been essential to managing treatment costs associated with the high-volume utilization of these treatments.

Current challenges in value-based care include stakeholders’ alignment on which metrics are measurable and are valuable to include in an agreement, along with the presence of extensive technology and an unbiased third-party administrator to track and report on treatment outcomes. Successful implementation of such programs also involves patient adherence to treatments coordinated and monitored by physician practices or hospital systems.
 
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Topics: Industry Trends, Market Access, Data & Analytics

MMIT Reality Check on Narcolepsy (May 2020)

Posted by Matt Breese on May 29, 2020

According to our recent payer coverage analysis for narcolepsy 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: Specialty, Market Access, Payer, Branding & Marketing

MMIT Reality Check on Low Testosterone (May 2020)

Posted by Matt Breese on May 22, 2020

According to our recent payer coverage analysis for low testosterone 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: Specialty, Market Access, Payer, Branding & Marketing

Trends That Matter for Medical-Benefit Drug Spending

Posted by Peter Johnson on May 21, 2020

Spending on prescription drugs that are covered under the medical benefit increased by 65% between 2014 and 2018 for commercial insurers and 40% for Medicare, according to Magellan Rx Management's annual Medical Pharmacy Trend Report.

"The increase in medical pharmacy spend seems to largely be driven by inflation," Kristen Reimers, Magellan's senior vice president of specialty clinical solutions, tells AIS Health. "This can be a combination of two things, increasing costs of existing drugs and providers utilizing newer more expensive drugs. The pipeline was extremely robust and new therapies to market are contributing to inflation, driving the trend."
 
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Topics: Industry Trends, Market Access, Data & Analytics

MMIT Reality Check on Pain Narcotic Opioid (May 2020)

Posted by Matt Breese on May 15, 2020

According to our recent payer coverage analysis for pain narcotic opioid 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: Specialty, Market Access, Payer, Branding & Marketing

MMIT Reality Check on Anemia — Chronic Kidney Disease (May 2020)

Posted by Matt Breese on May 8, 2020

According to our recent payer coverage analysis for anemia treatments due to chronic kidney disease, 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: Specialty, Market Access, Payer, Branding & Marketing

Trends That Matter for Biosimilar Medications Cost Savings

Posted by Peter Johnson on May 7, 2020

Biosimilar medications can offer meaningful cost savings for payers, but market and regulatory barriers are still preventing them from realizing their full economic potential, according to a March 31 Johns Hopkins University study funded by the ERISA Industry Committee.

"We could see and empirically prove that patients…tended to be better off if they were on the biosimilar," Mariana Socal, a physician and researcher at the Johns Hopkins Bloomberg School of Public Health and one of the study's authors, tells AIS Health. "They had lower out-of-pocket costs when they were on the biosimilar."
 
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Topics: Industry Trends, Market Access, Data & Analytics

MMIT Reality Check on Ophthalmic Anti-Inflammatory (Apr 2020)

Posted by Matt Breese on May 1, 2020

According to our recent payer coverage analysis for ophthalmic anti-inflammatory 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: Specialty, Market Access, Payer, Branding & Marketing

Radar On Market Access: Oncology Drugs Drive Price Growth in Medical-Benefit Spend

Posted by Peter Johnson on Apr 30, 2020

Spending on prescription drugs that are covered under the medical benefit increased by 65% between 2014 and 2018 for commercial insurers and 40% for Medicare, according to Magellan Rx Management's annual Medical Pharmacy Trend Report.

"The increase in medical pharmacy spend seems to largely be driven by inflation," Kristen Reimers, Magellan's senior vice president of specialty clinical solutions, tells AIS Health. "This can be a combination of two things, increasing costs of existing drugs and providers utilizing newer more expensive drugs. The pipeline was extremely robust and new therapies to market are contributing to inflation, driving the trend."

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Topics: Market Access, Data & Analytics, Provider, Payer

MMIT Reality Check on Juvenile Idiopathic Arthritis (Apr 2020)

Posted by Matt Breese on Apr 24, 2020

According to our recent payer coverage analysis for juvenile idiopathic arthritis 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: Specialty, Market Access, Payer, Branding & Marketing