Market Access

Intermountain Plays Pivotal Role in Optum-DaVita Deal

In a big healthcare merger or acquisition, sometimes the divestitures required for regulatory muster tell a more interesting story. In OptumHealth’s purchase of DaVita Medical Group’s practices, Intermountain Healthcare taking on DaVita’s Nevada operations might be the most curious piece. The deal impacts DaVita’s large medical groups in California, Colorado, Florida, Nevada, New Mexico, and […]

HealthHUBs: CVS-Aetna’s Expansion Into Primary-Care a Major Disruptor

HealthHUBs: CVS-Aetna’s Expansion Into Primary-Care a Major Disruptor   Shortly after CVS Health merged with Aetna in November 2018, CVS Health announced the debut of its “HealthHUB” concept stores in Houston. These stores, which feature up to 80 percent of the primary-care scope (barring physicians) plus expanded staff and durable medical equipment, position CVS to […]

Will Netflix-Style Payment Models be the New Norm For High Cost Drugs?

With specialty drug prices increasing each day, states are challenged to manage costs while patients face cost barriers to drug access, which negatively impacts adherence and cure rates. Hepatitis C, for example, is a costly disease impacting tens of thousands of people in the United States, which has historically struggled with a track record of […]

The Changing Specialty Drug Reimbursement Landscape

Advancements in medicine have led to the development of new specialty drugs treating a greater number of rare conditions. In the early 1990s, specialty drugs were limited to a small number of populations, with only 30 drugs available in the market. Presently, more than 400 specialty drugs are available and the developing drug pipelines indicate […]

Building A Market Access Advantage During Early Stage Development

How can pharma companies build market access advantage during early stage development? The market access environment in the US has become tougher than ever for innovative pharma companies with payers and policy makers increasingly scrutinizing the drug prices and demanding cost-effectiveness data to justify the heavy price tags. Therefore, it is of vital importance for […]

Growing Patient Involvement in Health Technology Assessment (HTA)

Health technology assessment (HTA) agencies such as National Institute for Health and Care Excellence (NICE – UK), Scottish Medicines Consortium (SMC – Scotland), Pharmaceutical Benefits Advisory Committee (PBAC – Australia) and Pan-Canadian Oncology Drug Review (pCODR – Canada) have been at the forefront of incorporating user input and feedback in drug reviews. Patient and caregiver […]

Cystic fibrosis: Market shake-up to come?

This article, a Cortellis Market Insight report, is adapted from the author’s comprehensive Cystic Fibrosis Disease Report. Publication of the report coincides with Cystic Fibrosis Awareness Month in May in the U.S. and Canada, which aims to raise awareness and improve understanding of the disease. Cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies have transformed […]

In China 4+7 equals quality generic medicines at affordable costs

China is overhauling its healthcare system to align with the changing economic and demographic situation China’s healthcare system is undergoing a series of major reforms to the regulatory and reimbursement policies. These reforms are aimed at closing the demand gap for novel and cost-effective therapies, particularly those generally developed and available in the western countries […]

Virginia and West Virginia Ban Copay Accumulators. What’s Next?

In March 2019, Virginia and West Virginia became the first states in the nation to ban copay accumulators—an increasingly common benefit adjustment that prevents manufacturer drug coupons from paying-down patient deductibles and out-of-pocket maximums. Many employers and managed care organizations adopted these programs for the 2019 benefit year, and more are expected to follow in […]

Will Specialty Drug Exclusions by PBM Giants Bring Down Drug Spending for 2019?

Formulary drug exclusion is a well-known utilization tool used by the largest pharmacy benefit managers to control rising drug costs. Besides providing payers and PBMs greater negotiating power with drug manufacturers, formulary exclusion can impact sales revenue of key brands and could force patients to switch their prescription drugs. PBMs Express Scripts and CVS Caremark […]