Ohio recently cleared a key hurdle in its plan to revamp how Medicaid enrollees' pharmacy benefits are managed, choosing Gainwell Technologies as the single PBM that will replace big-name firms including Cigna Corp.'s Express Scripts, CVS Heath Corp.'s Caremark, UnitedHealth Group's OptumRx and Centene Corp.'s Envolve Pharmacy Solutions, AIS Health reported.
Although PBMs and insurers generally oppose state moves to carve out pharmacy benefits from their Medicaid managed care contracts, Ohio says it expects the new single-PBM approach will "drive transparency, reduce pharmacy costs and simplify provider administration."
Radar On Market Access: Ohio Names New Medicaid PBM, Sues One of Current Vendors
Posted by Leslie Small on Mar 16, 2021
Topics: Industry Trends, Market Access, Payer
MMIT Reality Check on Non-Small Cell Lung Cancer EGFR Mutated (Mar 2021)
Posted by Matt Breese on Mar 12, 2021
According to our recent payer coverage analysis for non-small cell lung cancer EGFR mutated 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
Treatment of advanced prostate cancer usually involves androgen deprivation therapy (ADT), and the current standard of care is luteinizing hormone-releasing hormone (LHRH) receptor agonists, such as leuprolide acetate, which is administered by a health care provider as an injection or implant. It is available as AbbVie Inc.’s Lupron Depot and Eligard from Tolmar Pharmaceuticals, Inc. to treat prostate cancer.
Topics: Industry Trends, Market Access, Product Release, Data & Analytics
Radar On Market Access: FDA's Breyanzi Approval May Not Change NHL Management
Posted by Angela Maas on Mar 9, 2021
With the FDA's approval of Bristol Myers Squibb's Breyanzi (lisocabtagene maraleucel) last month, there are now three chimeric antigen receptor T cell (CAR-T) therapies to treat a certain type of non-Hodgkin’s lymphoma (NHL). A Zitter Insights poll shows that payers do not anticipate its approval as having much of an impact on their management of the space, AIS Health reported.
On Feb. 5, the FDA approved Breyanzi for the treatment of adults with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy, including diffuse large B-cell lymphoma not otherwise specified, high-grade B-cell lymphoma, primary mediastinal large B-cell lymphoma and follicular lymphoma grade 3B.
Topics: Industry Trends, Market Access, Product Release
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
Radar On Market Access: New Heart Failure Drugs Offer More Therapy Options
Posted by Jane Anderson on Mar 2, 2021
Treatment for heart failure still relies significantly on tried-and-true generic drugs, but new brand-name entrants — including Novartis' Entresto (sacubitril/valsartan) and Amgen's Corlanor (ivabradine) — are important additions to prescribers' clinical arsenals against the high-mortality condition, industry insiders tell AIS Health.
"Generic heart failure drugs, including beta blockers, ACE inhibitors, and ARBs [angiotension receptor blockers] have historically been used and continue to be the backbone of therapy," says April Kunze, Pharm.D., senior director of clinical program development for Prime Therapeutics. "However, in the past few years, additional treatment options have become available. Entresto is now recommended as a first-line treatment option in patients with an ejection fraction <= 40%."
Topics: Industry Trends, Market Access, Product Release
According to our recent payer coverage analysis for HIV 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
"I think the pharmacy benefit overall will be something that states are looking at in order to find savings in some way — whether through carveouts or through another policy — just because there are limited levers that the state is going to be able to pull to save money," says Rachel Dolan, a senior policy analyst with the Kaiser Family Foundation’s Program on Medicaid and the Uninsured.
Topics: Industry Trends, Market Access, Data & Analytics, Payer
MMIT Reality Check on Type 2 Diabetes (GLP-1 and Combo) (Feb 2021)
Posted by Matt Breese on Feb 19, 2021
According to our recent payer coverage analysis for type 2 Diabetes (GLP-1 and Combo) 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
Radar On Market Access: Pass-Through Rebate Models Need to Demonstrate Value
Posted by Peter Johnson on Feb 18, 2021
With the Trump administration's rebate rule delayed and possibly slated for repeal by Democrats in Congress, major changes in how the PBM industry distributes rebate revenue will have to come from the private sector, AIS Health reported.
The Biden administration will suspend implementation until 2023 of the so-called "rebate rule," a Trump administration regulation that would have revamped the Medicare prescription drug rebate system, and DC insiders expect the regulation will be repealed by Congress before then. Meanwhile, a growing number of PBMs that deal in the commercial market have pitched plan sponsors on a 100% pass-through rebate structure, in which the PBM collects its compensation through a fee or surcharges rather than diverting a share of rebate revenue.
Topics: Industry Trends, Market Access, Payer