The Parallels Between Access Decision Making and 3D Printing
3D printing, or additive manufacturing, creates three-dimensional objects from digital models by adding material, typically layer by layer. By contrast,
When Health Insurers Can’t Predict the Future
Crystal balls have been associated with fortune telling for several hundred years. Today, actuaries do not use crystal balls to
How Payers Confront Racial and Ethnic Disparities
The Statue of Liberty has welcomed generations of immigrants to the United States — its torch a symbol of enlightenment.
Unmasking Payers’ Not Paying for Face Masks
Superheroes like Batman, Spiderman, Captain America, and Black Panther wear masks, and their brave acts reduce social costs. When these
Payers’ Trust in Blockchain Does Not Buy Payer Cooperation
The official motto of the United States of America can be found on our currency and coins: “In God we
Abortion Services: When States Determine Access to Care
Way back, surveyors chiseled marks in stone structures to serve as a “bench” for a leveling rod, ensuring consistent measurement.
Taking Aim at Payers and Gun Violence Prevention
Everyone negatively impacted by gun violence hopes it is the shot heard around the world. Yet in the United States,
The Bets Payers Make
Perhaps you’ve noticed that a standard deck of playing cards has 52 cards, just as there are 52 weeks in
Payers and Hospitals Always Paint by Number
Paint-by-number kits assign colors to specific areas to reproduce art, including great works like Leonardo da Vinci’s The Last Supper
Payers’ Response to COVID-19
In these dark and uncertain times, we seek light and predictability — even if that means a new normal. The
The Closing of the American Formulary
Someone once said something like, “When one door closes, another opens; but we often look so long and so regretfully
The Brands Payers Love
Do you believe in love at first sight — like the instant head-over-heels connection between Cinderella and Prince Charming in
Busting the Myth That PBMs Are Addicted to Rebates
Sometimes you have to take a step back to see the big picture — the forest for the trees. Sometimes
Unpacking Payers’ Reception of Bundled Contracts
During the holiday season when gifts are often exchanged, one might recall the old proverb: Don’t look a gift horse
How Price Protection Pumps the Brakes on Drug Price Inflation
If you’ve experienced the joy of attending the Macy’s Thanksgiving Day Parade, you know that the balloons are huge. The
Cutting Through Health Economics and Outcomes Research Hacks
Life hacks are those simple, clever methods that boost productivity or efficiency. While the term life hack was coined in
WSJ’s Comparison of Drugs to Soda Falls Flat
Cherry Coke is sweet, but cherry picking a comparator to maximize the contrast effect can leave a sour taste in
Who Owns Population Health – Government, Employers, Payers, or Hospitals?
Population health is on fire and, importantly, makes sense. And though the term is somewhat new (popularized by the Triple
Why a “Favored-nation” Clause Meant to Lower Drug Prices Won’t Work
A level playing field helps to ensure a fair contest between two teams — it wouldn’t be fair if one
When the ACO Fever Breaks
Fads, crazes, hits, and styles come and go. Looking back, the popular diet, toy, song, or haircut now seems silly.
What Payers Can Get Away With
Why pay taxes? Likely to avoid the potential consequences of tax evasion. Why slow down after spotting a police car?
Payers’ Irregular Views on Standard of Care
Imagine a world without standards. There would be disagreements about everything. There would be no shared understanding of time and
Payers’ Exceptions That Prove the Rule
You’re probably familiar with the mnemonic “I before E, except after C” which couples both a spelling rule and an
The Bottom Line on How Payers Prefer Lower Costs
Many policymakers think there is a drug rebate crisis, and consultants who should know better have led them astray by
If ICER leads, will payers follow?
Sherpa guides have led explorers through the Himalayas for many years. In such challenging conditions, an effective guide is knowledgeable,
Hopes and Fears of a Single-Payer’s Monopolistic Powers
Winning a game of Monopoly — assuming players have the stamina to play to the end — depends on some
Fitting Thoughts on Payer–PBM Integrations
Invariably, you’ve questioned the fit of two or more things in countless situations — when working on a puzzle, trying
5 Ways Payers Pay For Innovation
The light bulb has become a symbol of innovation for good reason. Thomas Edison, the inventor and a cofounder of
Discounting Problems with Rebates
Criticism of rebates between sellers and buyers is not new. For example, Standard Oil received rebates from railroads beginning in
Cutting Out Talk of Disintermediating PBMs
There is growing scrutiny about the spend and trend of prescription drugs and the role PBMs play in it. Many
Playing Scrabble as a Metaphor for Selecting Analogs
Life and work are full of decisions — many small decisions and a few big decisions. One of the big
Payers’ Common Problems with Rare Conditions
The near-monopolistic control the De Beers corporation exercises is the primary reason diamonds cost so much. Diamonds are not rare,
Why Payers Absolutely Prefer Absolute Measures of Risk Reduction
Benjamin Franklin said nothing in this world except death and taxes is certain. Of course, there are other some other absolutes,
Time to Revisit Payers’ Views on Long-Term Outcomes
You know the old saying, “An apple a day keeps the doctor away”? Or how about the idiom “An ounce
Three Common Pricing Research Mistakes
The Magilla Gorilla Show’s theme song chanted that “at any price, a gorilla like Magilla is mighty nice.” And MasterCard’s “Priceless” campaign
Why US Payers Often Want to Excise Ex-US Data
The spiritual “Dem Dry Bones” with catchy lines like “Hip bone connected to the back bone” provides an overly simplistic
Formulary Data Are History and May Not Predict the Future
Organizations often make plans for the New Year, and reflections on the past year are typically part of this process.
