Life Sciences

How far to push, how much to pull?

Medicare & Reimbursement Advisor Weekly, May 27, 2009

Editor’s note: Some of you have been asking about push/pull strategies lately. I thought this article written a couple years ago by our medical advisor, Michael Yanuck, MD, would be a good rerun. Dr. Yanuck’s contact information appears on p. 3.

Once you have managed care’s attention about your product, what can you do to ensure a successful approval process for your drug? Strategies vary; there are probably as many as there are managed care plans. The following are five strategies to consider.

1. Rebates. They always look attractive on the surface, but the devil is in the details. Are your rebates linked to using all of your company’s products? Are they based on favored tiering status? Are they based on exclusivity or certain volume targets? Whereas the pharmaceutical industry looks at these as essen- tial issues, many managed care plans look at rebates as roadblocks to getting products on the formulary. Many are beginning to shun the all-or-nothing rebate system, and this could adversely affect your entire product line. Also, companies are becoming more savvy about the net cost after rebate compared to other products, especially generics.

There are fewer classes of drugs today without a generic equivalent, which discourages the use of brand-name drugs, unless the net cost of these drugs is sufficiently competitive with the generics, allowing for tiering copayment differences.

2. Push/pull strategies. Is your company ready to partner with managed care organizations (MCO) to help educate their doctors as to the advantage of your product in the market? Are MCOs willing to conduct continuing medical education programs on the disease topic without having them sound like commercials? Are they available to work with the plan to put together literature (e.g., comparative dosing data) that helps the physician switch to this new drug from the existing plan drug if the plan makes your drug the preferred option? Not all managed care plans pursue this strategy. Some want no help at all from pharmaceutical companies; others will solicit help to work together, especially if this is a major formulary change.

3. Adherence programs. This approach is fast becoming the wave of the future, especially with high-cost medications (e.g., those for mental health; HIV; inflammatory disease, including asthma; and chronic conditions, such as hepatitis C). Plans are seeking compliance programs to ensure that the member is benefiting from taking the medication. If the medication is not being used, the member’s lack of compliance and adherence may cause:

  • Resistance
  • Expensive treatments to be less effective
  • Longer treatment times
  • Multiple courses
  • Cure failures
  • Significant medical cost for increasing

physician visits, ER treatment, and

hospital admissions

How can a pharmaceutical company help an MCO make sure that it is getting the bang for its expensive buck? One tip is to team up with one of the services that does reminder calls for patients.

4. Registries/data collection. Is your company available to help with obtaining and processing plan data in disease-specific registries and helping the plan collect quality information, pay-for-performance data, or Health Plan Employer Data and Information Set details? This is not to say that MCOs must depend on a pharmaceutical company for this information, but a partner to help with this would benefit many small managed care plans. This information, of course, would have to be personal health information blinded to the pharmaceutical company to ensure privacy compliance.

5. Disease management (DM): Support programs or literature that would comprehensively support a DM program. Many plans are looking for the best way to do DM. Some are employing passive programs to give the members literature about their condition. Other plans are trying the interactive approach, with a case manager making calls and doing one-on-one education of higher-risk members. Find out whether your company can fill gaps for plans. Some companies may embrace these ideas; others may hold pharmaceutical companies at arm’s length.

Feel out your clients and see where they fit, and where you can do the most to help.

Editor’s note: Dr. Yanuck is president of Michael Yanuck, MD, PA Medical Consulting. Contact him at myanuck@tampabay.rr.com.