Market Access

2022 Research Agendas

Commercial Benefit Dynamics

Commercial Benefit Dynamics provides insights on the evolution of benefit designs in the commercial health plan channel, supporting timely, effective responses to emerging access opportunities and risks for brands.

  • Payer Pharmacy Strategies

    Available April 2022

    • Assessment of benefit design trends, including formulary tiering, cost sharing, deductibles, and premiums​
    • Evaluation of use of enhanced and restrictive formularies
    • Utilization management tool use​ tracking
  • Payer Medical Benefit Strategies

    Available July 2022

    • Evaluation of medical benefit management and tactics​
    • Assessment of specialty pharmacy use, buy-and-bill approval rates, preferred distribution channels, and site-of-care selection​
  • Patient Affordability and Assistance

    Available September 2022

    • Analysis of regulation/management of patient assistance and accumulator/maximizer programs
    • Evaluation of copay assistance use​
    • Predictions for accumulator/maximizer shifts
  • Biosimilar Management Forecast

    Available November 2022

    • Assessment of payer management of reference brands as biosimilars emerge
    • Evaluation of pricing biosimilars relative to brands
  • Market Alerts

    Ongoing Updates

    Timely analysis of payer responses to significant market events, including: 

    • FDA approvals or rejections of new products
    • Market entry of branded or generic drugs
    • Expansion of treatment guidelines or recommendations
    • Release of high-profile head-to-head trial data

Government Benefits Dynamics

Government Benefit Dynamics provides insights on potential changes in government benefits over the next two years, assisting companies in anticipating emerging access opportunities and risks.

  • Medicare Part B Payer Strategies

    Available April 2022

    • Assessment of Part B market shifts
    • Tracking of Part B benefit design​ and cost sharing
    • Evaluation of proposed policy changes​ in Part B
    • Predictions of impact of Part B regulations on stakeholders
  • Medicare Part D Payer Strategies

    Month of Release TBD

    • Forecasting of trends in Part D benefit design and cost sharing
    • Comparison of Medicare Advantage prescription drug (MA-PD) and Prescription Drug Plan (PDP) business models
    • Predictions of policy changes in Part D
    • Evaluation of impact of Part D regulations on stakeholders
  • State Control Impact

    Available September 2022

    • Assessment of state pharmacy control activities
    • Evaluation of impact of state actions on access
  • Medicaid and Underinsured Trends

    Available November 2022

    • Assessment of recent Medicaid rule changes that affect access ​
    • Review of state utilization of 1115 waivers​​
    • Predictions of exchange marketplace shifts
  • Market Alerts

    Ongoing Updates

    Timely analysis of payer reactions to significant recent events, including: 

    • Congressional activity relating to government programs
    • CMS policy releases
    • Medicare/Medicaid/exchange plan business activities

Additional Market Insights Research Topics


 

Commercial-Focused Research Topics

(Release Dates TBD)

  • Quality Performance and Priorities
    • Identification of payer and IDN quality improvement priorities
    • Assessment of payer performance on quality metrics
    • Tracking of best pharma quality programs and relationships
  • Advanced Payment Model Evolution
    • Assessment of payer efforts in establishing innovative payment models (e.g., ACO, PCMH)
    • Evaluation of impact of APMs on stakeholders
  • Value-Based Contracting Trends
    • Assessment of the prevalence of value-based contracts, along with level of payer success in these agreements
    • Identification of therapeutic areas most often gaining inclusion in value-based contracts
    • Evaluation of barriers to successful participation in value-based contracts
  • Employer Benefit Priorities
    • Assessment of employer needs and trends in benefit design
    • Tracking of employer priorities in commercial benefits

Government-Focused Research Topics

(Release Dates TBD)

  • CMS Innovation and APM Assessment
    • Assessment of CMMI demonstration model impact
    • Measurement of success of advanced payment models in government business
  • Quality Performance and Priorities
    • Assessment of payer performance on Medicare star, Medicaid HEDIS, HIX, and ACO quality metrics
    • Identification of quality programs government payers are pursuing
  • Senior Behavior Impact
    • Assessment of senior level of satisfaction with Medicare components
    • Predictions of senior benefit utilization as benefits evolve
  • 340B Dynamics
    • Assessment of impact of 340B policy changes on access
    • Analysis of IDN dynamics as 340B rules evolve

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