2023 Trend Report

Applying stricter, trial-based inclusion and exclusion criteria in these cases enables payers to align resources R A R E & S P E C I A LT Y L A N D S C A P E with the positive patient outcomes in clinical results, while managing the high costs of rare and specialty therapies. Meanwhile, payers may use other techniques for specialty products launching in competitive markets with multiple pr [...] Even now, as more high- cost products are set to launch in the near term, payers remain committed to finding and maintaining that delicate balance. [...] Meanwhile, due to the high costs and significant expansion of rare and specialty therapies as a whole, payers ranked economic and contracting priorities among four of the nine highest-value drivers in the pharmacy and therapeutics (P&T) review process in 2023. [...] Payers indicated they tend to consider RWE in their decision-making as a “nice to have” for follow-up class reviews after launch.12 P E R S P E C T I V E S F R O M H E A LT H C A R E P AY E R S 2023 Alnylam Rare & Specialty Trend Report Despite overall trends where large PBMs and national payers tend to be proportionately represented due to their volume of covered lives, several value dr [...] This growth in subcommittees among national plans is likely due to the number of rare and specialty drugs entering the market, coupled with the broad organizational commitment to keeping up with new products and providing patients with access. M E D I C A L V S . [...] P H A R M A C Y B E N E F I T M A N A G E M E N T Similar to the 2021 and 2022 report findings, payers surveyed in 2023 also prefer pharmacy benefit over medical benefit. [...] However, while payers representing the majority of covered lives report “success in cross-benefit management,” this is limited to the visibility that each payer has across benefits. In short, cross- benefit management can only be effectively operationalized in instances where patients use that particular payer for both pharmacy and medical benefit coverage. [...] Specifically, 67% of employers surveyed in 2023 reported being highly active in looking for strategies to maintain their benefit plans, as more high-cost, one time therapies become available and increase the likelihood of a “lightning strike” claim. [...] I N C R E A S E O F P B M T R A N S PA R E N C Y Payers surveyed in 2023 expressed support for legislation aimed at creating more transparency on the part of pharmacy benefit managers (PBMs) around their drug pricing agreements and disclosure requirements for rebates or other discounts with manufacturers. Congress is actively considering legislation to increase PBM transparency and addre [...] In response, payers surveyed in 2023 indicated they will continue assessing the situation and considering how to proceed with prudence.