Spotlight on Market Access
-
GOP Lawmakers Cry Foul at Part D Stabilization Demo
With the Medicare Part D national average monthly bid amount (NAMBA) set to spike 180% next year, CMS late last month unveiled a new demonstration program aimed at stabilizing a market that is experiencing unprecedented volatility.
However, some Republicans in Congress are up in arms over the demonstration, arguing that it contains “extra-statutory, eleventh-hour policy changes” aimed at cleaning up a problem created by the Biden administration’s most-touted health policy achievement.
-
Pharma Can Take Variety of Approaches to Enhance IDN Partnerships
Integrated delivery networks (IDNs) are becoming an increasingly larger stakeholder within the U.S. health care system. As of January 2024, almost 80% of physicians were employees of hospitals/health systems and other corporate entities such as private-equity firms, according to an April report prepared by Avalere Health and commissioned by the Physicians Advocacy Institute. Pharma manufacturers can take steps to enhance their partnerships with these entities, said industry experts at a recent webinar.
The Aug. 8 webinar was sponsored by Eversana, an independent provider of services to the life sciences industry, and presented by print and digital content provider Pharmaceutical Executive, an MJH Life Sciences brand.
-
Study Offers Clues About Biosimilar Uptake Drivers, Barriers
With policymakers and industry stakeholders increasingly focused on the cost savings opportunities tied to biosimilars, a new Health Affairs study sheds light on some of the factors that influence uptake of these near-copies of pricey biologic medications.
Among almost 200,000 commercial and Medicare Advantage enrollees who newly initiated one of seven biologic drugs with available biosimilar versions — filgrastim, bevacizumab, epoetin alfa, trastuzumab, pegfilgrastim, infliximab and rituximab — the share of people initiating a biosimilar increased from 1% in 2013 to 34% in 2022. Patients who were younger than 18 years were less likely to initiate a biosimilar than other age groups. Meanwhile, enrollees in commercial high-deductible health plans were more likely to use a biosimilar, compared with those in MA plans.
-
KFF: Medicare Advantage Boasts the Highest Gross Margins in Health Care
Of all privately insured markets, Medicare Advantage had the highest gross margins per member in 2023, reaching $1,982, according to a new analysis from KFF on insurers’ financial performance. Margins have been consistently higher in MA than other sectors over the past decade. KFF pointed out that while gross margins are generally one good indicator of financial performance, they do not necessarily mean higher profitability, as gross margins do not account for any administrative costs or tax liabilities. Researchers analyzed data compiled by Mark Farrah Associates based on information provided by insurers to the National Association of Insurance Commissioners.
-
MMIT Payer Portrait: UPMC Health Plan
UPMC Health Plan is the health insurance unit wholly owned by the University of Pittsburgh Medical Center. UPMC operates a large health system of 40 hospitals throughout Pennsylvania and Appalachian regions of New York and Maryland, as well as several international locations. Its health plans serve members across the spectrum of insurance products, including Pennsylvania’s managed Medicaid program and the Affordable Care Act exchanges. It is currently the third-largest insurer in its home state and the fourth-largest integrated insurer in the U.S. UPMC also operates a Program of All-Inclusive Care for the Elderly, Community LIFE, and is a joint owner of Maryland Physicians Care, a provider-sponsored managed Medicaid plan.
The Latest
Complimentary Publications
Premium Categories
Premium Categories
Meet Our Reporters
Meet Our Reporters