NAVLIN Insights Team
NAVLIN Insights gives you an advanced set of capabilities, frameworks, and methods. These are all derived from a robust stakeholder panel, providing critical answers to your specific payer marketing and market access questions.
NAVLIN Insights gives you an advanced set of capabilities, frameworks, and methods. These are all derived from a robust stakeholder panel, providing critical answers to your specific payer marketing and market access questions.
Articles by NAVLIN Insights Team
Delivering Value to Leading Payers
Assessment of Strategic Priorities, Competitive Dynamics, and Innovations Impacting Biopharma Access Seven leading payers represent nearly half of all US medical lives and 54% of pharmacy lives: UnitedHealth Group CVS Health, Cigna Elevance Health Kaiser Permanente Humana Centene As these organizations evolve their business models and ultimately their approaches to care and drug management, biopharma companies may need to shift key strategies for optimal brand access. Payers prioritize internal and external investments that advance their capabilities, contain costs, and differentiate from competitors across five broad strategic goals: value-based care advancement, consumer experience simplification, traditional care model disruption, horizontal membership growth, and vertical diversification (see Figure A). Figure A: Leading Payer […]
Informing Optimal Pricing Strategies with a Comprehensive Modeling Approach
Strategically pricing new therapies has always been vitally important for pharmaceutical manufacturers. After the 2022 passing of the historic legislative package, known as the Inflation Reduction Act (IRA), strategic pricing strategies have become especially pivotal. The IRA gives manufacturers less flexibility to adjust their pricing strategies due to penalties that are now applied for price increases above a certain threshold. Setting the right price at launch is critical now more than ever for commercial success. The pricing of a product has many repercussions that can severely boost or hinder success both for the manufacturer and the patients it’s intended to help. Pricing not only directly impacts market access and patient […]
The Influx of Generic Launches Leaves Narrow Opportunities for Multiple Sclerosis Access
Since the launch of Sandoz’s Glatopa in June 2015, generic options have slowly entered the multiple sclerosis market, providing some cost relief to payers in this high-cost market. Generic entrants, along with rising costs and a perceived lack of differentiation among brands on key clinical outcomes, solidify multiple sclerosis as one of the most extensively managed markets by commercial plans. Both long-tenured and newer brands are faced with stricter monitoring of utilization and greater scrutiny in access decisions. Our budgets are tighter than ever and we’re trying to really reduce costs. MS is an area of high drug spend, one of the top drug spend categories. Now that we have […]
Case Study: Primary Research Meets Data-Driven Sources and Technology to Form Powerful Market Access Solutions
The case for primary market research, Real-World Data (RWD), and deep healthcare experience combined to deliver targeted market access strategies. As diseases become more complex and market access becomes more restrictive, with multiple sources of market research and data analytic solutions available, pharmaceutical executives are often overwhelmed with various sources of information. Leaders must learn how to integrate these sources and translate this information into actionable insights that they can apply to their business decisions and strategies. In our latest case study, see how EVERSANA leveraged deep healthcare expertise, capabilities, and services, enabled by a rich collection of data sources, then married it with leading primary market research frameworks and […]
European Commission’s Long-awaited Pharma Legislation Review Gets Mixed Reception
NAVLIN Brief The European Commission has finally released its proposal to revise the European Union’s pharmaceutical legislation. The document includes proposals for a new Directive and a new Regulation, which revise and replace the existing pharmaceutical legislation via the largest reform in over 20 years The Commission proposes new incentives for AMR-related products, greater transparency around public funding of products, shortening the period of regulatory protection from 10 years to eight, and speeding up regulatory processes by shortening the EMA’s assessment time from 210 days to 180 days Despite industry generally welcoming the overall objectives of the revision, both EUCOPE and EFPIA have concerns that the legislation review will pose […]
Left-Right-Left: The Latest in Pharma-Payer Ping Pong
Biopharmaceutical companies have offered financial assistance for commercially covered patients’ out-of-pocket (OOP) cost sharing for 20+ years. However, in the ongoing evolution of controlling versus encouraging patient access to specific drugs, payers and biopharma also have a long history of one-upmanship. Are pharma motivations for offering copay assistance centered on the patient, their own bottom line, or some mix of both? And regardless of intent, should payers let affected members’ deductibles or even maximum OOP costs reach their thresholds through external dollars? In this latest NAVLIN Insights article, learn more about how each are trying to balance patient access with financial demands – and what to expect in the future. Complete […]
