Securing Market Access (PH129)

Reimbursement, Payer Relationships and Healthcare Reform

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Published 2009
123 Pages
350+ Metrics
Charts and Diagrams

Overview Companies Metrics Excerpts

Strengthen payer relationships through communication:
Of all factors contributing to product success, payer access could be the most critical. Without the best reimbursement status for a drug, the investments your company made during drug development may end up as a lost cause. Securing Market Access: Reimbursement, Payer Relationships and Healthcare Reform examines the processes, strategies and best practices that industry leaders have implemented to build strong relationships and gain payer access.
This report is a tool for companies and payer management teams to adjust their strategies to meet growing payer demands and facilitate the reimbursement process:
Improve payer communication and formulary submission success
Metrics on payer targeting, communication methods and timing guide the strategic recommendations leading to healthier and more lucrative payer relationships for pharmaceutical companies with payers.
Increase the efficiency of your managed market department and payer management teams
Analyze benchmarking data from surveyed companies on organizational structure, headcount distribution for various functions within the managed markets group, account distribution and resource allocation.
Understand the impact of potential healthcare reform on managed markets teams
Although there are no clear-cut solutions to healthcare reform, this report provides recommendations for drug companies to prepare for both minor and major changes to the healthcare system. Interviewed pharmaceutical executives discuss their strategic responses to potential changes that could be on the managed markets horizon. Cutting Edge Information's analysts designed the practices contained within to help managed markets teams develop strategies to respond effectively to various scenarios that could emerge.
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Companies Included in Payer Relationships Research
- Acorda Therapeutics
- Allergan
- Amicus Therapeutics
- Axcan Pharma
- Boehringer Ingelheim
- Genzyme
- Grunenthal
- GlaxoSmithKline
- Janssen-Cilag
- Lundbeck
- MAP Pharmaceuticals
- Merck
- Merck Serono
- Novo Nordisk
- Pfizer
- Quintiles
- Roche
- United Therapeutics
- Wyeth
- ...plus more
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Payer Relationships Metrics
Securing Market Access' three chapters include structure, budget, staffing and key performance metrics data collected from 20 top pharmaceutical and biotechnology companies.
Strengthening Payer Relationships through Communication
- Percentage of all companies specific targeting managed care institutions, by type of account:
- Percentage of companies targeting managed care groups, by portfolio type:
- Ranking of importance for managed care institutions
- Ranking of importance for managed care institutions, by portfolio type (primary care, specialty, and product-balanced)
- Development phase during which companies initially contact payers
- Number of contacts with payers during each phase of development
- Payer interfaced per phase by portfolio type (primary care, specialty, and product-balanced)
- Percentage of companies' preferred methods of communication with payers, by phase: email, telephone, face-to-face
- Year after drug approval that communication with payers stops
Managed Markets Structure, Staffing and Budgets
- Percentage of companies with formal managed markets departments
- Departments in which managed markets groups typically reside
- Average staff size of a managed markets department (in FTEs)
- Average staffing allocation of a managed markets department's personnel
- Average managed markets FTE allocation by portfolio type (primary care, specialty, and product-balanced)
- Average FTEs per product ratios by portfolio type (primary care, specialty, and product-balanced)
- FTEs and FTE-to-product ratios by portfolio type (primary care, specialty, and product-balanced)
- Account manager FTEs by product focus and type of account
- Account manager per product by company and type of manager (regional account managers or national account managers)
- Percentage of companies that organize account managers by geography, by portfolio type (primary care, specialty, and product-balanced)
- Average budget for a managed markets department
- Average budget allocation for a managed markets department
- Average budget per product ratios by portfolio type (primary care, specialty, and product-balanced)
- Budgets by portfolio type: primary care-product-focused (as well as specialty-focused and balanced) companies - also per product
- Managed markets marketing budget allocation by portfolio type (primary care, specialty, and product-balanced)
- Managed markets sales manager budget allocation by portfolio type (primary care, specialty, and product-balanced)
- Managed markets account manager budget allocation by portfolio type (primary care, specialty, and product-balanced)
- Managed markets administrative budget allocation by portfolio type (primary care, specialty, and product-balanced)
Healthcare Reform and its Impact on Managed Markets Teams
- Cost ranges for comparative effectiveness research
- NICE's probability of Rejection vs. Cost per QALY
Additional Data
- Percentage breakdown of all healthcare spending by payers
- Average costs for pharmacoeconomic research
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Payer Relationships Report Sample
The following is an excerpt from Chapter 1, "Payer Trends and Strategic Recommendations."
Develop Strong Value Statements to Gain Payer Access
The conversation between drug manufacturers and payers has changed since the mid 1990s. Over time, one of the biggest changes to market access strategies is that they focus on value. In the past, drug makers competed for payer access by offering contract advantages to provide payers with better prices. But engaging in a price war between products is no longer enough to gain competitive reimbursement status. In the current reimbursement environment, payers require drug makers to compete on value and product attributes — backed with hard data — instead of competitive contracting as their sole offering.
The Company 36 executive feels that drug makers are just now starting to realize how to move payer conversations beyond simply the contracting aspects to be most beneficial, relationships between payers and market access teams should begin early in drug development. The interviewee observed that the longer a company works with its payers, the better it understands the disease state and the potential new drug's market. It can more effectively shape its value statement and position the drug for competitive formulary access. Relationships between payers and market access teams need to begin early in drug development.
Contracting Changes
On the other hand, changes to contracting dynamics are affecting payer conversations. Tier positioning, for example, has evolved to become much more sophisticated, especially regarding access contracts or performance contracts. Interviewed executives agreed that...

The following excerpt is taken from Chapter 3, "Strengthening Payer Relationships through Communication."
Making First Contact with a Payer
When to begin communication with a payer about a drug in development varies greatly among different companies. No longer can manufacturers approach payers after approval and registration, as many companies had grown accustomed to 10 years ago. Payers are demanding specific safety and health outcome information about drugs that can only be properly compiled if a manufacturer is in contact with the payer very early on in the development process.
Cutting Edge Information analysts surveyed pharmaceutical manufacturers and asked at which stage in a drug's development they typically contact payers for the first time. Figure 3.8 shows that responses are fairly mixed. The highest number of respondents — 28% — choose Phase 3a as their point of first contact with payers and 14% chose Phase 3b. An incredible 79% of manufacturers wait until Phase 3a or later to make first contact with payers.
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