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Access and Reimbursement: Beyond Managed Care
by Mark Zitter
Chief Executive Officer
A few years ago when we wanted to know how payers were affecting pharma products, we just asked them. But today, we at TZG believe that it’s hard to get a complete access and reimbursement picture by speaking only to payers.
A case in point: For the past seven years, our Biologics and Injectables Index has surveyed payers on the current and prospective management of biotech therapies. They described their current practices and strongly predicted becoming more aggressive in the future. Two years later we looked at the changes and – guess what? – payers really hadn’t become more restrictive! When asked why they hadn’t, payers responded that they had tried, but plan sponsors hadn’t selected the more aggressive approaches.
Oncology Practice Managers in the Payer-Oncologist Relationship
by Kirk McConnell
Manager, Syndicated Studies
When the Zitter Group launched the Managed Care Oncology Index in the winte r of 2007, it was believed that sampling 100 payers and 100 clinical oncologists would provide unparalleled insight into how the payer/oncologist relationship shapes the market for oncology therapies. However, as the complexity of payer oncology management has evolved over the past two and half years, it became necessary to expand the scope of research beyond payers and oncologists. Click Image to Enlarge
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The Value of the P&T Commitee in a Changing Market Place
by Nicole Dautel
Director, Tactical Offerings
Health plan P&T committees serve as the internal committees empowered to evaluate and determine access to pharmaceutical products. 
While managed care does not drive specific therapies used by physicians, they do provide preferred formulary positions to those seen as more valuable. Should therapies be perceived as equally efficacious and safe, then appropriate financial analysis will determine therapeutic preferences. It is important for manufacturers to keep in mind that health plans generally review each product, or class of products, in all disease states, at least once a year -- regardless of product life cycle. The rigor of these reviews has already increased in the face of several product withdrawals and additional safety scrutiny on the part of the FDA, and we expect this trend to continue with the advent of comparative effectiveness research.
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If you would like more information about The Zitter Group and our offerings, please email us at: contact@zitter.com
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