Your Guide to Developing a Best-in-Class Specialty Pharmacy Network Strategy
Why Develop a Specialty Pharmacy Network Strategy? Specialty pharmaceuticals often require high-touch, labor-intensive services to expedite patient access and improve therapy adherence. Additionally, patients requiring specialty therapies are often medically complex and challenging to manage. These factors highlight the need to identify SP network partners with the proper expertise to achieve optimal product distribution and patient access, making biopharma relationships with specialty pharmacies (SPs) more essential than ever. Planning and constructing a specialty pharmacy network is no small feat. Biopharma companies must consider all nuances of each of their specialty agents when making distribution strategy decisions. These decisions exist on multiple levels: product distribution across available channels, competitive differentiation for […]
Peeking Behind the PBM-lead GPO Curtain
‘PBM-lead GPO,’ a Newly Created Term to Describe Large Scale PBM-Owned Rebate Aggregators PBM-led group purchasing organizations (GPOs) are not true group purchasing organizations in scope, nor are they pure rebate aggregators. Rather, PBM-lead GPOs are organizations formed by PBMs with one or more members, whose primary purpose is to aggregate purchasing volume to negotiate discounts with biopharmaceutical manufacturers. Forming PBM-lead GPO Entities Increases ‘Big 3’ Market Control While Generating Revenue and Creating Downstream Rebate Ambiguity Leading PBMs began forming GPO-like entities after significant market consolidation and vertical integration in the late 2010s left few remaining M&A targets, and they “saw the writing on the wall” with respect to profit […]
Ready or Not, Biosimilar Adalimumab Brings the Heat in 2023
Anticipated Growth in U.S. Biosimilars Market U.S. payers and other healthcare stakeholders have eagerly awaited the launch of biosimilar alternatives to high-cost originator products as a new cost-control lever. However, much of the U.S. healthcare market has been frustrated by the sluggish incorporation of biosimilars into the marketplace, as compared to the notably smoother process taking place in European and overseas markets as early as 2006. Adalimumab Primed for Impact Recent federal legislation has accelerated biosimilar development and market entry, creating more opportunity for payers to significantly lower their drug spend and for patients to lower their out-of-pocket costs. Pairing this development with the timing of legal settlements for top-selling […]
Case Study: Benchmarking Pathway-Specific Engagement with Health Plans & Organized Providers to Identify Best Practices
Tapping into primary market research and subject matter expertise can help uncover opportunities to more effectively meet their needs and position your brand for inclusion within their pathways. As stakeholders seek to leverage oncology clinical pathways as a way to maximize patient outcomes and decrease costs, biopharmaceutical companies with pipeline and branded oncology drugs must ensure timely, effective engagement strategies with key customers to optimize brand inclusion within pathways. In our latest case study, the NAVLIN Insights team shares the challenges one client faced in collecting feedback from customers influential in the implementation and administration of pathways. See how EVERSANA can help you forge strategic partnerships that optimize your […]
Payer Oncology Access Management in 2022
Payers balance the severity of disease with the need to control high-dollar utilization. As pharmacy spend continues to rise, payers are seeking ways to manage costs in the highest cost therapeutic areas, including oncology. While there is appetite to manage access for both oral and office-administered oncology agents, payers struggle with which tactics to implement without sacrificing patient outcomes. Pharmaceutical companies should expect to see changes in payer management for oncology over the next 2-3 years. In a recent article, the NAVLIN Insights team outlines payer access management in oncology today and takes a closer look at how access will evolve in the coming years, including the impact of the Inflation Reduction Act and which brands may […]
Developing Best-in-class Copay Programs for Gross-to-Net
Importance of Copay Assistance Programs A copay assistance program is an invaluable strategic cost-saving tool that biopharmaceutical companies integrate into their patient services offering. These programs are used to support a brand’s value proposition, while offsetting high-priced branded drugs, all of which can be the ultimate differentiator for a biopharmaceutical company. Copay programs are designed to reduce patients’ out-of-pocket (OOP) costs to compete with generic alternatives. These programs have many benefits for patients and health care providers. However, if not properly managed, they can become cost prohibitive. Therefore, it is critical to find the right balance between putting the patient first by designing a best-in-class copay assistance offering and maintaining […]
