A Payer’s Perspective on Prior Authorization

What message is your prescription drug delivering?Before manufacturers debut a new prescription drug they need to create a strategy to optimize coverage and commercialization. But part of that strategy consists of crafting a message that resonates with patients, providers and payers. And that’s where a lot of manufacturers get tripped up. Alex Mindlin of Valuate Health joins The IDI to explain how she validates manufacturers’ value messaging by combining strategic content and market research -- what she calls “creative market research.”Follow Alex on LinkedIn.Follow Valuate Health on LinkedIn or on the web.

Many pharmaceutical companies say attacking health inequities is a strategic objective, but addressing the topic is hard to do. Why is this so? This episode's guest, Elisa Remoundos,  Senior Vice President and Group Creative Director for Entrée Health, believes that for pharma and market access to tackle health inequities they need to rethink the social determinants of health that can have a huge impact on adherence, compliance, health outcomes, and societal burdens.Elisa also wrote about SDoH and market acccess here. Follow Elisa on LinkedIn. Follow Valuate on LinkedIn or learn more here.

What do payers think about prior authorization? Dr. Andrew Hertler is Chief Medical Officer at Evolent Health. He recently co-authored an op-ed about prior authorization, touching on gold-carding, a controversial solution to addressing prior authorization challenges. Joining Hertler is regular guest John Hennessy, a Principal with Valuate. Topics include:Why exceptions can sometimes be problematic.What happens after a prior authorization is rejected.Pathways: Who makes the decisions? How are they updated?How should pharma  think about payers?What can manufacturers and market access do to help pathways?Follow Andrew on  LinkedIn. Follow Valuate on LinkedInLearn more about Valuate.

It’s no secret that pharmaceutical manufacturers and payers don’t always see eye to eye.But in order for pharma market access to do its job it needs to better understand payers -- how  they think, what keeps them up at night, and what’s trending.That’s why Valuate conducted its Second Annual Market Access survey late last year. The goal was to better understand payer perspectives on everything from the Inflation Reduction Act to biosimilars to gold bagging. Tony Gibson, a Principal with Valuate Health, returns to The IDI to break down the results. You can also contact Tony if you want an exclusive readout of the survey.Follow Tony on  LinkedIn. Follow Valuate on LinkedInLearn more about Valuate.

So you’ve developed a great new specialty drug but will patients and providers utilize your therapy correctly? A great hub can  help but implementing one is no easy task. Justine Hughes, a vice president with Archbow Consulting, joins The IDI to explain where pharma and biotech hubs stumble -- and how they can succeed. Follow Justine Hughes on LinkedIn. Follow Valuate on LinkedIn. Learn more about Valuate.

The new year will be critical for pharma and market access. The industry will need to turn its attention back to the Inflation Reduction Act as the first 10 drugs are up for negotiation with the feds. Plus, there's the small matter of electing a new President. Al Jackson joins the IDI to help break down what it all means and where all this activity in Washington is headed. An attorney by training, Al was most recently EVP and head of health and public affairs at Ketchum.Follow Al Jackson on LinkedIn. Follow Valuate on LinkedIn. Learn more about Valuate. 

Getting a cancer diagnosis and navigating treatment can be a lonely experience, as guest Cora Meese shares on this episode of The IDI. Thanks to early detection, Cora is now a breast cancer survivor, but she didn’t get there on her own. With the help of friends and family, including podcast guest John Hennessey, Cora was able to successfully navigate her oncology journey, and connect with groups like the Young Survival Coalition. As we recognize Breast Cancer Awareness Month, listen to Cora share her personal journey and reflect on how her insider knowledge as a cancer patient has impacted her work in market access.  Cora Meese, MBA, is Executive Vice President, Director of Client Services, for Entree Health. John Hennessy is a principal with Valuate Health and Vice President of the Board of Directors of the Young Survival Coalition. Follow Valuate on LinkedIn. 

It’s hard to think of an aspect of health care more vexing than prior authorizations. In fact, prior authorizations are so frustrating that Congress is looking into a legislative solution. This episode of The IDI we have two guests to explain the state of prior authorization and how to improve the process. John Hennessy is a principal with Valuate Health with a background in oncology and cancer care.Syam Palakurthy is co-founder and CEO of SamaCare, a company that streamlines the prior authorization process for medical benefit drugs. Follow Valuate on LinkedIn. 

Pharma and biotech have developed amazing therapies and treatments to help people living with cancer. But effective cancer care should be more than just chemo and an effective drug. Exercise and wellness can help. A lot.What role should pharmaceutical manufacturers and market access teams play in exercise and wellness for cancer patients though? Do they incorporate exercise? Isn’t their cancer-fighting drug enough? Today’s guests believe pharma and market access should factor in exercise and wellness when treating cancer. And they’ll explain how pharma and market access can take all this into consideration.John Hennessy is a principal with Valuate Health. He’s been on The IDI many times and he’s held many roles in the world of oncology and cancer care.First-time IDI guest Sami Mansfield is the founder of Cancer Wellness for Life, an organization focused on developing oncology exercise resources for individuals, hospitals, and corporations. She’s been in this space for more than 20 years and was one of the first oncology exercise specialists in the United States.Here are just a few research findings about the benefits of wellness and exercise on cancer care patients, including two articles co-authored by Sami Mansfield. Follow Valuate on LinkedIn or visit us at ValuateHealth.com. 

Your new drug has made it to the insurers’ formulary, but will providers actually prescribe it? Pull-through challenges abound; getting physicians to prescribe your drug means training and coordinating field staff. Encouraging pharmacies to stock and recommend your drug. Educating patients. And more. Lastly, there’s the challenge of measuring success – what does successful pull-through look like anyway?Jack Timko, Senior Principal, Valuate Health, returns to The IDI to offer his insights. Follow Jack on LinkedIn.Follow Valuate on LinkedIn or visit us at ValuateHealth.com.