MedSpan Musings — Tips for better market research

When conducting market research with the hospital pharmacy department, ensure that the right section is informing your actions.

While some hospital pharmacies limit their scope of practice to their individual hospital, others are responsible for the purchasing and management of drug therapies throughout the integrated delivery system.

• Pharmacy directors — Sets policy for operations, contracting, inventory management, and intra-delivery system distribution. The pharmacy director typical is a voting member of the P&T Committee, thereby influencing product selection.The pharmacy director tends to be the most knowledgeable among his or her staff regarding billing, coding and reimbursement for drug therapy. However, in our experience, the level of expertise in these areas varies between hospital pharmacy directors.

  Integrated delivery systems may have one pharmacy director for inpatient care and another for outpatient care. They report to a Vice President of Pharmacy. Standalone hospitals tend to have one pharmacy director.

• Clinical pharmacists — Are often stationed throughout the hospital. Share drug insights with other clinicians. Develop drug monographs for the P&T Committee. Each clinical pharmacist specializes in one or more disease categories (e.g., cardiovascular disease) or hospital patient care unit (e.g., emergency medicine).
• IV operations managers — Oversees compounding processes and clean rooms. IV operations managers are important respondents for studies involving IV therapies.
• Pharmacy buyers — Work directly with wholesalers and drug companies to execute the delivery system’s day-to-day buying practices.

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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).

Expansion towards Universal Coverage and Lifecycle Management

Healthcare reform is a 2000+-page legislation that could have a significant impact on the lifecycle management of pharmaceuticals, medical devices, and diagnostic imaging procedures.  Reading the legislation indicates that the following aspects of healthcare reform are of particular interest to healthcare manufacturers.

• Expansion towards universal coverage
• Funding expanded coverage
• Biosimilars
• Enhancing the quality of care
• Comparative effectiveness research
• Episodic and bundled payments
• Funding preventive care

Over the next few days, we’ll examine the various aspects of healthcare reform that fall into each category.  We’ll evaluate their impact on lifecycle management of pharmaceuticals, medical devices and diagnostic imaging procedures.  Our analysis will show that healthcare reform offers healthcare manufacturers many new levers to pull in their quest to maximize their return on investment.

Expansion towards Universal Coverage

In many ways, healthcare reform will move us towards universal coverage of all US citizens. 

• Medicaid expansion – Healthcare reform requires all states to expand coverage to everyone below 133% federal poverty limit (FPL).  This includes providing coverage for childless adults who meet the income limit.
• National insurance exchange – Healthcare reform will establish non-profit co-operatives where the uninsured and those who prefer to not use their employer-provided plans can purchase coverage.  Premiums will be set by the market.  The federal government will subsidize the cost of premiums for citizens who qualify based on income considerations.  Citizens with income up to four times the FPL will qualify.
• Elimination of preexisting condition exclusions – After 2013, health plans will not be able to deny coverage to applicants based on preexisting conditions.
• Coverage of all dependent children until 26 – All children, regardless of income or place of residency or marital status will qualify for coverage under their parent’s policy.
• Prohibit lifetime limits and annual limits on the dollar value of benefits for all beneficiaries – In today’s market, most health plans place an annual and lifetime limit on the benefits they will provide for medical and pharmacy coverage.  Healthcare reform will terminate those limits. 

These aspects of healthcare reform will have a significant impact on the lifecycle management of pharmaceuticals, medical devices, diagnostic imaging procedures and more.

• Increase in number of covered US citizens – The most obvious impact of healthcare reform is that almost all US citizens will have coverage for their healthcare costs.  Moving towards universal coverage leads to increased utilization of healthcare resources and a greater revenue opportunity for manufacturers. 

  However, on the flip side of the coin, the increase in the number of covered lives and healthcare resource utilization will drive health plans and the Centers for Medicare and Medicaid Services (CMS) to more closely manage costs.  For example, health plans will feel an increase in pressure to reduce the number of hospital admissions and emergency room visits, utilization of diagnostic imaging procedures and access to select drug therapies.

  The movement towards universal coverage, in conjunction with the wave of mergers and acquisitions among health plans, will increase the number of covered lives per health plan.  The increase in the number of covered lives per health plan increases each organization’s negotiation leverage with healthcare manufacturers.  That leads to downward pricing pressure for healthcare manufacturers.

  Moving towards universal coverage will increase the workload for physicians, hospitals and other providers.  Any pharmaceutical, medical device, diagnostic imaging procedure that saves time for the manufacturer will enable the provider to manage their workload.  This is a benefit that healthcare manufacturers can market to the extent that labor savings are documented by compelling data.

