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

MMIT Reality Check on Rheumatoid Arthritis (Sep 2018)

Posted by Matt Breese on Sep 21, 2018

According to our recent payer coverage analysis for rheumatoid arthritis (RA) 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 Step Therapy for Part B Drugs

Posted by Matt Breese on Sep 20, 2018

In a move that industry analysts see as a positive development for the managed care sector, CMS issued new guidance that will allow Medicare Advantage (MA) plans to use step therapy for Part B drugs starting in 2019, AIS Health reported.
 
CMS is giving MA plans that offer a Part D benefit the ability to "cross-manage" drugs across Part B and Part D. In other words, plans could require patients to try alternatives covered within Part D before moving on to relatively expensive physician-administered drugs in Part B, Credit Suisse analyst A.J. Rice explained in a research note.
 
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Topics: Specialty, Provider, Payer

Radar On Market Access: NASHP Unveils PBM Model Act

Posted by Matt Breese on Sep 20, 2018

The National Academy for State Health Policy (NASHP) recently unveiled a model act aimed at helping states bring more transparency to PBMs, AIS Health reported.  
 
NASHP Executive Director Trish Riley says the academy's latest model legislation aimed at reining in prescription drug costs, which was developed in consultation with its pharmacy cost work group, is a compilation of states' recently enacted PBM laws. 
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Topics: Specialty, Industry Trends, Market Access

Radar On Market Access: Indication-Based Formularies in Part D

Posted by Matt Breese on Sep 18, 2018

The Trump administration continues to take steps aimed at bringing down drug prices. In the latest move, CMS Administrator Seema Verma said in an Aug. 29 memo to Medicare Part D plan sponsors that they can begin using indication-based formularies in contract year 2020, AIS Health reported.
 
Starting in 2020, "Part D sponsors may utilize step therapy-like requirements within their [prior authorization] to promote cost-effective drug therapy by requiring the use of one formulary drug for a certain indication prior to authorizing coverage of a second drug for that indication," explains the memo.
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Topics: Specialty, Industry Trends, Market Access

MMIT Reality Check on Diabetes (Sep 2018)

Posted by Matt Breese on Sep 14, 2018

According to our recent payer coverage analysis for diabetes 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 for Epinephrine Medications

Posted by Matt Breese on Sep 13, 2018

In August, the FDA approved Teva Pharmaceuticals' generic version of Mylan N.V.'s EpiPen — a move the FDA says will provide a lower-cost option, though Teva hasn’t released pricing details, AIS Health reported. 

In May, after consumers around the country reported difficulties in finding EpiPens to treat severe allergic reactions, the FDA announced shortages of two brands of epinephrine auto-injectors: Mylan Inc.'s EpiPen and Impax Laboratories, LLC's Adrenaclick.

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Topics: Specialty, Industry Trends, Payer

Radar On Market Access: Express Scripts’ 2019 National Preferred Formulary

Posted by Matt Breese on Sep 13, 2018

With 48 new exclusions on its 2019 National Preferred Formulary (NPF), Express Scripts Holding Co. is getting more aggressive in its attempt to broaden access to pharmaceuticals and bring value to its clients, AIS Health reported. But some industry stakeholders are questioning its strategy of excluding more specialty drugs.
 
In 2019, the NPF will cover more than 25 million lives and will include 3,886 medications. The PBM estimates that the exclusions, including multiple sclerosis drug Extavia, hepatitis C medication Mavyret and HIV drug Atripla, will save $3.2 billion.
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Topics: Specialty, Industry Trends, Market Access, Payer

Radar On Market Access: Patients' Perspectives in Value Assessment

Posted by Matt Breese on Sep 11, 2018

Including patients' perspectives in value assessments ultimately will be of more value to payers and providers, particularly as medication becomes more personalized, and manufacturers should make sure they are gathering this information, industry experts tell AIS Health.
 
"Too often, value assessments place greater emphasis on cost compared with humanistic value or societal impacts, such as quality of life and productivity," says Ross Maclean, M.D., Ph.D., senior vice president and head of medical affairs at Precision Health Economics. "Patient factors are often critical to successful treatment, and it is important to understand that patient perceptions and attitudes toward disease burden (including lifestyle impact), mode of administration, treatment frequency and side effects may all affect adherence."
 
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Topics: Specialty, Industry Trends, Provider, Payer

MMIT Reality Check on G-CSF (Sep 2018)

Posted by Matt Breese on Sep 7, 2018

According to our recent payer coverage analysis for G-CSF 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 New Class of Migraine Drug

Posted by Matt Breese on Sep 6, 2018

For years, clinicians have mostly prescribed generic prescription drugs to treat migraines. But a new class of relatively high-cost specialty biologic products is threatening to upend payers' calm, AIS Health reported.
 
According to Mesfin Tegenu, R.Ph., president of PerformRx, LLC, current migraine treatments supported by clinical evidence "include beta blockers, tri-cyclic anti-depressants and some seizure medications." The situation changed in mid-May, when Amgen, Inc and Novartis AG's Aimovig got the regulatory greenlight in the U.S., and two more calcitonin gene-related peptide (CGRP) inhibitors — Teva Pharmaceuticals' fremanezumab and Eli Lilly and Co.'s galcanezumab — are under FDA review, says an Institute for Clinical and Economic Review (ICER) report on migraine treatments.
 
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Topics: Specialty, Industry Trends, Market Access, Provider, Payer