Phil Blog

Why Strong Market Access Doesn’t Always Translate to Covered Dispenses

Strong market access, the ability of a pharmaceutical manufacturer to secure reimbursement and coverage for their products from payers and other decision-makers, does not always translate to covered dispenses at the pharmacy level – particularly for specialty and specialty-lite therapies. Manufacturers must also navigate a complex prescription fulfillment and payer utilization management landscape to overcome barriers to patient access. Here are the three biggest reasons why good market access does not guarantee coverage and what commercialization teams can do to overcome this challenge

Prior Authorization Reform: CMS rule aimed at improving Medicare Advantage draws praise

Editor’s Note: While there is a patient-centric intent to many prior authorization (PA) practices, they often create a significant operational burden for healthcare providers and disrupt the patient experience. Today, most branded medications witness low HCP PA submission rates which in turn result in high rates of prescription abandonment and manufacturer patient assistance overutilization. Both have negative consequences for pharmaceutical brands that are most commonly felt in the form of reduced brand loyalty and gross to net (GTN)

Drug Pricing - 2023 Likely To Be a Crucial Year for Pharma — and Insurers

Editor’s Note: Even casual observers of drug pricing reform would be apt to conclude that change is in the air and more disruptions to standard drug pricing practices are inevitable. As price takers, drug manufacturers are keenly aware that in today’s complex drug channel, even small policy changes can generate ripple effects that impact all stakeholders. With the Inflation Reduction Act of 2022 representing the most significant federal drug pricing legislation in decades and various other measures in play, manufacturers can be sure that tomorrow won’t look like today when it comes to drug pricing policies

For ALS patients, doctors, a new medicine reignites concerns about healthcare access

Editor’s Note: Innovative therapies that promise to improve the quality of life and/or slow disease state progression for individuals with complex health conditions like ALS remain out of reach for many due to the cost of therapy. While many point the finger at pharmaceutical companies for setting list prices that by all appearances are astronomically high, the cost to bring an innovative therapy to market has never been higher and is complicated even further when the target patient population is small. The bottom line is that all stakeholders can agree that financial barriers shouldn’t prevent patients that can significantly benefit from a life altering therapy from accessing it

Pharma companies boost drug prices to start year, but hikes lag inflation and don’t tell the full story

Editor's Note: With the increasing prevalence of expensive, branded specialty medications for complex health conditions, drug pricing remains a hot issue in the healthcare industry. Industry stakeholders and the public at large continue to point their fingers at drug manufacturers for the practice reported ON in this article - inflating list prices year over year. What they fail to consider is that drug manufacturers lack substantial pricing power in the drug channel with middlemen extracting more significant concessions year over year that erode manufacturer net revenue

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