The vast majority of US pharmaceutical executives understand that managed care plans, health insurers, and pharmacy benefit managers (PBMs)—the payer market—have a dominant say over whether their products’ annual revenue will be $10 million, $100 million, $1 billion, or more. Although the market has been changing over the past few years, particularly with the introduction of new specialty biopharmaceutical products, the message remains the same: Access to managed markets and improving product reimbursement by payers are essential to maximizing product revenue in the
With the proliferation of Sunshine Laws, which seek to make the consulting/financial relationships between the pharmaceutical industry and healthcare providers (and executives) more transparent, pharmaceutical companies have to come to rely on the services of market research providers to produce, in blinded environments, the business intelligence and marketing feedback that they desperately need to better understand payer markets. In the past, Advisory Boards were relied on heavily for this role, but Sunshine Laws have created another weighty concern for pharmaceutical company attorneys, and the very nature of how Advisory Board information can be obtained may have to undergo a revolutionary change to adapt to the new environment.
One profound result of these changes has been an abundance of managed care market research providers, each jostling for the attention of pharmaceutical product personnel and reimbursement and access units. However, the number of targeted payers—commonly medical directors and pharmacy directors within the health plans, health insurers, and PBMs—is relatively stable. The issue becomes, what are the critical success factors for gaining the best access to this limited (approximately 300) group of key decision makers?
(1) The ability to get them to answer your call. The average age of these payer decision makers is between 40 and 65. Many have been in their present positions for more than 10 years and have established relationships with market research companies based on long-term familiarity, trust, and a well-earned confidence that their personal opinions and sensitive, corporate proprietary information will not be shared inappropriately.
The number of these desired executives is few (compared with physicians of nearly any specialty), and they are inundated with requests to participate in market research projects. A market research provider who can get on their schedule and gasin their commitment to participate can be invaluable to obtaining the business intelligence the pharmaceutical executive needs.
(2) The size and variability of the network. A pharmaceutical manufacturer may focus on one large segment (e.g., commercial) of the payer market, but they may need feedback regarding other significant market segments (e.g., Medicare parts B and D, Medicaid, Veterans Affairs, TriCare, long-term care). It is critical that the market research provider’s network include executives who can shed light on managed care organizations’ approaches to these varied markets and can speak to the differences that may be seen in their firms’ formularies for these separate products.
(3) Solid relationships with the consultant community. Also of importance is the market research organization’s ability to reach out on occasion to industry consultants (often former payer executives) who can provide helpful, fuller insights into what current payer executives may think about new products. This can be useful for both questionnaire development and validation of responses.
(4) A provider who understands the payer market. Many in the pharmaceutical community may believe that managed markets research is a commodity business—so many providers are available, that prices can be driven down. To some extent, this is true, but the value of a provider who truly understands the payer market becomes quickly apparent once the survey development process begins. With the knowledgeable input and understanding of not only the disease state but with an informed view of how most health plans, insurers, and PBMs will approach the area in question, much time can be saved in developing the questionnaire and this can result in briefer survey instruments and importantly, smaller honoraria or other incentives needed to convince busy executives to participate.
(5) The ability to obtain feedback through classic and innovative methods. Time is invaluable to the pharmaceutical sponsor and to the payer executives. In many cases, the sponsor requires far faster turnaround times than can be afforded through conventional survey means. This may prompt the market research organization to consider a different approach than the standard in-depth telephone interviews (which often require weeks to schedule). Innovative products are necessary to meet the needs of the pharmaceutical industry, and to fit the busy timeframes of the targeted payers. A market research organization that can provide flexible ways to obtain critical information and can make it as easy as possible for their network to participate will continue to offer the best mix of services and outcomes for the sponsor.
Every pharmaceutical manufacturer wants to know whether their pipeline product will be reimbursed on copayment tier 2 or the lowest possible specialty tier (and what it may take to get it there). For most new agents, this is the penultimate criteria for whether a
US launch will
be deemed a success. Getting this information before the FDA makes an approval
decision is critical. Partnering with the right market research to reach the
real decision-makers within the payer market can make all the difference in the
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