How Pharma Can Improve Access to Patients

Feb 14, 2013
Pharmaceutical manufacturers can have greater access to patient populations if they respect the cost/benefit equation and follow these six recommendations.

In a forum last fall, pharma marketing leaders focused on access to patients in a managed-care environment as a top challenge facing their industry. The forum host, Medical Marketing & Media, invited Express Scripts to respond with an article about how pharma can address this challenge from a PBM viewpoint.

In the past, drug marketing primarily targeted physicians because commercial success was determined by whether they prescribed one drug over another. Pharma then found that direct-to-consumer campaigns could greatly influence script-writing. But starting in the late 1990s, the old marketing channels had limited success, as access to patients was increasingly controlled by managed care, including PBMs.

Given this shift, here are the six things that I suggested would enhance drugmakers’ access to patients through PBMs.

  1. Develop new medications with truly better efficacy or outcomes. This may seem obvious, but last year, the Food and Drug Administration approved only 39 new brand drugs, including two diagnostic agents. Of those, 23 were unique new therapies, and 14 were “me too” drugs.

  2.  Be honest with yourselves about the relative value of your drug. Understand what matters to the decision-makers, and ask if you make a difference in those criteria.

  3. Understand how your drug will fit in therapy. A drug may not replace the front-runner but may have value for second-line therapy. In that case, expect – indeed, embrace – the need for a step therapy edit. Payers want novel and improved treatments, but we also want second and third agents because they lower therapy costs. Be aware, though, that if you are the second or even fifth agent to market, success will be tied to pricing.

  4. Show us data that are useful. How well your drug compares to a placebo doesn’t do much. We are suspicious of proxy measures and assumptions about the costs of a disease that are not based on actual incurred medical expenses. Tell us how your drug compares to the standard of therapy. Demonstrate actual improvements in outcomes or new outcomes that are meaningful to patients.

  5. Start working with the payer community well before the expected product launch. Before you make final decisions on marketing and pricing, seek feedback about the value points for the payer, the likely place in therapy and how we expect to see it priced.

  6. Work with us, not around us. For example, direct-to-consumer advertising – encouraging patients to pressure their physicians’ script-writing, often to the detriment of the payer – drove the adoption of both prior authorization and step therapy. Similarly, the use and abuse of copayment cards has begun a backlash of closed formulary classes and limitations on nonpreferred drugs.

The road to successful marketing of pharmaceuticals has passed through physicians and then patients and entered the territory of payer influence. Those able to let go of old pathways and pioneer new ones will have the most success.

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