• Change in commercial plan demographics – Healthcare reform will lead to a change in the demographics of the lives that commercial plans cover.  For example, there will be an increase in the number of young adults who become covered by their parent’s policies.  Patients who previously were denied coverage due to a chronic disease will now have coverage.  Patients who suffer from diseases that are costly to treat, such as cancer, and exceed their annual or lifetime limits will now have continuous coverage.  These changes in demographics could affect the priorities that health plans assign to select disease states and how they manage the products and procedures used to diagnose and treat them. 

  This could enhance access to some healthcare procedures and products and, therefore, increase their utilization.  Conversely, changes in the demographics could reduce access to procedures and products and, therefore, increase their utilization.

• Change in Medicaid demographics – Raising the income limit to qualify for Medicaid coverage and allowing coverage of childless adults will change the demographics of Medicaid plans.  A significant number of new beneficiaries who previously were uninsured will be older and sicker than those currently covered by Medicaid.  Today’s Medicaid beneficiaries are primarily younger women and children. 

  For the same reason and with the same implications, some people currently covered by commercial plans will qualify for Medicaid coverage and convert.  Converting to Medicaid coverage will reduce the cost of coverage.

  Changing the demographics of Medicaid beneficiaries could lead to a change in priorities of for managing diseases and the emphasis on negotiating rebate contracts and managing access to products and procedures.  For example, after 2013, Medicaid plans could place a higher priority on managing cardiovascular and chronic diseases and a lower priority on managing schizophrenia.  Changing priorities for negotiating contracts could exert downward pricing pressure on some healthcare products and lessen pricing pressure for others.

  Covering older and sicker patients could improve the overall, historically-low Medicaid compliance rates.  This could enhance the utilization of products among Medicaid populations.

• Uninterrupted coverage – Upon implementation of healthcare reform in 2014, there will be uninterrupted coverage for patients receiving high-cost therapies due to elimination of lifetime and annual limits.  This is likely to increase the utilization of products and procedures associated with diseases that are very costly to treat.
• Elimination of the Medicare Part D coverage gap – Healthcare reform will gradually eliminate the Medicare Part D coverage gap by 2019.  This will enhance access to therapies for Medicare Advantage beneficiaries, which will drive their increased utilization.

In our next blog post, we’ll look at how healthcare reform will be funded and how that could affect lifecycle management of healthcare products and procedures.

Pharmaceutical Lifecycle Management and Healthcare Reform

Healthcare reform will have a significant impact on lifecycle management of pharmaceuticals.  As we will demonstrate over the next few days, healthcare reform will offer drug companies many new levers to pull to support the appropriate use of their drugs.  Healthcare reform is much, much more than expanding towards universal coverage.

First, let’s start with a definition of lifecycle management (LCM).    Based on conversations with many drug company marketers, lifecycle management is defined as maximizing a drug’s profits during its commercial life.  Almost all marketers suggest that a drug’s commercial life begins at launch and ends due to one or more of the following factors…

• Patent expiration of the branded drug and the launch of multiple generic competitors that cost significantly less than the branded drug.
• The launch of branded alternatives that offer a significant clinical and/or economic advantage.
• A change in treatment algorithm that shifts preference away from a branded drug.

LCM planning begins during Phase II or, more likely, early Phase III trials.  However, implementation of LCM strategies and tactics begins after the drug’s launch.   Implementation begins at that time as, after launch, a drug demonstrates its commercial viability, the potential return on investment (ROI) from additional investments and the needs of clinicians and patients outside of a controlled environment (ie, clinical trials). 

Most LCM strategies and tactics are implemented within a few years after a drug’s launch as that provides time to generate a sufficient ROI.  Many LCM strategies (eg, clinical trials) take many years to plan, implement and yield an acceptable ROI. 

Many attributes of LCM differ significantly from those of day-to-day marketing

Lifecycle Management	Day-to-Day Marketing
Starts years prior to drug launch	Starts one year prior to drug launch
LCM focuses on long-term strategic positioning	Day-to-day marketing focuses on such short-term issues as… n  Increasing quarter-to-quarter sales. n  Driving increased awareness of a drug. n  Sales training. n  Supporting sales as it addresses day-to-day customer issues. n  Developing educational programs that facilitate utilization of the drug. n  Positioning a drug compared to therapeutic alternatives.
Multi-disciplinary	Mostly self-contained within the marketing department
Global focus to maximize ROI	Regional focus (eg, U.S., Europe) to meet local healthcare needs

 

Lifecycle management is a complex initiative and some drug companies dedicate staff to planning and implementing LCM initiatives.  Other drug companies assign LCM responsibilities as part of a marketer’s overall responsibilities.  With either approach, the long-term success of a product requires spending sufficient time and creativity to develop winning LCM strategies.