Market Access

Cell and Gene Therapies: Five Key Access and Reimbursement Strategies

Cell and gene therapies are revolutionizing the field of medicine by offering life-changing benefits to people with rare diseases and cancers. These therapies have been gaining considerable attention recently, both for addressing long-standing unmet needs and for being exceptionally pricey. As of October 2019, five cell and gene therapies have been launched in the United […]

Massachusetts Enhances Ability to Negotiate Medicaid Drug Rebates

Massachusetts Enhances Ability to Negotiate Medicaid Drug Rebates Massachusetts FY 2020 Budget includes strengthened ability for the state to seek supplemental rebates from drug manufacturers for drugs purchased through MassHealth, the state’s Medicaid program. The effort could be a blueprint for other states seeking to reduce state spending on some of the highest cost drugs […]

Implications of updated WHO Essential Medicines List

The WHO recently published an updated version of its list of essential medicine and diagnostics. The first WHO essential Medicines List, published in 1977, was a needed revolution in healthcare as it helped establish that medicines fulfilling unmet needs are essential yet remain inaccessible to too many. Since then, the list has been updated every […]

UnitedHealth Prefers Oncology Biosimilars Over Roche’s Herceptin, Avastin

Effective Oct. 1, 2019, UnitedHealthcare will be adding utilization criteria for Avastin and Herceptin for members under commercial and community health plans. United is adding a requirement that patients use the biosimilars Kanjinti and Mvasi prior to using the original cancer drugs. Mvasi (bevacizumab-awwb) is the first FDA-approved biosimilar to Avastin (bevacizumab) for the treatment of […]

Limited distribution drugs 101

What are limited distribution drugs? “Limited distribution drug” status is generally assigned to specialty medications with complex regimens to manage. These drugs are expensive, accounting for around 45 percent of the pharmacy drug spend per Express Scripts’ 2018 drug trend report, and require special handling, administration, or monitoring. The therapy areas with the highest number […]

States Continue to Explore a Public-Option Plan to Offer Affordable Healthcare

In May 2019, Washington became the first state to pass legislation to create a public option health plan. Other states are following a similar path, but are at different stages of the process. Several other states are planning to expand coverage options, reduce costs, and increase access to affordable healthcare options.   What is a […]

A Look at PBM Drug Spending: Trend Fueled by Specialty Drug Growth

Annual trend reports from the national pharmacy benefit managers can yield a wealth of knowledge and insights. Several key trends emerged through analysis of the 2018 drug trend reports from CVS Caremark, Express Scripts, Prime Therapeutics, and MedImpact. Analysis can be found in the chart below, or downloaded here. IngenioRx* and OptumRx** reports are not […]

Evolution of Health Technology Assessment (HTA) in China

Asian pharma markets have been in the limelight for some time now for increasingly dynamic drug policies, expanding coverage, increasing affordability and potential economies of scale. While Indonesia and the Philippines are striving towards universal healthcare coverage, South Korea and Taiwan are focusing on managed entry agreements. China is not behind in the race with […]

Moving Forward From Medicare Part D Rebate Reform

Moving Forward From Medicare Part D Rebate Reform: Pricing Transparency and What it Means for Patients, Providers, and Life Sciences Companies Last week’s announcement from the Trump administration that it was abandoning its Medicare Part D and Medicaid rebate reform efforts was a surprise but the debate over point-of-sale (POS) discounting and drug pricing transparency […]