The Congressional Budget Office (CBO) is an independent, nonpartisan agency that serves Congress by providing economic and budgetary analyses of proposed legislation. It estimates the financial impact of proposed bills and assigns them a budget score, which is used by lawmakers to determine how the bill will affect the federal budget over a typical 5-to-10-year…
What are PDABs? Prescription Drug Affordability Boards (PDABs) are state-appointed entities empowered to review drug prices, and, in some cases, set upper payment limits (UPLs) in an attempt to lower drug costs for identified populations within the state. The boards typically consist of five to nine members with expertise in healthcare economics, pharmacology, medicine, health…
Direct Drug Price Negotiations and Inflation Rebates The Inflation Reduction Act (IRA) made several key changes to Part D. The Centers for Medicare and Medicaid Services (CMS) can now negotiate drug prices for certain high-priced/high-utilization medications. Additionally, drug companies are now required to pay CMS a rebate for Part D and B drugs if prices…
What is Claims Data? Healthcare claims are submitted by providers to insurers for reimbursement. Nearly every encounter a patient has with the health care system generates a claim which, along with payment information, contains data on a patient’s diagnoses, procedures, and medications using standardized billing codes. This real-world data can be used for commercial targeting,…
Social determinants of health (SDOH) are the conditions in which people are born, live, and work that shape their health and quality of life. Categories of Social Determinants of Health (SDOH) The US Department of Health and Human Services buckets SDOH into 5 main categories: economic stability, education access and quality, healthcare access and quality,…
Patient assistance programs typically offer free or discounted medications, copay assistance, or other forms of assistance to patients who are uninsured or underinsured and cannot afford their medications. Many drug manufacturers offer patient assistance programs (PAPs) to help patients access the medications they need but cannot afford. Who Qualifies for PAPs Support? Each patient assistance program…
The Inflation Reduction Act (IRA) of 2022 aims to improve the accessibility and affordability of prescription drugs for Medicare beneficiaries. The Inflation Reduction Act adjusts the Part D benefit design, reforms drug price negotiations between the Centers for Medicare and Medicaid Services (CMS), and establishes a program that allows Part D beneficiaries to pay prescription…
As healthcare is continuously evolving, pharmaceutical companies are searching for innovative tactics to engage healthcare professionals (HCPs). As sales representatives are being turned away, and the traditional “door-knocking” selling model changes, new pharmaceutical marketing solutions are needed for life science companies to reach HCPs more effectively. At Magnolia Market Access, we’ve identified several pharma marketing…
Many factors go into launching a new pharmaceutical product. The process of gaining approval and the commercialization of a new pharmaceutical product is deeply complex and can take many years of careful planning, coordination, and execution across multiple stages. At Magnolia Market Access, we work closely with our pharmaceutical and biotechnology clients to ensure success…
Field Reimbursement Managers (FRM) assist healthcare professionals (HCPs) in navigating payer requirements to expedite access for patients and streamline reimbursement for products administered in the office. The need for FRMs has grown in importance as pharmaceuticals and the reimbursement landscape have evolved, and provider practices—especially those in specialty areas like oncology—may be experiencing staffing shortages and…