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Healthcare Brand Management Market Access Concepts

Healthcare Medical Pharmaceutical Directory

.COM

www.HealthcareMedicalPharmaceuticalDirectory.com

Healthcare Brand Management Market Access Concepts

What is Access?
The degree to which a healthcare product is:

Easily prescribed/used by providers


Reimbursed by health plans Effectively promoted/sold in a market segment Available through a variety of contractual arrangements and supply chain sources

Access And Reimbursement


If payers do not reimburse for the product, it is less likely caregivers and patients can use it Marketing and sales initiatives of manufacturers will be much less effective The product will not be able to generate enough revenue to be commercially viable

Competitors will gain an advantage through their market access initiatives

Planning Access
The product must be correctly positioned with primary prescribers and provide clear clinical value in patient treatment

Identify channel(s) your product will be used most, where it realizes greatest revenue potential
Target the predominant prescribers and payers in the channel

Develop and implement a contracting strategy for each channel, include customers and leading payers
Fortify the products position with physicians through clinical marketing strategy and accelerate growth with sales tactics, ongoing promotion and pull-through KOL support establishes a conduit of influence into clinical decision makers and their peers

Planning Access
A direct customer contract can be undermined if product is available at a lower price through a GPO contract Distributors, wholesalers and other reseller contracts need channel alignment to protect agreements and maintain profit continuity in other market segments Discounts, rebates and other financial features need to be accounted for throughout agreements to assure margin and true profit is realized before transactions are underway Commercial contract pricing needs to be reconciled against government contracts requiring best price

Planning Access
Sole awards and preferred product positions provide premium access but require the steepest discounts and garner the most competitive attention Rebates based on volume contracts need clear definition and dedicated resources to maximize access and accurately manage rebates through sales tracings, chargeback data It is necessary for pharmaceutical companies to balance direct contracting strategies with healthcare clients versus GPOs; healthcare entities engage in both arrangements depending on their procurement preferences

Planning Access
Customer supply chains featuring distributors, wholesalers and other sources vary, contracts needs to account for these Maintaining/expanding access requires a budget to open new initiatives and provide marketing/sales resources to propel them Access requires selectivity, fortifying/expanding access should be based on customer need, reimbursement potential, available resources and long term ROI The product must be correctly positioned with primary prescribers and provide high clinical utility

Pull-Through Reinforces Access


Establishing a leading contractual arrangement and/or preferred status is just the beginning

Physicians and patients need to know they have access to the product, be familiar with the products attributes and establish the processes to procure it through
Sales uptake and ongoing momentum is driven by a wellsupported sales force and strong marketing initiatives to fortify and expand share/revenue New competitors will launch pull-through initiatives to penetrate the market, established competitors will widen share and prevent newcomers from getting traction Physicians and payers need to be continually engaged and cognizant of the product and its manufacturers value

Connectivity Coordinates Access


Access is driven by connectivity and throughput of information:
Social Media propels clinical and promotional messaging to healthcare professionals, patients and consumers Healthcare plans make data-driven decisions based on care/cost outcomes, claims processing reporting and member utilization Pharmaceutical companies rely on blended data to effectively contract, maintain compliance, determine share, assess marketing/sales ROI CMS/Federal and state sponsored plans are data dependent to fund programs such as Medicare, Medicaid, 340B, reimburse providers and pharmaceutical companies, as well as maintain patient eligibility files ACOs are hugely dependent on electronic information flow to manage their protocols and assess performance

Examples of Market Channels


Dialysis Long Term Care Mail Order Pharmacy Home Infusion Hospitals Infusion Clinics Military Treatment Facilities/MTFs Oncology Clinics Physician Practices Retail Pharmacies Specialty Pharmacies Surgical Centers/Outpatient Surgery, Veterans Administration/VA Hospitals & Clinics

Each channel requires an access strategy

Leading Pharmacy Entities


Retail Pharmacy
CVSCaremark Rite Aid Target Walgreens Wal-Mart

PBMs*
ARGUS BioScrip Catalyst RX CVSCaremark Medco Restat SXC Health

In addition to contracting with pharmaceutical manufacturers, PBMs contract with retail pharmacies to fill prescriptions for pharmacy plan customers

*PBMs: Pharmacy Benefit Managers

A Note About PBMs


PBMs contract with brand and generic manufacturers for better pharmaceutical pricing and actively manage utilization of prescription medication by customer plan members PBMs feature their own formularies and assertively negotiate for rebates based on volume/preferred status with pharmaceutical companies Some PBMs like Express Scripts, Medco, and SXC operate their own mail order pharmacies, others like ARGUS, CatalystRx and Restat do not PBMs manage prescription plans for employer, government (Medicaid, Medicare, TRICARE, etc.) and other sponsors PBMs offer clinical programs to manage some therapies closely, these provide access opportunities for manufacturers

A Note About Mail Order Pharmacies


Mail order pharmacies dispense maintenance therapies (cholesterol, diabetes, contraceptives, hypertension, etc.) in 90-day supplies, it is key for manufacturers of maintenance therapies to have contracts with mail order pharmacies They charge plans/patients less, the concept is patients are getting their medications in bulk 90-day supplies versus 30-day retail increments Mail order pharmacies typically operate specialty pharmacy units as well to dispense injectable products to support advanced patient care CVSCaremark, Walgreens, Rite Aid and Wal-Mart operate mail order pharmacies in addition to their retail pharmacy operations

