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MRIoA offers an extensive library of educational resources to help our clients stay informed about emerging clinical procedures and therapies to support improved clinical decision making.

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Market Insights & Industry Trends

Regulatory

  • Gold Card and other key regulatory requirements become effective 1/1/24 in 9 states.
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Data Insights

  • ClearPath Optimal list identifies 240 high codes accounting for $66 million in annualized medical spend per 100K lives
  • Here are 10 CPT codes that we commonly see on the prior authorization list that could be removed to lessen the burden on providers, patients and ultimately administrative work for payers.  The top 10 codes are:
    • 46948
    • 46707
    • 57106
    • 43233
    • 43245
    • 43214
    • 46607
    • 43246
    • 43241
    • 43215
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Pharmacy

  • Innovative strategies in managing high-cost specialty medications (including GLP-1s can significantly impact plan drug spend)
  • Ozempic shows clinical benefit in patients with heart failure
  • The PBM marketplace is more competitive than ever. High levels of satisfaction can increase customer retention and lifetime value,1 so customer satisfaction is a key differentiator. Drug benefit management is increasingly complex, and plan sponsors depend on PBMs to deliver services seamlessly and help control costs.2
    A few key data points to ponder2

    • Overall satisfaction is at its lowest point since 2014
    • NPS decreased to 8 in 2023 and varies by respondent group
    • PBMs have room to improve in helping plans address the affordability of high-cost gene therapies
    • Respondents see both strengths and weaknesses of disruptive solutions like Amazon Pharmacy and Cost Plus Drugs

1 Otto AS, Szymanski DM, Varadarjan R. Customer satisfaction and firm performance: insights from over a quarter-century of empirical research. J. Acad. Mark. Sci. 2020;48:543-564.
2 Pharmacy Benefit Manager Customer Satisfaction Report

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Health

  • The U.S. Food and Drug Administration approved two milestone treatments, Casgevy and Lyfgenia, representing the first cell-based gene therapies for the treatment of sickle cell disease (SCD) in patients 12 years and older1
  • FDA approves cure for sickle cell disease, the first treatment to use gene-editing tool CRISPR2

1 FDA Approves First Gene Therapies to Treat Sickle Cell Disease
2 Groundbreaking approval for gene-editing tool CRISPR

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