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HealthPlanView Perspectives

What does an ACA repeal mean for Pharma?

The loss of coverage for ~30 million Americans is just the tip of the iceberg. Many believe that a repeal of the ACA is just weeks away. But the overall impact of the law’s demise has ever greater far-reaching consequences than the loss of coverage and elimination of protections for pre-existing conditions cited in the mainstream media. In particular, there are some changes that will impact the pharmaceutical industry in drastically different ways: Repeal of Medicaid Best Price increase The... Read More

How much access and coverage do health plans actually deliver?

One of the reasons that we built HealthPlanView was to redefine how account management and senior Market Access executives assess the value of the access and coverage that health plans are delivering. Most pharmaceutical manufacturers have a singular focus on Rx volume, delivered with little consideration of how that volume is derived. Rebates seldom consider the nuances of benefit designs and how patients seldom pay the copays that manufacturers contract for because of deductibles. The first... Read More

Do manufacturers pay for access or overpay for distribution?

The evolution of risk-shifting between payers, patients, and manufacturers is not completely accounted for in the structuring of rebate contracts. Much of the focus of these negotiations center around relative copay differentials and utilization management restrictions. Often ignored is the fact that, for many drugs, patients seldom pay the negotiated copay amounts. The rise of medical and pharmacy deductibles that total thousands of dollars negate these negotiated copays. These deductibles... Read More