Drug Price Negotiation, Prior Authorization, Payer Survey
Valuate Health Consultancy
Combining real world experience with advanced analytics and insights to improve market access for all.
What Do Payers Think About Market Access?
In the newest episode of The IDI podcast, Tony Gibson breaks down results of Valuate’s Second Annual Market Access Survey.
One surprise from the survey: “Customers appear incredibly receptive to manufacturing engagement regarding competitive benchmarking,” Gibson says. “That can come in many forms depending upon customer areas of interest and the manufacturer’s competitive areas of expertise.”
Listen to the episode on:
Contact Tony or Dina Steinfurth if you would like a customized readout and breakdown of the survey.
CMS to Make Initial Drug Price Offers
Centers for Medicare & Medicaid Services?is scheduled to make its initial maximum fair price offers to participating?pharmaceutical?manufacturers on February 1, kicking off the?drug pricing?negotiation period.
Reuters is reporting that five Wall Street analysts and two investors the negotiations will range in price cuts “from the statutory minimum of 25% to 60%.”?
PBMs Split Into Two Camps
A coalition of small PBMs is distancing itself from the big three industry players and supporting efforts in Congress to reform the industry.
Launched last September,?Transparency-Rx?counts seven smaller PBMs in its group: Affirmed-Rx, Liviniti, MedOne Pharmacy Benefit Solutions Rx, Navitus Health Solutions, RxPreferred Benefits, Pharmacy Benefit Dimensions, and Smith Rx, Formulary Watch reports.
Unlike CVS Caremark, Express Scripts, and OptumRx, which control 80 percent of the PBM market, Transparency-Rx is lobbying for more reform, including:
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Meanwhile, the largest PBM lobbying group, the Pharmaceutical Care Management Association (PCMA), nearly doubled its spending last year, rising from $8.7 million in 2022 to $15 million in 2023, per Reuters.?
Prior Authorization Update
Although CMS published its final rule updating prior authorization requirements last week, John Hennessy points out that the PA final rule does not apply to Part B or D.
So, should pharma manufacturers ignore the rule?
No, Hennessy says, and here’s why: “While the CMS rule regarding prior authorization excluded drugs, the agency received feedback from the healthcare community in favor of including drugs,” he says. “We can expect the agency to take that under advisement; we could see amendments to the rule going forward.”
Read our POV to learn how pharma and market access?can improve prior authorization:
You can also listen (and watch)?John Hennessy?discuss industry consolidation and the future of cancer care at home via?Clinical Pathways Congress + Cancer Care Business Exchange.
More Market Access Insights
Our colleagues at?Entrée Health and Archbow Consulting always have smart observations about market access. Here is their latest thinking:
Experts from Entrée Health worked with?PharmaLive and Med Ad News to combine their real-world experience with insights from across the industry to help?market access?marketers identify 10 trends that will effectively drive utilization and inspire coverage in 2024.?
Is a direct-to-patient access model viable for your product? In the wake of Eli Lilly’s recently launched LillyDirect, a website offering access to telehealth consultations and direct home delivery of certain drugs to treat diabetes, weight loss, and migraine, Archbow Consulting has a thought-invoking post considering whether a direct-to-patient program works for every product.
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