Five Trends That Will Shape the Current and Future Payer Market Landscape
As leading payers build new business models to ultimately advance their approaches to care and drug management, biopharmaceutical companies need to adjust their account engagement and drug access strategies accordingly. Here are a the top five healthcare trends and payer tactics that our Health Strategies Insights team is watching. 1. Horizontal membership growth for business mix and financial success Attracting employer-sponsored members and re-entering ACA public health insurance exchange marketplace. Capitalizing on attractiveness of Medicare Advantage business. Developing specialization in Medicaid. 2. Vertical diversification to advance control and total patient management Identifying more cross-channel acquisition targets or strategic partnership opportunities, particularly specialty pharmacies, medical groups, and technology companies. Launching innovative […]
COVID-19’s Impact on Brand Access
The current public health pandemic is impacting healthcare stakeholders from doctors and nurses in the frontlines to payers and PBMs. EVERSANA™ is monitoring the constant changes to access and benefit consideration, tracking payer responses, and key trends that may impact your brand access strategy. According to recent research released by Health Strategies Insights by EVERSANA™, patients affected by respiratory diseases and/or patients with compromised immune systems are given priority with less life-threatening chronic conditions, such as autoimmune disease, taking the back seat for now. Download the quick insights below to understand the impact of COVID-19 on brand access tactics and strategies. Discover our Insights! Chat with our Brand Access expert. […]
Brand Access Marketplace Dynamics: Respiratory
This summary provides highlights from robust longitudinal insights reports released throughout the year and available at our INTELLICENTER® portal. The Brand Access Marketplace Dynamics reports identify current and future access landscapes providing insights to support effective identification of opportunities and risks for Respiratory brands. Get answers to key questions such as: What level of influence do payers and organized providers have on access in the asthma and COPD treatments market? How will payer and organized provider management and contracting for branded asthma and COPD drugs evolve over the next two years, and how should companies prepare for these changes? How are payers responding to key events in the respiratory drugs […]
Brand Access Marketplace Dynamics: Multiple Sclerosis
This summary provides highlights from robust longitudinal insights reports released throughout the year and available at our INTELLICENTER® portal. The Brand Access Marketplace Dynamics reports identify current and future access landscapes providing insights to support effective identification of opportunities and risks for Multiple Sclerosis brands. Get answers to key questions such as: What level of influence do payers and organized providers have on access in the multiple sclerosis treatments market? How will payer and organized provider management and contracting for branded multiple sclerosis drugs evolve over the next two years, and how should clients prepare for these changes? How are payers responding to key events in the multiple sclerosis drugs […]
Brand Access Marketplace Dynamics: HIV
This summary provides highlights from robust longitudinal insights reports released throughout the year and available at our INTELLICENTER® portal. The Brand Access Marketplace Dynamics reports identify current and future access landscapes providing insights to support effective identification of opportunities and risks for HIV brands. Get answers to key questions such as: What level of influence do payers and organized providers have on access in the HIV treatments market? How will payer and organized provider management and contracting for branded HIV drugs evolve over the next two years, and how should companies prepare for these changes? How are payers responding to key events in the HIV drugs market, such as new […]
Brand Access Marketplace Dynamics: Autoimmune
This summary provides highlights from robust longitudinal insights reports released throughout the year and available at our INTELLICENTER® portal. The Brand Access Marketplace Dynamics reports identify current and future access landscapes providing insights to support effective identification of opportunities and risks for Autoimmune brands. Get answers to key questions such as: What level of influence do payers and organized providers have on access in the autoimmune treatments market? How will payer and organized provider management and contracting for branded autoimmune drugs evolve over the next two years, and how should companies prepare for these changes? How are payers responding to key events in the autoimmune drugs market, such as new […]
ACCESSEXPRESS® by EVERSANA Payer Coverage and Reimbursement Case Study
ACCESSEXPRESS allows you to have full control of the survey process getting answers to your most pressing business questions within hours. See how our client used our research platform to assess payer coverage and reimbursement for an upcoming indication expansion. Learn more about ACCESSEXPRESS® by EVERSANA! Fill out the form below to download the Case Study.
