Contact

Payer

Pharma

Provider

Formulary guidance and transparency from P&T to point of care

MMIT Reality Check on Hemophilia B (Factor IX) (Apr 2021)

Posted by Matt Breese on Apr 23, 2021

According to our recent payer coverage analysis for hemophilia B (factor IX) 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.

Read More

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

Trends That Matter for Copay Accumulator Programs

Posted by Leslie Small on Apr 22, 2021

Thanks to recent regulatory moves and the increasing prevalence of copay accumulator/maximizer programs, the tactics that payers use to counter drug manufacturer copay assistance continue to be a controversial topic in the health care sector, AIS Health reported.

Copay accumulators work by preventing any monetary assistance that pharmaceutical companies offer commercially insured patients from counting toward their deductible or out-of-pocket maximum. Their close cousin, copay maximizers, take the total amount of a manufacturer's copay offset program and divide it by 12, and that amount becomes the new monthly copayment for all patients on any given drug over the course of a year.
Read More

Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: UnitedHealth Reports 'Good Start to the Year,' But Expects COVID Earnings Hit Later

Posted by Leslie Small on Apr 22, 2021

UnitedHealth Group began the first quarter of 2021 on a high note, reporting earnings per share (EPS) and a medical loss ratio (MLR) that both beat the Wall Street consensus estimate and saying it expects to achieve greater full-year earnings than it previously estimated, AIS Health reported. However, executives warned that the majority of the unfavorable COVID-19-related impact they're expecting will transpire in the second half of the year.

UnitedHealth expects roughly 70% of the predicted COVID-related $1.80 EPS hit to occur in the back half of the year, Chief Financial Officer John Rex said during an April 15 conference call to discuss the company’s financial results. He said that projection is based on UnitedHealth's prediction that as the year wears on and vaccination rates rise, people will increasingly be able to access higher-acuity, previously deferred care.

Read More

Topics: Industry Trends, Data & Analytics, Payer

MMIT Reality Check on Growth Hormone Deficiency (Apr 2021)

Posted by Matt Breese on Apr 16, 2021

According to our recent payer coverage analysis for growth hormone deficiency (GHD) 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.

Read More

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

Perspectives on ACA Subsidy Expansion

Posted by Leslie Small on Apr 15, 2021

For an individual health insurance market that is already hitting its stride, the new pandemic relief legislation's expansion of Affordable Care Act (ACA) subsidies is yet another positive catalyst that should make the exchanges more attractive to insurers and customers alike, experts tell AIS Health.

Under the American Rescue Plan, which President Joe Biden signed into law on March 11, individuals who already qualified for premium tax credits under the ACA will see more generous financial aid. In addition, people who earn more than 400% of the federal poverty level (FPL) will be eligible for reduced premiums for the first time thanks to a provision that caps marketplace premiums at 8.5% of all enrollees' income.
 
Read More

Topics: Industry Trends, Data & Analytics, Payer

5 Things to Consider When Launching a New Drug: MMIT Meet the Expert webinar recap on Predicting Payer Uptake with Precision

Posted by MMIT on Apr 15, 2021

On April 6, MMIT kicked off a six-part Meet the Expert webinar series. The first session was focused on predicting payer uptake with precision. For example, many pharma manufacturers use analogs to predict payer uptake of a new drug being launched into the market. Tracking how an analog drug performed can help drug manufacturers improve messaging to payers, identify coverage challenges, and accurately predict payer uptake.

But choosing the right analogs can be challenging, said MMIT’s Carolyn Zele and Ritupriya Yamujala. Suppose the manufacturer’s drug is the first oral oncolytic for a particular tumor type. What criteria should the manufacturer consider in selecting an analog for comparison:

Read More

Topics: Product Release, Payer, Branding & Marketing

MMIT Reality Check on Acute Myeloid Leukemia (Apr 2021)

Posted by Matt Breese on Apr 9, 2021

According to our recent payer coverage analysis for acute myeloid leukemia 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.

Read More

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

Radar On Market Access: Interoperability Mandate Could Be an Opportunity for Payers

Posted by Peter Johnson on Apr 8, 2021

Payers should look at the looming interoperability mandate as a chance to gain a lasting advantage over their competitors, according to two health care information technology (IT) experts.

In a March 26 webinar hosted by America's Health Insurance Plans (AHIP), IBM Vice President Michael Curry of Watson Health and Jeff Rivkin, research director for payer IT strategies at IDC Insights, said payers should do more than meet the minimum interoperability standards, AIS Health reported.

Read More

Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Study Highlights Promise of Bundled Payments in Employer Plans

Posted by Jane Anderson on Apr 6, 2021

A bundled payment program run by San Francisco-based digital health company Carrum Health resulted in an average per-episode savings of more than $16,000 per orthopedic or surgical procedure, a recent RAND Corp. analysis found.

Counting both procedures reimbursed under the bundled payment program and procedures reimbursed outside the program, per-episode costs for the three procedures studied — spinal fusion, major joint replacement and bariatric surgery — were 10.7% lower overall, on average, than costs for comparable procedures prior to implementation of the program. That added up to a total savings of $4,229 per episode, the study found.

Read More

Topics: Industry Trends, Data & Analytics, Payer

MMIT Reality Check on COPD (Apr 2021)

Posted by Matt Breese on Apr 2, 2021

According to our recent payer coverage analysis for COPD 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.

Read More

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