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
Editor’s Note: One of the silver linings of the COVID-19 pandemic is that it accelerated the digital transformation of the United States healthcare ecosystem. Essentially overnight, the healthcare system flipped from a model that relied nearly exclusively on in-person care delivery to a blended care model mixing in-person and virtual. Key healthcare stakeholders (HCPs, patients, caregivers), accustomed to seamless digital experiences in other industries, were eager to adopt more widely accessible digital health technologies during the pandemic and continue to demand new ways of managing their health
Editor’s Note: In the era of specialty launches and increased payer utilization management requirements, life sciences brands need to be strategic to overcome prior authorization hurdles if they wish to unlock patient access to drive brand growth. Commercial leaders understand that utilization management requirements like PAs can be disruptive in the prescription access journey - often resulting in prescription abandonment and misaligned incentives that can impact brand growth. Despite this reality, most brands have been unsuccessful in creating actionable, real-time feedback loops on the prior authorization process that allows them to respond to the dynamic challenges facing their brands
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
Editor’s Note: In today’s tough macroeconomic and regulatory environment, there is no question that the pharmaceutical industry faces headwinds. Biotech companies in particular that face many of the same market challenges as more established players yet are still relying on investor capital to fund their operations are in a particularly precarious position. While being conservative with finances is prudent in a sluggish economy, it’s not a strategy that positions life sciences organizations for long term, sustained growth
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