Oncology Market: Outlook of Brand Access and Insights
The oncology market is constantly changing and EVERSANA continues to assess current and future market trends, payer willingness to pay and the optimal patient support services to ensure you have all the insights you need to answer your most critical business questions. In this summary, our Health Strategies Insights team provides highlights from multiple reports which helps to identify the current and future access landscape for Oncology. Learn more about our Oncology Brand Access and Insights products & capabilities! Download the Summary.
Validate and Inform your Account Access Strategies and Tactics
With $250 million in product revenue, our client is the U.S. subsidiary of a European niche biopharmaceutical company looking to build its presence in the U.S. marketplace in anticipation of future product launches. See how the Health Strategies Insights by EVERSANA Team helped the client put an account strategy in place for each key payer account as quickly as possible. Learn more about our Account Access products & capabilities! Contact us with your questions and global pricing needs, and an expert will follow up shortly.
Autoimmune Patient Services Best Practices
Autoimmune Patient Services Best Practices provides highlights from an annual report, available in conjunction with a live, interactive database, updated quarterly which helps to identify patient services best practices by users (e.g., prescribers, office staff and patients) which gives insights into the most valued and highest rated patient services for brands across the autoimmune market. Learn more about our Patient Services and Hubs products & capabilities! Contact us with your questions and data needs, and an expert will follow up shortly.
Improving the Impact of an Oncology Patient Access Program
Our client, a specialty pharmaceutical company focused on the research and development of new therapies in two high-cost complex drug categories, sought to benchmark its patient assistance program against those of its competitors in order to improve relationships within target oncologists’ offices. The Challenge The client needed to assess the image of its patient assistance program among oncologist, practice manager, and specialty pharmacy partners. Specifically, our client wanted to: Benchmark customer perceptions of its patient assistance program versus those of its competitors, Assess the impact of the program on patients and physicians, Identify unmet needs of patient services program offerings, and Identify opportunities to enhance and improve patient services offerings. […]
U.S. physicians disagree with Germany’s determinations of the value of diabetes medicines
According to a recent study from Health Strategies Insights by EVERSANA, 89% of U.S. physicians disagree with Germany’s determinations of the clinical benefit of innovative diabetes medicines. Learn more about our Market Access products & capabilities! Contact us with your questions and data needs, and an expert will follow up shortly.
What’s next for ICER? Pharmaceutical pricing watchdog to venture beyond the pill.
