MMIT (Managed Markets Insight & Technology)

For almost 20 years, MMIT has dedicated itself to addressing the “what and why” of medication coverage. It has established itself as a reliable partner for pharmaceutical companies, payers, and healthcare providers in the marketplace.

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Even at 10% Discount, Eylea Biosimilar Pavblu Offers Lower-Cost Option

Dec 5, 2024 | mmitnetwork.com | Angela Maas

Although the FDA has approved five biosimilars of Regeneron Pharmaceuticals, Inc.’s best-selling Eylea (aflibercept), patent infringement lawsuits by the drugmaker have kept those competitors off the U.S. market — until now. Following a successful defense of its Pavblu (aflibercept-ayyh), Amgen Inc. recently launched the drug at risk. The agent is entering an increasingly crowded therapeutic class, but it’s one that’s also costly for payers, which may be seeking some savings, say industry experts.
Warranties Can Help Mitigate Risk for Payers, Manufacturers Alike

Dec 5, 2024 | mmitnetwork.com | Angela Maas

As manufacturers continue to bring more advanced therapies onto the U.S. market, payers are grappling with how to afford these agents. And while the products may be life-changing for some patients, they may not have the desired outcome in others, leaving payers on the hook for an unsuccessful treatment. This has resulted in various contracting opportunities, including warranties.
Study Makes Case for Rethinking Medicare Drug Price Negotiation Timeline

Dec 5, 2024 | mmitnetwork.com | Jinghong Chen

Small-molecule drugs and biologics may produce similar health benefits, but because small molecules tend to be priced lower than biologics, they often represent better value, according to a recent Health Affairs study. And the study authors argued those findings suggest it could be worth revising how the Medicare Drug Price Negotiation Program is set up.
‘Buckle Up’: Second Trump Administration May Be ‘Mixed Bag’ for Health Care, Biotech

Nov 21, 2024 | mmitnetwork.com | Angela Maas

The second administration of Donald Trump may well run the gamut as far as its impact on health care and pharma. Biotech companies may benefit from a good business environment, prompting more mergers and acquisitions, but they may also experience challenges in working with what could be somewhat unconventional leaders of federal agencies, such as Robert F. Kennedy Jr., whom President-elect Trump tapped on Nov. 14 to run HHS.
First Dual Inhibitor of Its Kind Is Expected to Have Some Impact in Psoriatic Arthritis

Nov 21, 2024 | mmitnetwork.com | Angela Maas

A recently approved treatment for psoriatic arthritis (PsA) brings a new mechanism of action to the therapeutic class. And while payers and rheumatologists varied in their expectations of what the drug’s impact on coverage of and prescribing for the class will be, almost half said they expect it to have at least some effect, according to a survey by Zitter Insights. On Sept.
From Lame Duck to GOP Trifecta, Path for PBM Reform Remains Fuzzy

Nov 21, 2024 | mmitnetwork.com | Leslie Small

With Donald Trump set to be the 47th president and Republicans in control of both chambers of Congress, 2025 is shaping up to be a year in which the GOP has enough political might to pass PBM reform — if it has the political will. Yet two pharmaceutical industry trade groups do not appear to be counting on Republicans’ ability to quickly prioritize a health care issue.
Part D Redesign, MFPs, Plan Changes Will Impact Contracting Strategies

Nov 7, 2024 | mmitnetwork.com | Angela Maas

While changes to the Medicare Part D benefit resulting from the Inflation Reduction Act (IRA) are already underway, Part D plans and manufacturers still face a good deal of uncertainty as to how the Medicare landscape is going to shake out. Changes to Medicare Part D plans in 2025 will almost certainly impact a large swath of beneficiaries, as well as manufacturers’ contracting strategies for 2026, said industry experts at a recent webinar hosted by Avalere.
Medicare’s Protected Class Policy Hinders Rebate Negotiation, Study Finds

Nov 7, 2024 | mmitnetwork.com | Tim Casey

A Medicare Part D policy forbidding plan sponsors’ formularies from excluding nearly all drugs in six “protected” classes hinders payers’ ability to negotiate prices and may lead to significantly higher costs to the health care system, according to a recent analysis published in Health Affairs. The study’s lead author notes this is the first peer-reviewed trial suggesting Part D plans “can’t negotiate as high of rebates as they might otherwise be able to” for drugs in the protected classes.
The ACA Marketplaces in 2025, at a Glance

Nov 7, 2024 | mmitnetwork.com | Jinghong Chen

HealthCare.gov enrollees have more health plan options in 2025 compared to previous years, yet the average benchmark plan premium in states that use the federal enrollment platform increased modestly, according to CMS. In most states, the open enrollment period for Affordable Care Act marketplace coverage runs from Nov. 1, 2024, to Jan. 15, 2025.
Flexible CAR-T Monitoring Period Could Help With Post-Treatment Barriers

Oct 17, 2024 | mmitnetwork.com | Angela Maas

In the seven years since the approval of the first chimeric antigen receptor T-cell (CAR-T) therapy, the agents have proved to be effective in the treatment of non-Hodgkin lymphoma. But the one-time-use agents come with risks, including the potentially fatal cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), so the FDA requires patients remain near their treatment center for four weeks after administration, which can be onerous for patients.