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The Active Ingredient features expert insights and commentary from leaders of ZS Associates' global pharmaceuticals practice.

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How to Survive in Pharma's Payer-Empowered World

Posted by Ed Schoonveld on Fri, Feb 15, 2019

This blog post was originally published on ZS's pricing and access blog, The Price of Global Health.

Until recently, commercial success for a prescription drug mainly involved getting the drug on payer formulary and creating pull-through with sales force efforts toward physicians. Success was defined as securing full, unrestricted access and building significant share through share of voice. The rapidly rising cost of healthcare, new emerging pharmaceutical technologies with breakthrough potential, public concerns over drug pricing, and a gradual shift from fee-for-service to value-based payment models are transforming the pharmaceutical market. Today’s market is much more complicated, as public and private payer management is more restrictive, medical communities are more willing to engage in value vs. cost trade-offs, and providers are taking a more holistic and integrated healthcare delivery focus.

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Topics: healthcare ecosystem, payers, value-based payments, pharma manufacturer, pharma landscape, pharma commercial model, patient value, pharma decision-making, access journey

Even in a Favorable Regulatory Environment, Will Biosimilars Gain Traction in the US This Year?

Posted by Pratap Khedkar on Fri, Jan 25, 2019

Christina Corridon co-wrote this blog post with Pratap Khedkar.

Despite 16 approvals in the last four years, just six biosimilars currently are being marketed stateside. The U.S. biosimilars market hasn’t progressed as anticipated, yet some experts are wondering whether the biologic follow-ons can redeem themselves with a breakout year in 2019.

The U.S. biosimilars market has a tough road ahead. The WAC list price differential between biosimilars and the originator drugs is hovering around 30%, on average, which likely isn’t speeding biosimilars’ adoption in the U.S. Rather than playing the long game and waiting for the U.S. landscape to become more attractive, some biosimilar manufacturers like Momenta are choosing to exit the market. And others like Pfizer have shuttered their preclinical biosimilar programs to focus their efforts elsewhere. On the flip side, the Trump administration has zeroed in on drug pricing and biosimilars as priorities—and, of course, the two are intertwined.

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Topics: Pratap Khedkar, Patients, payers, Christina Corridon, FDA, providers, european market, Biosimilars Action Plan, pharma drug pricing, U.S. market

The Humira Question: Will the Adalimumab Biosimilars Live Up to the Hype?

Posted by Prateek Yadav on Fri, Dec 07, 2018

Prateek Yadav co-wrote this blog post with Christina Corridon, Tucker Herbert, Didier Chicheportiche and Gustavo Poblete.

The biosimilars market in Europe continues to generate buzz as it captures considerable market share from major blockbuster-branded biologics. Most recently, Celltrion's Truxima, a biosimilar of Roche's MabThera (rituximab), captured 32% market share in 18 European countries. Regulatory agencies have also welcomed biosimilars for the promise of the potential cost savings that they bring. Earlier, the U.K.’s National Health Service reported that switching patients from branded drugs to biosimilars and generics led to a savings of £324 million last year.

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Topics: Pharma, Biosimilars, Competition, payers, biosimilar launch, healthcare marketplace, pharma landscape, humira, physicians, adalimumab

Five Steps to Address the Pain Points of Co-Pay Accumulator Programs

Posted by Howard Deutsch on Wed, Jan 31, 2018

In the cat-and-mouse co-pay card game, payers have made their next move. Pharmacy benefit managers have been promoting “co-pay accumulator” programs to plan sponsors as a way to reduce specialty drug spending. Left alone, these programs will result in confused patients who are less likely to adhere to their medications, and high costs for pharmaceutical manufacturers. Pharma companies need to respond.

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Topics: pharmaceutical industry, Pharma, healthcare, payers, manufacturers, PBMs, pricing, patient centricity, co-pay accumulator programs, health insurance, pharmacy benefit managers, co-pay cards, deductible

Two Blocked Payer Mega-Mergers and the Future of the Health Insurance Market

Posted by Paul Darling on Mon, Feb 27, 2017

Just weeks ago, a looming merger between two major health insurance companies threatened to alter the health insurance market’s competitive landscape. The $54 billion deal between Anthem and Cigna was blocked by a federal judge in early February, on the same grounds as a $37 billion deal between Aetna and Humana that was blocked in January. According to the judges’ rulings, both deals would have reduced competition and increased prices.

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Topics: health insurers, Pharma, Life Sciences, Humana, healthcare ecosystem, Paul Darling, payers, Anthem, Aetna, Cigna, mega-mergers, UnitedHealth Group

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