Stanton R.
Mehr, President, SM Health Communications LLC
In the course of a pharmaceutical launch program, most savvy
product managers and brand directors will want to test, compare, and evaluate
their managed markets launch strategy in a way that gives them a realistic
understanding of how their strategy will fare in the real rough-and-tumble
world of health plans, insurers, and pharmacy benefit managers. For most
products provided in ambulatory settings in the US, these payer institutions
control the majority of coverage decision-making and reimbursement. Therefore,
at some time prior to product launch, a litmus test of marketing plans is
necessary.
That final
overarching answer—will my product be placed on formulary and on what
copayment/coinsurance tier?—is the $1 billion question for most pharma
companies. This is everyone’s goal, but few well-proven options exist to obtain
strong, reliable response to the question. Even the term that pharma executives
use to describe how they will obtain the answer is vague in the minds of most.
“We will hold a ‘mock Pharmacy & Therapeutics Committee”: What exactly does
that mean? Is it a separate tactic or something that is part of another more
common managed markets tool?
Primarily,
a P&T Committee is the coverage decision-making body within a health plan,
insurer, hospital, or PBM that evaluates whether a product is safe, effective,
and of sufficient value to be considered for reimbursement by the plan for its
members. In many ways, it is a technology assessment committee, comparing new
pharma products and/or delivery devices against what the organization already
covers to decide whether the new technology is of sufficient value to its
members. In an actual health plan or PBM setting, the P&T Committee meets
on a regular basis (e.g., monthly or quarterly) and spends time deemed
sufficient to explore the product in question and vote its assent or dissent on
coverage. Therefore, if the objective to holding a mock P&T Committee is to
obtain a response as close to that seen in a real Committee setting, it is best
to emulate the latter as closely as possible.
What a Mock P&T Is,
and What It Isn’t. This means that one broad requisite for holding an
effective mock P&T Committee is that it is a live meeting of managed
markets experts. However, this can be done in a multitude of ways, and each of
which carry their own rewards (but risks, too).
(1) Managed
care advisory boards or webinars—well known, once ubiquitous, managed care
advisory boards typically brought up to 15 managed care medical directors and
pharmacy directors into one room, with pharmaceutical sponsors sitting either at
the roundtable or in the back of the room. Sometimes run directly by the
pharmaceutical marketing team or a professional facilitator, the goal of the ad
board (which were often done as a series held in geographical regions or by
types of plans or insurers) was to obtain responses to a specific list of
questions posed by the marketing team. In some cases, a “mock P&T
Committee” scenario is included in some portion of the ad board agenda, to try
to tease out the whether the managed care executives will, in the end, place
the product in question on a health plan formulary. The goal of an advisory
board is not necessarily the same as that for the mock P&T Committee. In
this setting, part of the problem resides in the very room where the mock
P&T is held. In no managed care organization are pharmaceutical company
representatives allowed to participate in P&T Committee meetings. This
would bias the proceedings and would like inhibit directed, full discussion of
the company’s product (or competition).
(2) P&T
“wargames”—P&T wargames are marketing activities in which pharmaceutical
company personnel combine with managed care consultants to play the role of
health plan executives, not to obtain accurate formulary decisions, but to
devise marketing strategies and approaches in response to possible outcomes of
the formulary decision. In other words, if one of the possible outcomes of a
P&T Committee decision is that Product X will not be placed on formulary
because it doesn’t provide sufficient value over presently covered agents, then
the wargames team may suggest increasing contracted rebates or discounts to
overcome this barrier. However, the P&T wargames is not focused on what
outcome is most likely, only what to do in the event it occurs.
(3) Product
theatres—Product theatres, often run at major clinical and professional
conventions, offers the chance for pharmaceutical companies to present their
marketing story to large groups of managed care professionals. This can be
accompanied by a staged P&T Committee review, where some of the issues that
may be raised in a real P&T Committee may acted out for the benefit of the
larger audience, along with some possible responses.
(4) The virtual
P&T Committee—In this format, a P&T Committee meets on a regular basis,
just like a real P&T Committee, to evaluate specific products or drug
classes for virtual health plan or
PBM. That is, it may represent a specific type of plan, such as a 1-million
member regional point-of-service plan, based on the East Coast, or a
500,000-member integrated health plan based in California. The committee
members are usually blinded to which pharmaceutical company is sponsoring a
session (as part of their regular meeting), and pharma executives are
prohibited from attending the meeting in real-time (that is, no one but the
Committee members are allowed in the conference room, no use of one-way
mirrored observation rooms, and no satellite feed of the actual meeting to
other sites). This minimizes inherent biases in discussions and decision
making. It also assures that all discussions and comments are encouraged, with
regard to how a real P&T Committee approaches the disease state, drug
class, or specific product. The result of the virtual P&T Committee is a
formulary decision based on a clearly developed scenario, which will set a
standard for how real managed care organizations of similar type will most
likely vote on the product. It is an outcomes report based on one scenario
(which can be a certain pricing level, including specific assumptions on
formulary positioning of competitive products, and of course, the value
proposition).
It is therefore as important to remember what a mock P&T
Committee is versus what it is not. What type of live meeting of managed care
experts a pharma company chooses to achieve its goals really depends on what
the expectations or objectives of that exercise. If seeking possible responses
to a set of P&T Committee decisions, a “wargames” scenario may be most
appropriate. If looking for general feedback on the managed care marketing strategy
or trying to develop the initial strategy is main objective, an ad board or
series of boards may be the ticket. But if the product team is seeking to
understand what is the likeliest P&T Committee decision based on their
product launch, the virtual P&T meeting is the best way to go.
Not Just for a New
Product Launch. Although the most obvious use of a virtual P&T
Committee meeting is for a pharmaceutical company seeking to test the outcome
for their own new soon-to-be-launched agent, it can be at least as useful to
better understand the effect of a competitor’s new entry on the company’s
mature product. Virtual P&T Committees have enabled a marketing team to
“pre-position” the competitor’s product, based on reaction from the committee
members, as well as conduct essential business intelligence on the probability
that the new agent will be (1) accepted onto the formulary, (2) at what
copayment tier, and (3) what effect, if any, if will have on the rest of the
product class. For example, will Product Y’s acceptance onto the formulary at
the preferred tier require all other products of the class to require prior
authorization before coverage can be obtained? The drug company can then
determine if a new strategy is necessary, such as increased rebating or better
comparative-effectiveness research will help mitigate these effects.
Again, what is the real objective of conducting a mock
P&T? That should define which format provides the greatest chance of
success in answering the question.
SM Health Communications
provides writing, consulting, and market research services for the long-term
care and payer markets. Its proprietary P&T Insight™ virtual P&T
Committee program is the leading mock P&T Committee product in the field. For
more information, please visit www.smhealthcom.com
or contact Stanton
R. Mehr, President, at stan.mehr@smhealthcom.com.