Earlier in the month, the Institute for Clinical and Economic Review (ICER) issued a call for public input to help identify and prioritize non-drug topics for ICER assessments in 2020. It may seem like the ICER has always been focused on driving down the price of drugs, conducing health technology assessments to properly calculate the true value of drugs that create a burden upon our healthcare system. However, given the organization’s growth and focus on evolving their research, expanding beyond traditional pharmaceutical agents is a logical next step for the organization. Although pharmaceutical agents represent roughly 16.8% of US personal healthcare expenditures1, there is still a lot of so-called “wasteful […]
Developing an Optimal Hub to Ensure Product Access
Prior to launching a new Hub, our client, a global biopharmaceutical company, needed to ensure that the services offered would be superior to those of other companies and ensure their product’s access in an increasingly competitive category. The Challenge Our client’s product was one of only a handful of FDA-approved products in a specific category. In anticipation of additional novel treatments entering the market and increasing competition, our client believed it was critical to work with prescribing physician offices to facilitate and simplify reimbursement as well as distribution through a specialty pharmacy to ensure product access. The client recognized that a productive Hub could offer many useful services to physician […]
Decoding ICER: Successful Pharma Engagement with ICER for U.S. HTA Review
How pharmaceutical and Biotech companies engaged ICER drives the outcome. Reactive responses to ICER review have led to poor outcomes and numerous downstream impacts to payer access and pricing. Cohesive enterprise engagement has demonstrated significantly better recommendations and less pressure for the US payer community. Unfortunately, ‘reactive-response’ is more common than ‘enterprise engagement.’ KEY SUCCESS FACTORS ICER ENGAGEMENT Managing an ICER review is a time critical process with multiple checkpoints and opportunities to engage in the process. The process will define a transparent flow. However, the large number of steps combined with speed or review requires that the manufacturer has plans and all data available long before the review begins… […]
Integrated Delivery Networks: Learning to Engage With a New Customer With Very Different Needs
As the healthcare provider landscape rapidly evolves to deliver on the promises of value-based care and efficiencies of scale, integrated delivery networks (IDNs) have emerged as a dominant force in the US market. Meanwhile, biopharmaceutical manufacturers have struggled to understand the needs of IDNs and how to engage with them in a meaningful way. Leveraging Health Strategies Insights’ proprietary syndicated industry research on IDNs, combined with EVERSANA™ MANAGEMENT CONSULTING real-world experience of helping biopharmaceutical brands better address the needs of this critical customer, this article will examine three key elements: • The rise and evolution of IDNs • The challenges and implications for biopharma manufacturers attempting to meaningfully engage with […]
Global Biosimilar Competitor Assessment – Who Wins in Biosimilar Access and Why?
The introduction of biosimilar products has created interesting changes in payer behavior across the global markets. For both innovator and biosimilar companies, it has been an effort to understand the demands of payers and succeed in what looked like a ‘winner-takes-all’ opportunity. As the first round of biosimilar introductions has passed, there are some interesting findings across the western pharmaceutical markets. Biosimilar Competition Reveals Unique Buyer Types Among European and US Stakeholders EVERSANA identified two unique buyer types when conducting a segmentation analysis based on the reaction of EU and US customers to biosimilar competition and company performance. Economic buyers (e.g., France, Germany, and select payers of the US) treat […]
German and United Kingdom Physicians Express Frustration with Health System Challenges
This brief by Health Strategies Insights summarizes preliminary results compiled from twelve 30-minute, one-on-one, in-depth, telephone interviews with a mix of physician specialists from the United Kingdom (U.K.) and Germany. While the physicians discussed benefits of their respective health care systems, many raised significant challenges and limitations in providing the care they believed would be best for their patients, including long appointment wait times, limited access to innovative medicines, financial constraints and lack of clinical and prescribing flexibility. Perspectives of physicians in the U.K. and Germany are informed by their direct professional experiences, and also by differences in cultural values between these markets and the United States. Read the full […]
Power in numbers: Seven national plans manage almost half of the medical lives in the U.S.
Market Access Macrotrends provides insight for you to stay on top of market access trends, anticipate how the healthcare landscape is evolving, and provide strategic guidance for your organization. Market Access Macrotrends answers your questions about changes in the access environment related to: • Current and emerging U.S. access trends • Response by stakeholders to market access trends • Changes to the access landscape over time Contact us to purchase the full report.