Health plans with their own mail-order operations include Cigna (Tel Drug), Humana (FutureScripts), BCBS (Prime Therapeutics) and United HealthCare (Prescription Solutions)

Leading Payer Plans


Commercial Plans
Aetna BlueCross BlueShield plans* Cigna Humana Kaiser United Healthcare WellPoint (14 BCBS plans)*

Government Payers
Medicaid (state-based, federally subsidized) Medicare TRICARE (active/retired military) 340B Plans

*There are 38 BlueCross BlueShield plans affiliated with the BlueCross BlueShield Association

A Note About 340Bs


340B is a Federal drug discount program established in 1992, it requires drug manufacturers to provide outpatient drugs to eligible health centers, clinics and hospitals at a discounted/negotiated rate (average 50% below retail)

The 340B market segment has been growing due to issues with the economy and larger numbers of uninsured persons but margin is lower as 340B is price driven
340B is also known as "PHS pricing" or "602 pricing, patients discounts are created by contractual arrangements between the care provider and a pharmacy

Entities eligible to participate in 340B include:


Black Lung Clinics Disproportionate Share Hospitals (DSHs) Family Planning Clinics Federally Qualified Health Centers (FQHCs) Federally Qualified Health Center look-alikes (FQHCLAs) Hemophilia treatment centers HIV / Ryan White Clinics Sexually transmitted disease and tuberculosis clinics State-operated AIDS Drug Assistance Programs Urban Indian organizations

GPO and Healthcare System Leaders


GPOs
Amerinet Gerimed Epic HealthTrust Purchasing Group (HPG) Innovatix ION (M MedAssets MHA Novation PDM Premier

Healthcare Systems
Dept. of Veteran Affairs/VA HCA Inc. Community Health Systems Trinity Health Partners Healthcare NYC Health & Hospitals Corp. Kaiser Permanente Universal Health Services Inc. Catholic Healthcare West Adventist Health System Tenet Healthcare Corp.

GPOs are frequently a part of the Healthcare System access formula

A Note About GPOs


Group Purchasing Organizations (GPOs) contract with manufacturers of brand or generic pharmaceutical products, medical devices, equipment and other items used in healthcare settings

Healthcare entities pay a membership fee to join a GPO to get access to discounted pricing GPOs negotiate with manufacturers, GPOs also collect 1-3% margin from drug products and provide other services to gain
Some GPOs are business units of distributors/wholesalers but do not take possession of products, they are price-driven, contracting entities HPG, MedAssets, Novation and Premier are larger independent GPOs

Wholesaler operated GPOs include INN, ION (AmerisourceBergen), VitalSource (Cardinal Health), Onmark, U.S. Oncology (McKesson) An array of customer groups use GPOs including healthcare systems, hospitals, oncology clinics, home infusion, surgical centers, dialysis clinics, physician groups and long term care companies

Nursing and Assisted Living Facilities


Nursing Facilities
HCR ManorCare Golden Living Life Care Centers Kindred Healthcare Genesis Healthcare Corp. Sun Healthcare Corp. SavaSeniorCare Extendicare Health Services ELGS Skilled Healthcare Corp.

Assisted Living
Emeritus Corp. Brookdale Senior Living Sunrise Senior Living Altria Senior Living Five Star Quality Care Assisted Living Concepts Merrill Gardens HCR ManorCare One Eighty-Leisure Care Life Care Services

Once highly fragmented, consolidation among nursing and assisted living facility operators continues which will greatly concentrate revenue sources in the future

Long Term Care Pharmacy and Home Infusion


LTC Pharmacies
Guardian Pharmacy Millenium Pharmacy Omnicare Partners Pharmacy PharMerica Senior Care Pharmacy

Home Infusion Providers


Apria AxelaCare Home Solutions CarePoint Partners Healix Home Solutions Infuscience Lincare OptionCare/Walgreens Vital Care

The home infusion provider market continues to evolve through consolidation of existing providers and hospitals expanding their services into home infusion offerings

Surgical Centers and Dialysis Clinics


Surgical Centers
Amsurg HVP Meridian Surgical Partners SCA Surgical Care Affiliates Symbion United Surgical Partners

Dialysis Providers
American Renal Associates Centers for Dialysis Care DaVita Dialysis Clinic Inc. Fresenius Innovative Dialysis Systems Renal Advantage Renal Care Partners Satellite Healthcare U.S. Renal Care

GPOs are frequently a part of the Surgical Center access formula

DaVita and Fresenius control two-thirds of the U.S. dialysis market, consolidation in the channel is frequent and driven by cost controls to generate revenue under Medicare patient care performance standards and reimbursement limits

Access Summary
Each market channel requires its own access strategy Fully account for primary physicians and payers in each channel to position, price and promote product successfully Contracting may involve direct-to-customer, distributor, GPO, wholesaler, payer and other arrangements to succeed in the channel

Competitors are selectively stronger/weaker in different channels, exploit channels they are weakest in to grow product sales
Contracts are only part of market access, contract management, pullthrough and connectivity are necessary to maintain/expand sales/share performance Be selective, fortification and expansion of access requires clinical performance to demonstrate true value and gain acceptable reimbursement levels --plus suitable resources to sustain initiatives for acceptable financial returns

For ongoing business and clinical healthcare industry resources, please go to: www.HealthcareMedicalPharmaceuticalDirectory.com

Healthcare Medical Pharmaceutical Directory

.COM

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