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Perspectives on Amazon Pharmacy

Posted by Leslie Small on Dec 24, 2020

Amazon.com, Inc. made a splash in the health care world on Nov. 17 when the online retail powerhouse unveiled new pharmacy offerings that aim to disrupt the prescription drug market with increased convenience and savings, AIS Health reported.

In addition to setting up its own online pharmacy, Amazon is partnering with one of the three largest PBMs — Cigna Corp.'s Express Scripts — to offer a prescription-savings benefit that will be available to Amazon Prime members. "It can be used for discounts up to 80% off generic and 40% off brand name medications at over 50,000 participating pharmacies nationwide," according to a press release.
 
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: MCO Messaging Plays Key Role in COVID Vaccine Rollout

Posted by Lauren Flynn Kelly on Dec 24, 2020

States and the federal government recently began rolling out the COVID-19 vaccine to health care workers across the country. Health plans, particularly those that serve high-risk individuals, may be ideally situated to coordinate care and update members on vaccination opportunities, experts tell AIS Health.

The FDA on Dec. 11 authorized emergency use of the COVID-19 vaccine made by Pfizer Inc. and BioNTech in individuals age 16 and older. Then the agency on Dec. 18 authorized Moderna’s vaccine for emergency use in people 18 years or older.

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Topics: Industry Trends, Market Access, Product Release, Payer

Radar On Market Access: Biden Probably Won't Roll Back New Prior Authorization Proposal

Posted by Leslie Small on Dec 22, 2020

Building on previously finalized regulations aimed at advancing data interoperability in health care, CMS on Dec. 10 proposed a new rule that would require certain health plans to make their prior authorization processes more efficient and share even more data with providers and patients, AIS Health reported.

If finalized, the rule would apply only to managed care Medicaid and CHIP plans, fee-for-service Medicaid and CHIP plans, and Qualified Health Plans (QHPs) on the federally facilitated exchanges.

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Topics: Industry Trends, Payer

MMIT Reality Check on Breast Cancer HR+/HER2+ (Dec 2020)

Posted by Matt Breese on Dec 18, 2020

According to our recent payer coverage analysis for hormone receptor-positive, human epidermal growth factor receptor 2-positive (HR+/HER2+) breast 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

Trends That Matter: Centene's ACA Expansion

Posted by Leslie Small on Dec 17, 2020

Centene Corp., which has come to dominate the Affordable Care Act exchange market by continuing to expand even when other carriers pulled back, is facing more competition now that the market has stabilized and insurer participation has increased, AIS Health reported.

Given that dynamic, Citi analyst Ralph Giacobbe advised investors recently that he was placing a "negative catalyst watch" on Centene due to the new competitive pressures it's facing. Centene, he observed, "was displaced as the lowest priced plan in a number of markets," and so the insurer "will have to rely on retention and new market entry to offset competitive pressures, which could prove challenging and may stunt growth relative to expectations."
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: First Round of Vaccines Are Expected to Be Free to the Public

Posted by Leslie Small on Dec 15, 2020

With FDA issuing emergency use authorization to the coronavirus vaccine from Pfizer Inc. and BioNTech last week and Moderna Inc.'s offering not far behind, in the coming months there will undoubtedly be a variety of vaccines being administered to Americans, AIS Health reported. But who will be paying for them?

"In the case of the COVID-19 vaccine, there is a very simple take-home message, which is that no one going to get the vaccine will be charged for the vaccine or its administration, no matter what type of insurance they have, or whether they have insurance at all," Karyn Schwartz, a senior fellow at the Kaiser Family Foundation (KFF), said during a Dec. 3 web briefing.

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Topics: Industry Trends, Market Access, Product Release, Payer

MMIT Reality Check on Nonmetastatic Prostate Cancer (Dec 2020)

Posted by Matt Breese on Dec 11, 2020

According to our recent payer coverage analysis for nonmetastatic 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

Perspectives on Biden Administration's Drug-Pricing Moves

Posted by Leslie Small on Dec 10, 2020

As is the case for other flavors of health care reform, President-elect Joe Biden's chance of passing substantial, transformative drug-pricing legislation is now highly dependent upon whether Democrats can eke out a majority in the Senate. While that question won't be resolved until Georgia completes runoff elections in January, industry observers point out that there are still ways that a Biden administration can address drug pricing, AIS Health reported.

"A president can do a lot even with a divided Congress," says Stephanie Kennan, a member of McGuireWoods Consulting's federal public affairs group. "Part of how well something gets done…depends upon the skills of the president or those negotiating for him. With Biden perhaps having a better understanding of the Senate, having come from the Senate, [that] might help him."
 
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Topics: Industry Trends, Payer

Radar On Market Access: Employers Show Interest in Moving to ICHRAs

Posted by Peter Johnson on Dec 10, 2020

Health care industry insiders say that employers of all sizes are beginning to take a serious look at moving some of their health benefits to Individual Coverage Health Reimbursement Arrangements (ICHRAs) starting in 2022, AIS Health reported.

In July 2019, the Trump administration finalized new regulations for ICHRAs, giving employers greater flexibility to reimburse qualifying employees buying health insurance policies on the individual market.

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Topics: Industry Trends, Payer

Radar On Market Access: Insurers Will Play Key Role in COVID Vaccine Distribution, Reimbursement

Posted by Brian Eastwood on Dec 8, 2020

As details continue to emerge about the availability of COVID-19 vaccines and how they will be administered, the role that payers will play in the process is becoming clearer, AIS Health reported.

It's imperative for health plans to do two key things at the same time, according to Katherine Dallow, M.D., the vice president of clinical programs and strategy at Blue Cross Blue Shield of Massachusetts. Payers need to help the entities that will be distributing the vaccine to identify the individuals who should be first in line to be vaccinated, and they need to use their resources to help educate the community.

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Topics: Industry Trends, Product Release, Payer