MMIT (Managed Markets Insight & Technology)’s Post

Payers are worried about the financial and clinical impact of alternative funding programs. MMIT’s Steve Callahan and Carly Nicholas explain their concerns, from regulatory non-compliance to patient eligibility delays to an overall lack of sustainability. Click here to read the deep dive: https://ow.ly/juMM50QI3kf. #AlternativeFundingPrograms #AFPs #Pharmacy #Payers

Payers are worried about the financial and clinical impact of alternative funding programs. MMIT’s Stephen Callahan and Carly Nicholas explain their concerns, from regulatory non-compliance to patient eligibility delays to an overall lack of sustainability. Click here to read the deep dive: https://ow.ly/FY0r50QI3h2. #AlternativeFundingPrograms #AFPs #Pharmacy #Payers

80% of payers anticipate significant challenges when adopting alternative funding programs, especially regarding long-term planning and regulatory compliance. Read our blog for the latest research: https://ow.ly/rZNY50QI3sL. #AlternativeFundingPrograms #AFPs #Pharmacy #Payers

80% of payers anticipate significant challenges when adopting alternative funding programs, especially regarding long-term planning and regulatory compliance. Read our blog for the latest research: https://ow.ly/70ki50QI3wP. #AlternativeFundingPrograms #AFPs #Pharmacy #Payers

As the battle rages on between legislators in power (collectively the government) and the pharmacy benefits industry ---providers (pharmacies, medical) and patients are caught in the cross fire. Has the vertical consolidation made the largest institutions too big too fail and too big to regulate? Will things have to get worse for anything to significantly change? How much more money will be wasted in the Medical-Industrial complex without improving access, affordability, and quality of care?

Has your organization began looking at the 2024 PUF files to see how Part D sponsors have begun positioning themselves for IRA changes? The changes in the standalone PDP market are insightful. Check out this paper where our Oliver Wyman Medicare team has looked at this in detail. #medicareadvantage #medicare #OWActuarial #inflationreductionact

One of the many objectives of the Inflation Reduction Act is to lower prescription drug costs and increase access to life-saving medications. But defining access continues to be a challenge. In preparation for drug negotiations with Medicare, today Centers for Medicare & Medicaid Services held the first of many listening sessions with patients and patient advocates. The goal being to provide patients with a venue for Medicare to understand patient's daily life dealing with their conditions and their thoughts on the value of therapeutic alternatives. I had the opportunity to listen to today’s opening session with CMS for apixaban/Eliquis, one of the ten drugs selected for negotiation for 2026. Unsurprisingly, one of the key themes from today’s speakers were their issues and concerns over continued access to their medications and the healthcare system in general. Concerns over formulary management becoming more demanding, confusion on financial assistance, issues with preferred pharmacy networks, worries over access in rural communities, and issues with basic enrollment in health plans. I commend the CMS for this first of many sessions to better define the situation at hand. However, we must recognize that these listening sessions are only continuing to bring to light the challenges that patients have accessing healthcare. #marketaccess #patientaccess #inflationreductionact #medicare #formulary

The industry is still a few years away from knowing the full impact that the Inflation Reduction Act will have on drug prices. But some critical provisions have already impacted drug plan sponsors for 2024. Our team has identified five areas that Medicare Advantage plans should consider when shaping their 2025 Part D strategy > https://owy.mn/47fU7EF #OWActuarial #Medicare #MedicareAdvantage

The largest PBMs -- UnitedHealth’s Optum Rx (owned by UnitedHealth Group), CVS Caremark (who owns Aetna) and Express Scripts (owned by Cigna) --process 80% of prescription claims. "Many PBMs, including the three largest, also own a mail-order pharmacy. In those cases, the PBM effectively sells a drug to itself. They can make a larger spread by marking up how much the health plan pays to the PBM." "PBMs also set how much a health plan pays for a medicine, and how much they reimburse a pharmacy for filling the prescription." How is this legal? Listen to this week's podcast with Alerie Stiles to discover more about PBMs. https://lnkd.in/eEhpVpDq Next week, Madelaine Feldman, M.D. sheds more light into this nefarious business practice. Subscribe to WORKING HEALTHCARE - don't miss an episode. #pbm #pharmacybenefitmanager #Optum OptumOPTUMRX PHARMACY, INC. UHC UnitedHealth Group UnitedHealthcare Express Scripts by Evernorth CVS Pharmacy House Rx Coalition of State Rheumatology Organizations (CSRO) American College of Rheumatology National Infusion Center Association (NICA) National Organization of Rheumatology Management-NORM https://lnkd.in/e2gbVdMv

Last week, Centers for Medicare & Medicaid Services unveiled the list of drugs that will be subject to Medicare drug pricing negotiation in 2026 and, unsurprisingly, many have voiced their thoughts and opinions. At The Evidence Base®, we have summarized some of the views from various stakeholders and experts in the field. A must read. #inflationreductionact #medicare #realworlddata #rwd #realworldevidence #rwe #hta