Featured Insights
May 20, 2022
It’s Time to Put Innovative Contracts Under Warranty
Jane Barlow and Susan Raiola discuss the mechanism and benefits of warranties in the realm of value-based contracts.
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April 20, 2022
The Medicare copay problem ain’t going away. Here’s how we can do better by patients.
A new study in Health Affairs has been blowing up my feed since it was published last week and underscores how important it is to help Medicare Part D patients with patient out-of-pocket expenses.
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April 15, 2022
On rare drugs, is ICER at least partly right?
Thanks to a whole set of powerful incentives, starting with the Orphan Drug Act, biotech’s pipeline is full of drugs for rare diseases. This phenomenon hasn’t gone unnoticed by insurers, who are complaining ever more loudly about the costs and the relatively, but understandably, skimpy evidence for approval.
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April 3, 2022
Paying for Gene/Cell Therapies is Only Half the Problem
The cost of personalized cell and gene therapies — particularly if the expected flood arrives — is certainly troubling for payers. And we have seen suggested various, and so-far imperfect, solutions to the upfront affordability problem. But even if the therapies are covered and paid for, the likelihood is that they will not be used as often as they should. And if used, they will not be as successful as their trials promise.
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March 9, 2022
Insights from PCMA: top market access signals
The Pharmaceutical Care Management Association Business Forum, held annually at the end of February, is an opportunity to get a read on the year’s key drug reimbursement and coverage trends. Here are the top three signals the Real Endpoints team took away from the event.
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February 4, 2022
A Solution to the Medicare Copay Problem
Jeff Berkowitz describes problems with Medicare copays that reduce adherence and persistence among seniors. He then describes RE Assist, Real Endpoints’ tech-enabled solution with key information on foundations for more than 30 diseases.
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December 20, 2021
Until the Evidence is There: A Conversation with Michael Sherman, Point32Health
Real Viewpoints sat down with Dr. Michael Sherman, the pioneering chief medical officer at Point32Health, who shared his perspectives on coverage issues, rare/orphan diseases, and the special challenge of value-based agreements
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December 20, 2021
Commercializing Rare-Disease Therapies Is Getting Tougher
For an industry increasingly dominated by these drugs, commercial programs may need to take on the risk once reserved for development
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August 17, 2021
What is the value of managing drug trend across both the pharmacy and medical benefit?
As a PBM, IngenioRx highlights their approach and the value of integrated management in their 2020 Trend Report and Specialty Supplement.
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August 12, 2021
ESI National Preferred Formulary Exclusion Changes
Impossible to exclude life-saving orphan drugs from formularies? Not anymore. ESI says “no” to Pfizer’s and Takeda’s Gaucher disease agents in favor of Sanofi-Genzyme’s.
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June 22, 2021
Dodging the Sword: The Cost-Saving Opportunity in Biologicals
The pharmaceutical industry faces a large and ugly problem: the growing economic burden on their payer customers of specialty drugs. As always with tangled problems, there is an increasingly popular Gordian Knot solution: slicing it through with the governmental sword of price controls.
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June 30, 2020
Value & Outcomes Spotlight
Opportunity Offered by a Good Crisis: COVID-19 IMPACT ON INNOVATIVE PRICING MODELS
An interview with Roger Longman, Cofounder and Chairman of Real Endpoints LLC in which he discusses innovative and value-based contracting models currently in use and reflects on the downstream effects of innovative pricing on patients and their out-of-pocket costs.
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April 20, 2020
Pink Sheet
Drug Coverage in the Pandemic: US Payers Shift Focus From Costs To Access, For Now
US payers are concentrating on ensuring access to health care during the COVID-19 pandemic, which has led them to relax, postpone or waive some formulary and coverage policies to avoid disruptions in patient access to prescription drugs.
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November 14, 2019
In Vivo
Market Access 2020: Understanding US Payer Expectations
Consolidation on the payer side is changing the dynamics of success in health care. Principals at Real Endpoints LLC examine
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June 11, 2019
Elsevier
Are Payers Ready, Willing, and Able to Provide Access to New Durable Gene Therapies?
Access to new gene therapies may be impacted by payer ability to absorb the cost of coverage. Payers are open to innovative financing models that improve financial predictability and reward clinical performance.
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March 1, 2019
In Vivo
Paying for Pharmaceutical Value: The Problem of a One-Size-Fits-All Definition
Combining a set of tailored, regularly updated value assessments with risk-sharing contracts allows us to deal with evidentiary uncertainty by
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February 13, 2019
AJMC
Examining New Payment Ideas for Curative Therapies
How can the health industry ensure that cutting-edge gene therapies and other curative treatments get to the patients that need them, without leaving payers financially exposed? Jane F. Barlow, MD, MPH, MBA, was a speaker at the FoCUS (Financing and Reimbursement of Cure in US) Project at MIT, during the session "Putting Theory into Practice" she was quoted saying the “accessibility issue lies largely with payers.” All payers are different, and “a lot has to do with how they manage risk in their population as well as the regulatory constraints."
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January 28, 2019
STAT
AstraZeneca strikes a ‘novel’ deal with Medicare plan to lower patient out-of-pocket costs
In a novel bid to lower medicine costs, a drug maker has agreed to adjust the discounts that a Medicare Part D plan will receive for a treatment based on how patients respond — and the deal automatically lowers out-of-pocket costs for patients, as well. “One of the major problems we have in getting drug therapy used by people who really need it is that, for those people who are on Medicare, who have to pay co-insurance or copays, there is no really good way for manufacturers to provide copay assistance, because they are not allowed to do so,” said Roger Longman.
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November 18, 2018
STAT
What rebates? Express Scripts touts a new plan to appease critics of the opaque drug-pricing system
Amid national angst over prescription drug pricing, Express Scripts is touting a new scheme it says will lessen the behind-the-scenes role that rebates play in rising costs. In effect, Express Scripts would create a two-tier system for its customers which could choose between a formulary with a high list price and high rebate, or the newer plan that will offer a lower list price and lower or no rebate.
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