Putting Together the Perfect Market Access Strategy with Insights

ANSWER
Provider organizations that have a high level of control or responsibility for the cost of care are likely to exert more influence over the pull-through of contracts with payers for formulary placement. It is important to understand when payer contracts may be more challenging to pull through because of powerful IDNs within a payer’s network.

RESOURCES

• Product: Healthbase
• Product: Market Overviews

ANSWER
MCOs are joining with PBMs and physician organizations. Examples include CVS/Aetna, UnitedHealth/OptumRX/DaVita, and Cigna/Express Scripts.  Achieving greater scale and cutting out middlemen should allow companies like CVS Health to cut medication costs in the short term, as they’ll enjoy greater leverage over the drug and device companies across the table and can realize efficiencies when they control the point of care, the means of distribution and the purse strings.

RESOURCES

• Product: Health Plan Analysis

ANSWER
It is important to engage with risk-bearing providers – and the payers with whom they contract – regarding the value of drug therapies and the evidence for the effectiveness of those drugs. As the healthcare industry moves away from the fee-for-service model, it is critical to understand how payers and providers approach cost and quality.

RESOURCES

• Product: ACO PowerProfiles