Getting an innovative prescription drug approved for patient use is a significant milestone – however, it's only the beginning and certainly does not ensure the brand's commercial success. Considering it typically takes ten years and over $2.6 billion for a life sciences manufacturer to move a drug from its initial discovery into the marketplace, commercialization teams must employ effective launch strategies that differentiate their brand to get it into the hands of patients. Launching into a category with generic alternatives presents a unique challenge because payers often limit patients' access to the new entrant through utilization management tools that favor the lower-cost generics
The prior authorization process (PA) presents a significant (and growing) roadblock for healthcare providers trying to get a patient started on a prescription therapy they deem best. In general, a PA requirement affects patients' experience with their healthcare. It represents a length of time – and the associated frustration – they must wait to receive their medication or go without the treatment they have been introduced to by their provider and may desperately need
The use of prior authorization (PA) to control the utilization of prescription drugs, especially specialty medications, is growing, with 79% of medical practices reporting that PA requirements increased between 2021 and 2022. By design, the PA process is a barrier to medication access – it can leave patients waiting for days, weeks, or even months for approval, and coverage denial may occur despite a therapy being appropriately prescribed. The negative consequences of delaying treatment are well documented, yet more than 8 out of 10 patients still experience delays accessing their medications for reasons such as cost and insurance challenges
As healthcare costs have escalated over the last several decades, public and private medical insurers have introduced different utilization management (UM) strategies to control healthcare expenditures. The proliferation of higher-cost specialty medications has accelerated the use of drug UM tools to control access, with prior authorization (PA) being the most common today. From the payer's perspective, PAs are necessary to improve quality of care and protect patients’ safety
A persistent challenge for life sciences manufacturers is growing access and affordability obstacles, exacerbated by hard-to-enter formularies and rigorous utilization management (UM) practices. Payers are tightening the screws year over year with new cost containment strategies. Where there used to be hoops, they are now on fire, making it more difficult than ever to ensure reimbursement at the pharmacy
Our consultants will work with you to analyze your current channel strategy and make recommendations for how to improve patient access and increase the percentage of scripts getting covered by insurance.