Express Scripts was the last large independent pharmacy benefits manager, or PBM, in the US. A PBM acts as a middleman in negotiations between drugmakers and the payers (i.e. employers, insurers, and government), which buy medicines in the US. With its $67 billion takeover of Express Scripts, health insurer Cigna is sending a signal that it will have to get bigger to deal with the most pressing malady of US healthcare: soaring costs. By buying Express Scripts, Cigna hopes to gain more scale so it can drive a harder bargain when buying drugs and services, not just from pharmaceutical companies, but also the doctors and hospitals that provide patient care.
read full article ›A first-of-its kind value deal between Illumina Inc. and Harvard Pilgrim Health Care Inc. is intended to generate data to support broad reimbursement by multiple payers for non-invasive prenatal tests made by multiple testing companies.
read full article ›Biopharma is not moving as quickly in 2018 as its counterparts in adjacent industry segments, and is confronting a strategic dilemma on how to address the prospect of a much more powerful set of rivals in the ongoing battle to own the patient experience in medicine.
read full article ›Labeling for reduction of cardiovascular risk may help a bit with payers, but the "twin problem" of pricing and lack of patient adherence is likely to continue to present hurdles for reimbursement.
read full article ›In the past, organizations working in different pockets of the health sector made decisions according to their own business priorities. But as pharmaceutical and life sciences pipelines rebound, consumer choice and provider cost-savings incentives are driving change in the industry’s commercial model. As US specialty drug spending hits an all-time high, purchasers, prescribers and patients are considering price as a key component of a drug’s expected health benefit.
read full article ›Two of the biggest pharmaceutical companies in the world did something unusual this week when they announced the introduction of breakthrough drugs: they charged less.
read full article ›Payers will be buying the way other industrial buyers do -- they'll comparison shop. It's crucial that biopharma provide them the appropriate measurement tools. If they don't, buyers will settle on the easiest point of comparison: price.
read full article ›It’s the Planck constant of the pharmaceutical industry: if you’re going to build a commercially successful drug, it needs to
read full article ›Paying a lot of money to get your drug to market first is, in most cases, going to be worth a lot less in a payer-engaged future than it was in the physician-dominated past.
read full article ›Transparent comparative evaluations are necessary for determining the relative value of drugs. But, in part because of resistance from drug companies and payers, stakeholders are finding other tools to help identify the appropriate choices.
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