Perspectives

Payer access goals are a mirage

An integrated managed care strategy is a necessity

​Pharmaceutical companies need to change how they address the increasing influence and challenges posed by managed care. Typically, managed care/payer strategies have flowed out of the brand strategy in the form of a goal for favorable "access" and a rebate budget to achieve it.

Creating a managed care strategy

Little understanding of payers and their various business objectives flowed the other way to affect the choice of end points for late-stage clinical trials, the strategies and tactics for engaging physicians, or the allocation of resources across various channels and tactics to engage patients. Given the growing influence and variety of managed care payment systems, this is no longer a tenable way to manage a brand.

Yet many pharmaceutical companies still sabotage their payer strategies from the beginning by setting managed care objectives narrowly - focused on “access.” Most payer strategies begin with the question, “What level of favorable access, defined as a percent of targeted lives covered, do we require reaching our sales goals?” But the value of a percentage point of “access” can vary from nothing to very high, depending upon the payer, plan, and region. Consequently, pharmaceutical companies’ attempts to maximize “access” within a rebate budget often lead to discounts that are a relatively poor investment. Rebate dollars could be better spent if allocated to maximize the expected impact on sales rather than the expected impact on “access.”
 
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Learn more about managed care
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