Since early childhood we have been programmed to seek recognition for good work, innovative thinking or succeeding where others have failed. As we matured, the form of recognition changed from a gold star to trophies, degrees, promotions and bonuses, but the pursuit continued.
MMIT's content offers payer, provider and pharma perspectives on emerging healthcare trends, from P&T to point of care. We leverage insights from clients, influencers and internal experts to analyze each topic or therapeutic area through our blog. Enter your email on the right to receive notifications when we post each week.
These days, government and healthcare go hand-in-hand. Although pharmaceutical executives battle against increasing regulation on Capitol Hill and providers change procedures to cope with new coding mandates ofICD-10, governmental oversight is a necessary evil within the pharma, provider and payer industries.
The introduction of health exchanges, as a result of the Affordable Care Act, bred a new ecosystem for U.S. health plans. Initial guidelines required payers and PBMs to shift their business models to remain competitive within their businesses. With new mandates on the horizon, health plan stakeholders scramble to invest in resources to prepare for tighter deadlines and many pharmaceutical manufacturers still lack a consistent measure of how their products will be covered under these new plans. Though regulators attempt to standardize the exchanges, the process is long and arduous, with so many changes creating more complexity elsewhere in the marketplace.
From P&T to point of care, many industry experts debate the future direction of managed care. Managed care plans focus on reducing cost while improving the quality of care for patients. However, it seems that many recent strategies focus on either one side of the equation or the other. As 2016 moves forward, pharmaceutical manufacturers and payers invest in optimizing their managed care strategy and driving value for their networks.
The following infographics highlight specific therapeutic area where pharmacy benefit or medical benefit coverage is restricted. These graphs portray restricted market access, in the form of prior authorizations, step therapies or not-covered statuses, based on U.S. payer-controlled lives:
PCSK9 Inhibitors: For the newly launched cholesterol treatments, Medicare Part D formularies are particularly restrictive, with a lack of payer coverage for many U.S. lives.Click on the image to view more.