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

MMIT Reality Check on Ophthalmic Anti-Inflammatory (Apr 2019)

Posted by Matt Breese on Apr 19, 2019

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

Perspectives on Insulin Management

Posted by Leslie Small on Apr 18, 2019

Amid increasing public scrutiny of rising insulin prices, some health insurers are taking matters into their own hands to help their diabetic members afford the lifesaving medications, AIS Health reported.

At the integrated health system HealthPartners, the members who are hardest hit by rising insulin prices are those in high-deductible health plans, says Young Fried, vice president of pharmacy plan services. But she says insulin affordability is also an issue for Medicare members who are in the Part D "doughnut hole." 
 
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Topics: Industry Trends, Market Access, Data & Analytics, Provider, Payer

Radar On Market Access: CMS Finalizes Medicare Rates, Unveils '20 Opioid Policies

Posted by Judy Packer Tursman on Apr 18, 2019

CMS recently released its annual payment information and policy updates for Medicare Advantage, MA Prescription Drug (MA-PD) and stand-alone Prescription Drug Plans, underscoring the need for a better approach to opioid monitoring and management, AIS Health reported.

Yet overall, industry experts say perhaps the most eye-catching features of CMS's 2020 MA and Part D Rate Announcement and final Call Letter are the better-than-anticipated pay rate and the lack of worrisome new mandates, policy changes or major technical issues.
 
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Topics: Industry Trends, Provider, Payer

MMIT Reality Check on Juvenile Idiopathic Arthritis (Apr 2019)

Posted by Matt Breese on Apr 12, 2019

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

Radar On Market Access: BioScrip, Option Care Will Join Forces Within Infusion Market

Posted by Angela Maas on Apr 11, 2019

Two of the country's largest independent infusion services providers recently unveiled that they have entered into a merger agreement. After coming together, BioScrip, Inc. and Option Care Enterprises, Inc. would be the No. 2 home/alternate site infusion provider in the United States, AIS Health reported.

Under the terms of the deal, publicly traded BioScrip would issue new shares to Madison Dearborn Partners, LLC and Walgreens Boots Alliance, Inc., which are the Option Care shareholders, giving them 80% of BioScrip's stock, with current BioScrip shareholders holding the remaining 20%. The new company would be publicly traded.
 
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Topics: Specialty, Provider, Payer

Radar On Market Access: Drugmakers Are Trying Array of Tactics to Counter Copay Accumulator Programs

Posted by Angela Maas on Apr 9, 2019

As more health plans are implementing copay accumulator programs, manufacturers are struggling to find ways to counter them, AIS Health reported.

Drugmakers may want to "evaluate [their specialty pharmacy] network and consider narrowing it to independent SPs that will accept contracts precluding sharing with payers/PBMs the patients who are participating in your copay offset program," recommends a recent survey report from Zitter Insights.
 
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Topics: Industry Trends, Provider, Payer

MMIT Reality Check on Acute Myeloid Leukemia (Apr 2019)

Posted by Matt Breese on Apr 5, 2019

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.

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

Radar On Market Access: Insurer Tools Aim to Help Members Save on Prescription Drugs

Posted by Leslie Small on Apr 4, 2019

As many Americans continue to struggle to afford their medications, health insurers and their PBMs are responding with tools that help consumers not only understand the cost of drugs before prescriptions are filled, but also find ways to spend less money on them, AIS Health reported.

However payers choose to design such tools, two keys to their success include making improvements over time and making sure members know about them before they might need them, according to Nathan Foco, senior director of market and sales intelligence for Michigan-based Priority Health.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: New Postpartum Depression Drug Presents Payer Challenges

Posted by Judy Packer Tursman on Apr 2, 2019

The FDA's recent approval of the first medication specifically aimed at treating postpartum depression is drawing a favorable response from clinicians, while payers could face challenges.

PBM executives tell AIS Health that the postpartum depression drug, Zulresso (brexanolone) injection, is likely to be covered under the medical, not the pharmacy, side of the benefit.
 
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Topics: Specialty, Market Access, Product Release, Provider, Payer

MMIT Reality Check on Opioid Dependence (Mar 2019)

Posted by Matt Breese on Mar 29, 2019

According to our recent payer coverage analysis for opioid dependence 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