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Managed Markets Insights

Perspectives on Medical Therapy Access, Reimbursement and Payer Influences

Asthma Patients Discuss Their New Inhalers With Doctors

Consumer Connect, a new subscription data service from Zitter Health Insights, helps biopharmaceutical companies understand the “whys” behind patient behavior with immediate, point-in-time consumer recall of key healthcare moments. Most recently, the team collected data on doctor visit experiences for asthma patients. Of the …

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Branded Agents Enter Generic Categories while Generics Enter the Specialty Space – How Do Payers Manage?

The anticipated entry of branded injectable cholesterol agents in a hyperlipidemia category predominantly occupied by generic agents is expected to issue a speedy wave of access injunctions. Concurrently, the expected arrival of generic multiple sclerosis agents in a category predominated by branded offerings is …

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Payers Hope for Price Relief on the High Cost of Specialty Medication

The FDA recently posted a non-binding draft guidance Biosimilar approval pathway designed to provide guidance on how much data manufacturers would need to submit for approval. According to FierceBiotech the four categories are1: Highly similar with fingerprint-like similarity, Highly similar, Similar, and Not similar. In …

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Prostate Cancer Leads in Clinical Pathway Adoption and Preferential Treatment

Over the past few years, payers have taken an increasingly aggressive approach in managing oncology care and controlling costs. To aid their goals, payers have implemented a number of utilization management tools, including clinical treatment pathways. These treatment algorithms, aiming to promote standardized, evidence …

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Understanding the United Healthcare Group Co-pay Offset Program Exclusions

As of Jan 1, 2014, United Healthcare Group (UHC) has directed designated specialty pharmacies in the company’s commercial insurance network to exclude the use of copay coupons for drugs in a range of categories.  All told, this exclusion includes more than 30 products across …

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