2019 PBM trend: Specialty sector at center stage

While big PBMs like ESI and CVS Caremark promote exceptional market control through their 2019 PBM trend reports, Prime Therapeutics failed to effectively control drug price inflation. In line with the trend for slow growth, commercial drug spending grew at an average of three percent. While drug utilization remains the leading cause of increasing specialty […]

Walmart ventures into mainstream health insurance: Medicare

Walmart’s evasive attempts to inch into the health insurance market created a buzz once the retailer confirmed on its plans to broker and sell Medicare Advantage plans. In October 2020, Walmart announced its insurance brokerage, Walmart Insurance Services, will begin to sell Medicare Advantage, Medicare Supplemental and Part D plans in 2021. Walmart plans to […]

Molina’s hunt to grab small MCOs expands growth into new markets

Well known for its acquisitions, Molina Healthcare expanded its existing Medicaid markets and entered a few new markets in 2020. Molina’s strategy to target small private plans and utilize its operational experience has been successful in boosting its growth. California-based Molina Healthcare is one of the nation’s largest managed Medicaid organizations with Washington, California, Michigan, […]

Searching for the silver lining: COVID-19 and influenza

Clarivate Epidemiologist Mike Hughes discusses how the pandemic’s public health restrictions have impacted seasonal influenza spread.   Signals from the southern hemisphere suggest we’re about to see a silver lining in the current pandemic: a sharp reduction in the number of seasonal influenza cases due to public health restrictions. We’ve modelled how these restrictions may […]

Formulary attributes: An influencer of drug access

A review of  2019 prescription drug sales in the United States reveals Humira, Enbrel, Revlimid, Imbruvica and Keytruda to be on top of the chart (DRG Sales data). Their specialty status and utilization volume make these drugs ideal candidates to ascertain relation between formulary management in commercial plans and drug access.  Highlights of the analysis […]

CMS unveils new alternative payment models targeting rural health and therapy areas

CMS continues to evolve its alternative payment model strategy to include downside risk, where providers assume financial risk for quality and cost of care.  Approximately 36 percent of U.S. healthcare payments were tied to alternative payment models in 2018 per the Health Care Payment Learning & Action Network. CMS announced three shared-risk APMs earlier this […]

Delays in clinical trials present opportunities for pharma companies to evolve

COVID-19 has upended clinical trial timelines – putting billions of forecasted sales at risk and delaying getting life-saving treatments to patients. This analysis from Garima Kaul, Senior Director, Research and Insights, Decision Resources Group, part of Clarivate, and Jamie Munro, Executive Director, CIRS explores the opportunities that delays in clinical trials present for pharma companies. […]

What’s driving oncology HTAs in South Korea?

Reimbursement in South Korea depends upon a favorable review by Health Insurance Review Agency  (HIRA), and some therapies may not be reimbursed because of shortcomings from the perspective of HIRA. To help pharma companies plan clinical trials and economic evidence submission in order to achieve favorable access in South Korea, we used the Context Matters […]

Biomarkers have several key roles in clinical trials and precision medicine

Biomarker use in clinicals trials has expanded over the last few decades. Designing a protocol that incorporates biomarkers can reduce trial timelines and increase the chance of success. However, biomarkers remain underutilized for a variety of reasons. Evaluating the trends in biomarker use allows us to monitor the effectiveness of new strategies and identify areas […]

Six U.S. healthcare policy questions hanging in the balance

Insights provided in this article were developed using data on and analysis of the impact of U.S. policy on healthcare and the pharmaceutical industry by analysts at DRG, part of Clarivate. DRG U.S. Managed Markets Insights provides robust qualitative insights on national, state and MSA level market access dynamics.   Ten years after the passage […]