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Managed Markets Insights

Perspectives on Medical Therapy Access, Reimbursement and Payer Influences

Co-pay Offset Programs: Separating Fact from Fiction

Are all co-pay offset programs directed at shifting market share to higher cost drugs?  Do they have any impact on patient access or adherence? Co-pay offset programs – manufacturer-sponsored discounts that reduce patient cost sharing – have become a dominant marketing tool available to …

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Mixed Response to Avastin’s Indication Removal for Breast Cancer

The removal of Avastin’s FDA approved indication as a first-line breast cancer treatment brings mixed reactions by payers and oncologists almost one year after the revocation. Both NCCN and CMS have stated that they will support Avastin’s use as a first-line breast cancer treatment, …

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New Control Techniques on the Horizon for Payer Oncology Management

Despite a consensus increase in management aggressiveness over the past two years, payers have not seen a corresponding rise in effectiveness, opening the door for new control techniques in the future management of oncology. Payer-reported levels of oncology management aggressiveness have increased substantially over …

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Cost-Sharing and PA Rates Differ between Medical and Pharmacy Benefit

Despite a plurality of payers reporting a disparity in cost-sharing levels and prior authorization rates for agents covered on the medical versus the pharmacy benefit, there is little attempt to reconcile the issue. Payers report that both prior authorization rates and cost-sharing amounts tend …

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Cost Concerns Continue to Dominate Benefit Design

To combat rising costs, payers look to increase utilization management and raise member premiums. Employers shy away from restricting utilization, but are on board with shifting cost-share to employees. Both payers and employers report that total medical and pharmacy costs, as well as disease …

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