Market Access

Medicare Advantage leader eyes 50 percent penetration — but when?

Evaluating UnitedHealth’s Managed Medicare Prediction Among the key takeaways from UnitedHealth Group’s first quarter earnings call was a prediction that the market penetration of managed Medicare plans will reach 50 percent, up from roughly one-third today. This is at least the second time in the past year that a UnitedHealth official has staked that claim, […]

With Cigna–Express Scripts, last PBM domino falls

The last pharmacy benefit management giant waiting for a potential suitor is off the board now that Cigna and Express Scripts plan a $67 billion merger. For Express Scripts, the last of the large independent PBMs, a merger with Cigna makes sense. Express Scripts was in a bind. After an ugly divorce, Express Scripts lost […]

CAR T-cell gene therapies enter the U.S. market

Ground-breaking anti-cancer immunotherapy Novartis and the University of Pennsylvania’s anti-cancer chimeric antigen receptor (CAR) T-cell therapy Kymriah has become the first ever gene-modified therapy approved in the U.S. The therapy takes the patient’s own T cells, engineers them to express a receptor that binds to the B-cell blood cancer marker CD19, and then re-infuses them […]

Direct-to-consumer: New avenue for PBMs could provide political shelter

Departing from their traditional role working for payers as third-party administrators of prescription drug coverage, two of the largest pharmacy benefit managers are taking a direct-to-consumer approach through drug discount programs.   The discount cards (also known as consumer cards, point-of-sales cards, or 100 percent copay cards) bypass the payers that PBMs typically serve, disrupting […]

Outcomes-Based Contracting Gain Steam

Amgen’s recent offer to refund to health plans the cost of its statin add-on therapy Repatha for eligible patients who take it and then suffer a heart attack or stroke highlights the extent pharmaceutical companies are willing to go to overcome insurance access barriers to expensive, groundbreaking therapies. The refund offer was announced along with […]