Market Access

Retail giant Walmart enters the U.S. health insurance sector with Medicare plan play

Big box behemoth Walmart is getting into the U.S. market for health insurance with a pilot effort in Georgia. If successful, it could offer coverage to millions of American seniors and would represent the latest example of a chimeric healthcare offering covering payment, provision and distribution. Clarivate market access analysts Parvathy Menon and Sayantani Biswas […]

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, […]

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 […]

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 […]

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 […]

New era of affordable insulin

Disease management for chronic conditions can be tricky if the cost of medications is unaffordable. Patients, especially the Medicare population, tend to ration the drugs in order to avoid high costs as these require prolonged usage. According to CVS Health, more than 30 million Americans are living with diabetes, one-third of whom do not have […]

Role of advanced IDNs grows as COVID-19 shifts market dynamics

The COVID-19 pandemic is fundamentally changing healthcare delivery in the United States, from the acceptance of virtual physician visits to payment reform, and from the consolidation of integrated delivery networks to the very survival of independent physician practices. The resultant healthcare environment will be one that is more integrated into daily life with provider reimbursement […]