When the Trump administration dropped the drug rebate rule it introduced back in January – a rule that intended to prohibit pharmacy benefit managers (PBMs) from pocketing some of the rebates they should be passing along to patients – the decision sent shockwaves through the healthcare industry, particularly the pharma…
With spiraling cost inflation and outcomes that lag many other developed economies, the US government’s healthcare insurance authority (CMS), is driving reform aimed at better quality and lower cost, and private payers are following suit. Both state and private payers are moving toward alternative payment models, like value-based payments, that…
With spiraling cost inflation and lagging quality indicators driving a transition to a value-based system, public and private payers are using sophisticated tools, including health technology assessment (HTA), to evaluate the benefits of the products they buy. In this environment, companies must demonstrate both clinical efficacy and differentiated economic value…
The issue of drug pricing has become a staple of the news cycle, with fresh headlines every few weeks spotlighting either the high cost of new breakthrough drugs, or jaw-dropping price hikes for established products. While these examples represent two very different sets of issues, in the minds of consumers,…
Provider-owned health plans are commanding a larger share of the strategic dialogue in hospital boardrooms. POHPs aren’t a new phenomenon. Emerging from a history of mixed success in the 1980s and ’90s, they have gained popularity as the industry moves from volume- to value-based payment and as risk shifts from…
For quite some time, providers, public and private payers, policy-makers, pharmacy benefit managers and patients have hoped the arrival of biosimilars would usher in a new era of competitive drug prices. However, as the U.S. market prepares to welcome its second biosimilar, Celltrion’s Inflectra, the future of biosimilars in this…