Insurance and Benefit Design
Insurance and Benefits Design provides insight on changes in insurance and benefit design in the next three years so you can anticipate the evolving access opportunities and risks for your company’s brands. Insurance and Benefit Design answers your questions about changes in the access environment related to: • Macrotrends • Benefit design and drug management • Employer coverage decisions • Consumer decisions and out-of-pocket costs You can use Insurance and Benefit Design to: Stay on top of the market trends…anticipate what you need to know Develop strategies for your assigned MBOs related to insurance and benefit design Educate account teams and internal stakeholders about changes that affect access Provide strategic […]
IDN Profiles
IDN Profiles provides insight on the size, structure, and business strategies of the leading IDNs so you can develop business and account plans. IDN Profiles answers your questions so you can develop business and account plans. Who are the leading IDNs? What are the organizational structure, payer mix, and strategic goals of each? How do the leading IDNs compare in terms of level of integration? Pharmaceutical and biotech professionals use IDN Profiles to: Prioritize target accounts Analyze the influence of individual IDNs Contact us to purchase the full report. Download the 2019 Research Agenda
Macro Trends – Delivery Of Care
Delivery of Care provides insight on changes in delivery of care in the next three years so you can anticipate the evolving access opportunities and risks for your company’s brands. Delivery of Care answers your questions about changes in the access environment related to: Site-of-care shifts Transitions of care Technological advances in care delivery Care coordination and population health You can use Delivery of Care to: Stay on top of the market trends…anticipate what you need to know Develop strategies for your assigned MBOs related to delivery of care Educate account teams and internal stakeholders about changes that affect access Provide strategic guidance to marketing teams related to opportunities and risks […]
Breaking Down the U.S. Payer Segment
Market Access Macrotrends provides insight for you to stay on top of market access trends, anticipate how the healthcare landscape is evolving, and provide strategic guidance for your organization. Market Access Macrotrends answers your questions about changes in the access environment related to: • Current and emerging U.S. access trends • Response by stakeholders to market access trends • Changes to the access landscape over time Learn how to set your strategy with macrotrends research from Health Strategies Insights.
How Could Policy Changes to Protected Classes Impact Part D Access and Contracting?
(Content Updated 5/17) CMS Protected Class Rule Finalized, Slightly Loosened for Biopharma Following CMS’ 2018 proposed rule allowing for new protected class exceptions and a comment period for stakeholders through the beginning of this year, CMS has released a final rule addressing the Medicare Part D Protected Classes. The proposed rule allowed plans to restrict their formularies for the six protected classes—anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals (ARVs), and immunosuppressants in several areas. Proposed Rule Final Rule 1. Broader use of prior authorization and step therapy to control utilization Amended to include only new therapy starts and completely excludes ARVs 2. exclusions of new formulations of existing sole-source drugs REMOVED 3. […]
Is your biosimilar product on the payer radar?
Biosimilars have been eagerly awaited in many European countries to realize cost savings from the biologics budget. Gaining insight on how European decision makers are currently prioritizing these biosimilars and how they expect this to shift by 2023 will allow a better understanding of the strategies that may prioritize revenue sources, identifying specific markets and indications, and determining which make/buy decisions would be most profitable. In order to answer this question, we performed a double-blinded survey that included 50 current or recent decision makers/influencers of healthcare policy across the top 5 EU countries. To participate, each respondent was required to hold or have held a position in a national, regional, […]
The Brink of the Biosimilar Revolution
Although biosimilars have not had the immediate uptake in the United States that they have had in Europe, health plans expect these products will become a staple of therapy for some diseases by 2020—if the price is right. Since the first biosimilar was approved in the United States in 2015, brand marketers have been bracing for the impact, given Europe’s fairly broad adoption of these products. But so far, biosimilars have not had a seismic effect on the U.S. market. This has been disappointing for both medical and pharmacy directors in U.S. health plans, who are eager to reap potential cost savings from biosimilars. This white paper examines why the […]