Denials, Delays and Deep Discounts: Poor Insurance Coverage for Pharmaceuticals at Launch

For brand teams, launch year has become a nightmare of denials, delays and deep discounts.

For the one in 10 drugs tested in clinical trials that wins FDA approval, payer coverage is becoming an exception to the rule. Therapeutic drug purchases in the US are mediated largely by large national insurance companies that purchase drugs on behalf of patients and negotiate net price with drug makers as well as rationalize care. The co-mingled roles of large insurance companies in negotiating price on one hand and choosing which agents rationally patients should be allowed to use on the other hand set up an unfortunate scenario at launch. Uncover the strategies and trends:

• The new therapeutics from 2018 compared with most current approved drug lists of large national payers
• The types of new products making it to the published formularies
• Access scenarios for commercial versus Medicare