What Managed Care Analytics Means to Pharma Brand Success – Part 2

In Part 1 of this two-part series, we learned about what managed care analytics means for pharma brand success and the factors that pharma companies need to keep in mind while planning their managed care strategy. In this part, we will explore how pharma account managers can leverage managed care analytics, in their constant endeavor of optimized contract performance, better formulary positions, and improved patient access and health outcomes.

The managed care model has seen significant growth in the US pharmaceutical industry, with an estimated 85% of all prescription drugs now reimbursed through a managed-care plan¹. The market access landscape is changing with increasing pricing pressures leading to increased approval of generics and biosimilars. The role and power of payers has grown to a point where addressing it has become essential for the very survival in this industry. There is also an increasing demand for evidence of improved outcomes/ lower cost of care from payers. These factors have forced pharma companies to deploy and measure managed market teams effectively.

Most account managers rely on market insights, intuition, and previous experience to make critical commercial decisions. Often these insights do not leverage the power of advanced and predictive analytics to focus on the end objective – better patient-driven outcomes. By deploying intelligent solutions to optimize their contract performance, such as managed care analytics, account managers can better manage the market dynamics, without letting the brand performance take a hit. The potential of analyzing and generating deeper insights from managed care data such as payer profiles, plan benefits, formulary structures, pharmacy claims, and drug volumes is enormous and mostly untapped.

According to a recent study, 58% of healthcare leaders allocated over 15% of their budget to predictive intelligence in 2018, envisioning savings of over 15% in the next five years². Meaning, by leveraging predictive and actionable insights to push for the most optimal contracting strategy with managed care stakeholders, pharma account managers can realize cost savings while increasing patient access to the drug.

Top Five Areas pharma account managers can leverage managed care analytics

This blog examines the top five areas where pharma account managers can leverage managed care analytics, in their constant endeavor of optimized contract performance, better formulary positions, and improved patient access and health outcomes.

1. Payer Contracting
2. Copay Elasticity
3. Managed Care – Payer/Plan-Level Reporting
4. Managed Care Influence Analysis
5. Payer Segmentation

PAYER CONTRACTING

By using historical data, brand performance can be predicted by changing managed care levers such as formulary tiers, restrictions to quantify the direct impact of plan changes, and the indirect spillover effects on the other plans. The analysis models data from multiple feeds and can play a significant role in determining the most optimal payer contracting strategy. This is done by assessing the impact of one formulary tier on the corresponding brand performance and enabling pharma account managers to determine the best negotiation options with payers. Also, predictive analytics can help account managers to conduct a cost-benefit analysis for each contracting strategy.

COPAY ELASTICITY

Copay cards are one of the most significant promotional investments that a pharma company can undertake to make treatment affordable to patients and maximize brand sales. Copay elasticity is measured as a degree of change in brand sales due to a change in one-unit copay price paid by the patient. By using patient-level data along with copay elasticity analysis, pharma account managers can assess the impact of their own brands’ and competitors’ copays by individual plan categories. This metric is significant as it helps identify geographies with the highest cost sensitivity and research the copay dynamics to broaden drug access.

MANAGED CARE – PAYER/PLAN-LEVEL REPORTING

While getting most of the available data for actionable insights is crucial for better market access,  these insights must be accessible on-demand. Providing business intelligence (BI) and data visualization at the point of decision-making will ensure confident strategies with aligned stakeholder buy-in on the desired outcomes. This means that account managers need clear visibility on all critical parameters to determine high potential targets. These parameters influence driving the performance of the essential accounts, such as:

• How do the accounts compare at a national vs. local level?
• How do the formulary accesses vary between the accounts?

In addition to providing a holistic view of brand performance, the BI dashboard can also leverage advanced analytics models to create simulations of the various market access scenarios. This enables the account managers to visualize and ascertain the impact of changing managed care levers on a brand, and the effect on the end patient. Read more on Axtria’s Field Reporting & Analytics capabilities.

MANAGED CARE INFLUENCE ANALYSIS

Technology, and the influx of digital channels, has changed the paradigm of how drug communication and promotions are carried out. When tied to a favorable managed care access, it results in a much lower need for resource/promotional budget allocation. With managed care gaining stride in the pharma sphere, pharma account managers must take these influences and other local drivers into account, when accessing resource allocation models. Managed care insights can help determine optimal team structures and sizes across geographies for National Account Managers (NAMs) and Regional Account Managers (RAMs).

PAYER SEGMENTATION

The payer (and plan) segmentation analytics includes various dimensions, such as:

• Number of patient lives covered,
• Coverage of the managed care plan (national vs. state),
• The degree to which the plan exerts influence on physician prescriptions,
• The degree of favorability amongst formulary tiers, and
• Market and brand potential.

Conclusion

Since there’s a significant variation in attributes, drivers, and behaviors of different payers, payer segmentation analytics will hyper-target and capture these changing behaviors, helping account managers identify lucrative segments to focus on and increase the likelihood of succeeding. Pinpointed insights from such solutions help design targeted action plans as well.

Fragmented systems and varying stakeholders can make managed care a tough nut to crack. This complexity is elevated with the incapability to untangle the complex interaction between the payer, provider, and patient. Well-rounded and nurtured data, feeding into sophisticated analytics models, collectively generating intelligent and actionable insights, can provide competitive market access to account managers. Axtria has deep expertise in managed markets and detailed analysis, and our solutions help guide ‘where to play’ and ‘how to win’ strategies in a multi-stakeholder model. Coupled with an innovative BI tool that provides an integrated view of metrics and robust what-if analysis, Axtria has enabled account managers to drive profitability without taking the focus away from patient health and outcomes.

REFERENCES

1. Partha Anbil’s ‘Managed Markets: Positioning Your Product For Success with Pull Through Strategies,’ February 2014. Available at http://www.pharmexec.com/managed-markets-positioning-your-product-success-pull-through-strategies
2. Jeff Lagasse’s ‘Healthcare executives anticipate predictive analytics will save 15 percent or more,’ August 2018. Available at https://www.healthcarefinancenews.com/news/healthcare-executives-anticipate-predictive-analytics-will-save-15-percent-or-more