When Payers Think Value-Added Services Subtract Value
Perhaps you remember the “But wait! There’s more!” line from the Ginsu knife ads. Or maybe you recall anxiously searching
How Payers Value Value-based Contracts
Value-based contracts between payers and manufacturers are in vogue. From the payer’s perspective, paying for performance by getting reimbursed for
When Payers Can’t Afford Manufacturers’ Savings
The Marshmallow Test — giving a young child a choice between eating one marshmallow now or getting two marshmallows if
3 Things (Beyond Products) Health Systems Want From Manufacturers
Manufacturers can bring truly innovative drugs and medtech to market. But to health systems, it’s not just what manufacturers do
Why Payers Love Crowded Markets
Some people dislike or even fear tight spaces, like crowded elevators. But for payers, there are several reasons to love
On Payers’ Views of Off-label Use
Off-label use of drugs and medical devices is legal and very common. Once a manufacturer has demonstrated to the FDA
Putting the Pieces of Formulary Decisions Together
Though all the king’s horses and all the king’s men couldn’t put Humpty Dumpty together again, it’s pretty easy to
Manufacturers’ and Payers’ Fixes that Fail
Manufacturers and payers are guilty of making quick fixes that address a symptom but not the underlying problem. Sure, these
Why Payers Help Successful Brands Succeed
In the dance between manufacturers and payers, brands that initially achieve commercial success often become more successful. There is a
When Payers Shift the Burden of Oncology Market Access Decisions
Cancer drugs: New products and uses and guidelines — oh my! Payers historically have avoided aggressive utilization management of cancer
7 Prior Authorization Myths Smashed
Payers’ use of prior authorization (PA) is often discussed but seldom fully understood. Myths and misconceptions related to PAs abound
Let’s Go Places Payers Want To Go
Here’s a bumper sticker: Honk if you know what your customer really wants. For a manufacturer, successful payer marketing hinges
How Payers Measure Management and Manage Measurement
Measurement is commonly linked with good management. You may be familiar with the old saw in carpentry measure twice, cut
When Payers Think Non-Inferior Products are Superior
Yes, sometimes payers view “non-inferior” products as being superior. Just how they react to new products with evidence of non-inferiority
A Funny Thing Happened on the Way to a Formulary Decision
While P&T committee meetings are typically serious and professional, like all social situations, funny things can happen. Pharmacy and medical
To Kill a Mock P&T/HTA Committee Meeting
A mock pharmacy and therapeutics (P&T) or health technology assessment (HTA) committee meeting is one of several methods manufacturers can
Why Payers Think a “Significant” Difference May Be Insignificant
An observer may ask whether a difference is significant. This seemingly simple question requires a nuanced answer, because there is
An inconvenient truth about payers not paying for convenience
Convenience products are those that are relatively easier to use than alternatives already on the market. Products that require less
PAYERS’ LOVE-HATE RELATIONSHIP WITH NEW STUFF
Change in health care is constant, and with that change payers expect new stuff — new products, services, evidence, guidelines,
5 Reasons To Question the Value of the Value Equation
Value. It is always wanted, commonly discussed, occasionally conceptualized, yet infrequently operationalized or measured correctly. But if optimizing value is
Budget Impact Analysis – Is the Juice Worth the Squeeze?
Payers often conduct a budget impact analysis to assess the affordability of a new offering, such as a drug, medical
Real-World Evidence – What Payers Really Really Want
Real-World Decisions In essence, payers make formulary management/medical policy decisions based on three criteria: efficacy, safety and cost. When a
5 Steps When Revisiting Your Payer Marketing Strategy
Are Payers Just Not That Into Your Brand? You’re trying to optimize market access for your brand, yet you have































































































