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Radar On Market Access: Clover Health Offers Pharmacogenomics Testing

Posted by Matt Breese on Jul 17, 2018

In-home primary care has become a de rigueur offering for Medicare Advantage (MA) organizations looking to avoid costly emergency room visits and hospital admissions. Clover Health aims to innovate the traditional multidisciplinary structure with pharmacogenomic testing that could lead to safer and more effective medication use, AIS Health reported. 
 
Clover currently serves about 600 frail, chronically ill members in its home care program, who on average have between six and 11 chronic conditions and are on 10 or more medications. The insurer in June began offering genetic testing capabilities provided by YouScript, a proprietary clinical decision support tool designed to assist in medication therapy management.
 
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Topics: Industry Trends, Data & Analytics, Payer

MMIT Reality Check on Alpha-1 Antitrypsin Deficiency (Jul 2018)

Posted by Matt Breese on Jul 13, 2018

According to our recent payer coverage analysis for alpha-1 antitrypsin deficiency 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 Value-Based Contracts

Posted by Matt Breese on Jul 12, 2018

As pharma manufacturers strive to demonstrate to payers their products' efficacy in the face of backlash against rising drug prices, one effective tactic may be to enter into value-based contracts. It's crucial for manufacturers to understand how other entities they wish to partner with approach value and to start preparing that value proposition early in the drug development process, AIS Health reported.
 
Different payers will come at value from different perspectives. "A standalone Medicare Part D plan has very different priorities than an integrated health system," says Larry Blandford, Pharm.D., an executive vice president at Precision for Value.  
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Amazon/PillPack Deal Has Limited Effect

Posted by Matt Breese on Jul 12, 2018

Amazon recently unveiled its plan to purchase PillPack — a tech-enabled startup that offers pre-sorted dose packaging and home delivery of prescription drugs for those taking multiple medications — yet industry analysts do not appear convinced that the acquisition will have a significant effect on PBMs or health insurers, at least not in the short term, AIS Health reported.
 
"We do not expect any material impact on our financial expectations for the MCOs we cover and thus we make no change to our estimates or ratings," Credit Suisse's A.J. Rice wrote in a research note.
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Centene Highlights New PBM Asset

Posted by Matt Breese on Jul 10, 2018

Amid a flurry of recent deal-making in the PBM sector, Centene Corp. highlighted the capabilities of the tech-savvy PBM it recently invested in, RxAdvance, during its June 15 investor day presentation, AIS Health reported.
 
Centene's equity investment in RxAdvance, CEO Michael Neidorff said, was made to complement the insurer's internal PBM, US Script. RxAdvance's technology and PBM cloud platform "will enable us to drive change across the care continuum," he added.
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Topics: Industry Trends, Data & Analytics, Payer

MMIT Reality Check on Advanced Prostate Cancer (Jul 2018)

Posted by Matt Breese on Jul 6, 2018

According to our recent payer coverage analysis for advanced prostate cancer 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: Gene Therapies Pose Challenges

Posted by Matt Breese on Jul 3, 2018

The FDA has multiple pathways for companies to get a review of promising drugs for conditions sorely in need of a treatment earlier in their development process than is typical, based on a surrogate endpoint. Following the FDA's approval of the first three gene therapies last year, the agency recently indicated that it will issue guidance on these products, including their potential approval based on surrogate measures. Yet this accelerated pathway holds challenges for manufacturers and payers, AIS Health reported.
 
The FDA has multiple programs that provide accelerated drug development and review: fast track designation, accelerated approval, breakthrough therapy designation and regenerative medicine advanced therapy (RMAT) designation, which was established in December 2016. The agency in November 2017 released draft guidance on applying the RMAT designation, which some gene therapies may qualify for.
 
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Topics: Specialty, Industry Trends, Product Release, Payer

MMIT Reality Check on Cystic Fibrosis (Jun 2018)

Posted by Matt Breese on Jun 29, 2018

According to our recent payer coverage analysis for cystic fibrosis 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 Outcomes-Based Drug Pricing

Posted by Matt Breese on Jun 28, 2018

While outcomes-based contracts for prescription drugs are a continual hot topic in the health care industry, experts who spoke on a panel at the World Health Care Congress cited several barriers that are keeping these contracts from proliferating widely: chiefly, not enough reliable data and regulatory issues such as the federal antikickback statute.
 
"The beautiful thing about value-based contracts is we are basically putting the patient at the center of everything," said Enrique A. Conterno, senior vice president of Eli Lilly and Co.  
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: FDA Guidance Give More Comfort for Payer VBCs

Posted by Matt Breese on Jun 26, 2018

The FDA recently issued final guidance that seems likely to pave the way for smoother negotiations between pharmaceutical manufacturers and health plans over agreements tying payment to a drug's performance on cost-effectiveness and quality measures, AIS Health reported.
 
In it, the FDA clarifies that drugmakers and medical device manufacturers may provide "health care economic information," which may not be found in the medical product's labeling, to payers and other "sophisticated" entities — and offers recommendations on how to disseminate it properly.
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Topics: Industry Trends, Market Access, Provider, Payer