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MMIT Reality Check on Growth Hormones (Jun 2018)

Posted by Matt Breese on Jun 21, 2018

According to our recent payer coverage analysis for growth hormone 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: Biosimilars' Change in Part D

Posted by Matt Breese on Jun 19, 2018

In just a little more than six months, biosimilars reimbursed in Medicare Part D will get a boost from legislation passed earlier this year. Plans and patients also stand to win, but manufacturers, not so much, industry experts told AIS Health.
 
In Part D, beneficiaries consistently pay a 25% cost share until they hit the catastrophic phase, when their responsibility decreases to 5% of the drug. During the initial coverage period, plan sponsors are responsible for 75% of a drug's cost; during the "donut hole" coverage gap, brand-name drugs' manufacturers must pay 50% of the drugs' cost, while plan sponsors' responsibility drops to 25%. Biosimilar manufacturers, by contrast, are excluded from having to provide this discount, leaving plan sponsors' responsibility at 75%. Yet as of 2019, biosimilars will be treated the same as brand-name drugs rather than as generics in the coverage gap.
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Topics: Industry Trends, Market Access, Provider, Payer

MMIT Reality Check on Multiple Myeloma (Jun 2018)

Posted by Matt Breese on Jun 15, 2018

According to our recent payer coverage analysis for multiple myeloma 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: In Value-Based Deals, Idea of Value Differs Among Firms

Posted by Matt Breese on Jun 7, 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.
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Topics: Industry Trends, Market Access, Provider, Payer

MMIT Reality Check on Chronic Lymphocyctic Leukemia

Posted by Matt Breese on May 31, 2018

According to our recent payer coverage analysis for CLL 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

MMIT Reality Check on Atopic Dermatitis (May 2018)

Posted by Matt Breese on May 31, 2018

According to our recent payer coverage analysis for atopic dermatitis, 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: Pharma Faces Limits When Providing Payers Drug Information

Posted by Matt Breese on May 31, 2018

Payers increasingly are looking to pharma to provide evidence that a drug will provide value, yet some restrictions still limit what information manufacturers actually can provide to payers, AIS Health reported.
 
"Generally, drug companies cannot talk to stakeholders about unapproved products outside of 'coming soon' ads and scientific exchange," says Ernest Voyard, a director in Avalere Health’s regulatory strategy practice. "However, FDA issued a draft guidance last year that included direction for conversations with payers that included safe harbors for conversations about investigational products, recognizing a need for payors to plan for the future."  
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Drug Cost Transparency Service

Posted by Matt Breese on May 24, 2018

Blue Shield of California has unveiled a program designed to show doctors lower-cost alternative medications and enable them to compare prices and make prescribing changes while meeting with patients in their offices, AIS Health reported.
 
The new Gemini Drug-Cost Transparency Service, which is developed by Gemini Health, LLC, taps into providers' existing electronic health record (EHR) systems. 
 
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Topics: Data & Analytics, Payer

Radar On Market Access: Outcomes-Based Drug Pricing

Posted by Matt Breese on May 15, 2018

While outcomes-based contracts for prescription drugs are a continual hot topic in the health care industry, experts who spoke on a panel May 1 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, Market Access, Payer

Radar On Market Access: CMS Targets Opioid Utilization

Posted by Matt Breese on May 10, 2018

CMS on April 2 finalized new policies in its 2019 Rate Announcement and Final Call Letter for Medicare Advantage (MA) and Part D plans that continue to focus heavily on ways to monitor and decrease opioid misuse, AIS Health reported.
 
To reduce the potential for chronic opioid use or misuse, CMS said that it expects Part D plan sponsors to implement a hard safety edit to limit initial opioid prescription fills for treating acute pain to no more than a seven-day supply. It also requires plan sponsors to implement an opioid care coordination edit at 90 morphine milligram equivalents per day.
 
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Topics: Industry Trends, Market Access, Payer