Market Access

What CVS and Anthem Gained From The Centene-WellCare Deal

CVS expanded through IlliniCare Health Plan The combined carrier formed by Centene and WellCare will have a greater market share with respect to number of enrolled lives. Centene and WellCare had to divest some of their entities to go ahead with the deal. Centene signed a definitive agreement with CVS to divest its Illinois health plan […]

The Year 2019 in Japanese Health Technology Assessment

With one of the highest life expectancies among countries and an increasingly aging population, Japan is at a juncture where there are more citizens requiring healthcare services than those contributing to the expenditure. The pressure to bring down healthcare spending is enormous and the need for a sustainable healthcare system is more crucial than ever. […]

Humana Grows Senior Health Business with Latest Deals

Humana is the second-largest Medicare Advantage payer in the nation after UnitedHealthcare, covering more than four million Medicare Advantage members (DRG July 2019 data). Recently, the insurer has been working to leverage and expand its pharmacy benefit management and care delivery through external investments. Following in the footsteps of competitors like UnitedHealth, Humana is looking […]

Cigna & Oscar Product Could Be New Disruptor in Small Group Market

It’s Oscar season in the health insurance industry. Cigna and Oscar Health kicked off a deal that will add power to each insurer’s position in the commercial space while playing off their respective strengths. Under the name Cigna + Oscar, the two carriers will be offering fully insured plans to small employer groups in to-be-announced […]

Top 10 Predictions for US Managed Markets in 2020 & Beyond

Last year, healthcare insurers laid the groundwork for collaborations that will continue through 2020 as they transition from a focus on geographic expansion, benefit design changes, and organizational up-sizing to vertical alignment and enhanced benefits. Meanwhile, patient outcomes, value-based care, and patient experience will continue to receive a large share of attention, while rising healthcare […]

Top 10 PBM Industry Macrotrends in 2019 & What to Expect in 2020

The PBM industry saw some significant changes in 2019, as some of the largest forces in the market vertically integrated and began implementing disruptive programs that redefined the way pharmacy claims are processed in the U.S. The disruptive strategies spanned from drug acquisition (the way PBMs negotiate discounts with pharma clients) through drug delivery (the […]

Express Scripts a Pioneer: Launches Curated List of Digital Therapeutics

What are digital therapeutics? According to the Digital Therapeutics Alliance, digital therapeutics “deliver evidence-based therapeutic interventions to patients that are driven by high quality software programs to prevent, manage, or treat a medical disorder or disease. They are used independently or in concert with medications, devices, or other therapies to optimize patient care and health […]

9 steps for modernizing your medtech account segmentation strategy

The complexity of the medtech purchasing ecosystem has rendered a traditional approach ineffective. Here’s how to get up to speed. Account segmentation and targeting used to be a pretty straightforward business: Examine CMS claims data to get a read on volumes being performed and compare against historic sales into the account to prioritize sales rep […]

Massachusetts Law Allowing Coupons Expires on Jan 1, 2020 Unless State Acts

In Massachusetts, Drug Coupons on the Brink Drug manufacturers are concerned that, barring legislative action, drug coupons in Massachusetts will soon be forbidden. The clock is ticking for lawmakers to preserve the existing law and no signs have emerged indicating they intend to act by an end-of-the-year deadline. The existing law permits manufacturer coupons, discounts, […]

Digital Therapeutics Target Mental Health, Substance Use Disorders

As advancements in technology-assisted treatments evolve, digital therapeutics are emerging as a vehicle for mental health and addiction treatment. Digital therapeutics have the potential to close gaps in care for patients, reduce demands on providers’ time, and enhance the effectiveness of pharmaceuticals, offering promise for stakeholders across the spectrum of healthcare delivery.   What are […]