Specialty Pharmacy Market Overview – Market Shakeout Continuing into 2018

Specialty Pharmacy Market Overview – Market Shakeout Continuing into 2018 As the specialty drug spend grows, specialty pharmacies are playing an increasingly larger role in access and delivery of medications and services. The specialty pharmacy market, while dominated by a few large companies, has an increasing number of participants. AMI’s annual report, Specialty Pharmacy Market […]

PBM P&T Practices The HEAT Initiative Is Gaining Momentum

PBM P&T Practices The HEAT Initiative Is Gaining Momentum. Care outside the hospital, like P&T committee responsibilities outside the hospital, is necessarily different. New processes and solutions, such as cloud computing, can help improve performance and transparency of benefit management for purchasers or users of health care services. The current role of PBMs includes concurrent improvement […]

Value-Based Contracting in Commercial Insurance

Value-Based Contracting in Commercial Insurance. Risk-sharing agreements, also referred to outcomes-based or value-based contracting, are an underutilized but slowly growing type of payment model that brings together health care payers and pharmaceutical manufacturers to provide drugs to patients. Under risk-sharing agreements, pharmaceutical manufacturers and payers engage in an agreement that attaches financial and clinical outcomes directly to […]

Provider Owned Commercial Health Plans

Provider Owned Commercial Health Plans. Provider-sponsored plans make up 15% or more of the health insurance market, and this percentage is growing, according to many of the projections by industry observers. Until recently, commercial health insurance products have, with only a few exceptions, been offered by health insurance companies. Now, health systems are increasingly assuming financial risk […]

Pharmacy Benefit Manager Market Continues to Evolve

Pharmacy Benefit Manager Market Continues to Evolve. Recent consolidation in the pharmacy benefit manager (PBM) industry has resulted in major market share divided by the three market leaders: Express Scripts, CVS Health (Caremark), and OptumRx (UnitedHealth Group). PBMs remain searching for a value proposition beyond drug distribution with their employer clients. As long as PBMs […]

Metro Areas Where Employers Influence Cancer Coverage Costs

Metro Areas Where Employers Influence Cancer Coverage Costs. Employers currently represent approximately 60% of the commercial insurance market dollars. The Employer commercial insurance market consists of more than 95,000 companies with self-insured plans, eighty percent of whom have less than 2,000 employees. Entering 2017, these employers face double-digit increases in the cost of prescription drugs […]

Outcome-Based Contracting Acceptance Grows in Market

Specialty Pharma Services

Outcome-Based Contracting Acceptance Grows in market with the concept of taking on financial risk on complex contracts as a result of market pressure combined with more familiarity. Outcome-based contracts between pharma companies and health insurers are becoming increasingly popular. In 2016, Novartis, Amgen, and Sanofi publicized risk-sharing, value-based, outcomes-based, or pay-for-performance deals, all of which vary […]

Health System Consolidation and Impact on Providing Care, Products or Services

Health System Consolidation and Impact on Providing Care, Products or Services: Consolidation among hospitals and health systems has been increasing for some time and is now quite broad in many markets. This activity comes from mergers and acquisitions, along with a major driver of larger organizations gaining market share from smaller competitors. The degree of […]