MedSpan Musings — Tips for better payer market research

MedSpan Musings — Tips for better payer market research  

The benefit covering a drug is not always obvious

When discussing benefit coverage of drugs with payers, remember that some health plans at first cover drugs under the medical benefit and then transfer those costs each month to the pharmacy benefit. Be sure to probe for this approach and its implications for drugs administered in physicians’ offices and alternate sites of care.

Advertisement

Payer 101: Three things every healthcare market researcher should know

How much do you know about the U.S. health insurance landscape?

In this post, we’ll discuss three basic aspects of U.S. health plan payers: type, geography, and size. Understanding these aspects will help you design a study sample that is representative of your market.

Here’s a MedSpan Research tip!

Clinical pharmacists are a good deal for drug companies’ market research. Consider clinical pharmacists as respondents when needing clinical insights regarding a new drug. Remember that health plan and some hospital-based clinical pharmacists specialize by drug class. Other hospital-based clinical pharmacists specialize by patient care unit (e.g., emergency department, ICU).

Compensation Specialists Via Episodic Payments Lowers the Cost of Care, According to Study

Compensating oncologists via episodic payments lowers the cost of care significantly compared to FFS payment.

Welcome back!

Well, it’s been a while since we’ve posted to our blog.  While we enjoy sharing thoughts with everyone, client work has taken priority.  We’ve just been too busy.

While our client work has not slowed down, we have missed our blog too much.  Therefore, we will continue sharing ideas with others to promote positive discussion.

Over lunch recently, a colleague asked me which sectors of the healthcare industry are growing quickly.  In contrast to the 1990s, when many segments were rapidly expanding, we could only identify one: healthcare IT.  Manufacturers of new drugs, medical devices and imaging technologies are fighting for market share in crowded fields with diminishing reimbursement. 

For example, a drug company just received FDA approval for another blood pressure medication.  A relatively costly branded medication is entering a very crowded market niche that offers a wide variety of generic alternatives.  How will this manufacturer gain enough market share to earn a return on its investment in research and development?  From a societal standpoint, why should payers reimburse the cost of this therapy when the primary issues with managing blood pressure are dietary management and therapy compliance?  No matter a drug’s clinical advantages if patients do not take their drugs for more than 6 to 9 months at a stretch.

Healthcare innovation is in a trough.  Many of the diseases that present obvious opportunities for new products have been addressed.  But, as always, the creativity of dedicated scientists will persist, resulting in new ideas and advances. 

In the meantime, how do we address healthcare’s other priority: reducing the cost of care?  Over the next few days, we’ll share some ideas.  Some of the ideas are variations on traditional approaches.  Others are simple but require the industry to go in a different direction.  We look forward to sharing our thoughts and hearing your feedback over the coming days.