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Welcome!
Are payers restricting access to your products? Is patient cost-sharing affe cting your market share? Are physicians influenced by reimbursement when making prescribing decisions for your products – and your competition’s?
If you answered “Yes” to any of these questions, you’re not alone. Access and reimbursement have become important issues for most life science products, whether drugs or devices, small or large molecules, outpatient or inpatient therapies, and breakthroughs vs. me-toos. And both government and commercial payers increasingly are employing demand side (cost-sharing) and supply side (use rules) tactics to minimize their costs and discourage inappropriate use.
Welcome to the first edition of Managed Markets Insights, The Zitter Group’s newsletter of reimbursement, access, and payer issues. We’ve focused on these topics for more than 20 years. Our syndicated and custom research studies utilize the largest payer samples in the industry, and we complement the results with surveys of physicians, employers, hospitals, retail pharmacy, and others. Every other month, we will bring to you proprietary data on market developments and future prospects as well as advice into how to generate further insights.
I hope you find Managed Markets Insights
valuable. Feel free to share it with your colleagues. I welcome your comments and suggestions, and can be reached at mzitter@zitter.com.
Sincerely,
Mark Zitter
CEO
Methodology Corner
by Judy Wu
Analyst
In today’s fast-moving and competitive marketplace, has your organization questioned how to:
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Track category perceptions in anticipation of landscape-changing external events (e.g. entrance of a new product, changes in treatment guidelines, etc.)?
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Assess the impact of ongoing internal initiatives meant to shape attitudes towards and utilization of a specific product?
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Identify and refine compelling and relevant stakeholder messages in order to position a product for market success?
If so, conducting multi-wave quantitative research studies may be the appropriate method to help your organization address these questions.
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Oncologists and Payers - The Buy and Bill Model
by Kirk McConnell
Manager, Syndicated Studies
In an oncology category marked by steady change, there has been one constant dynamic: oncologists fight to protect the buy-and-bill business model and payers long to transition oncologists out of the drug business. However, even that fundamental relationship has started to change.
According to the Winter 2009 Managed Care Oncology Index, a semi annual study that looks at the oncology landscape through the eyes of 100 payers and 100 oncologists, 40% of oncologists would prefer that infused therapies be distributed through click image to enlarge specialty pharmacy providers. Furthermore, payers no longer see buy-and-bill as the ultimate evil; 36% of payers cite oncologist buy-and-bill as their preferred distribution channel for infused oncology therapies.
These findings bring up an essential question, what changes in the oncology landscape have transformed the value proposition of the buy-and-bill business model? The answer, ASP reimbursement methodology.
click image to enlarge
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Managed Care Research Throughout the Product Lifecycle
by Connie Lin
Sr. Manager, Strategy & Analytics
 click image to enlarge
As the US healthcare landscape continues to evolve, ensuring coverage and access are critical for pharmaceutical and biotech manufacturers to grow, to maintain utilization, and to continue to bring to market innovative therapies. Product teams can maximize their resources by identifying the key issues affecting utilization and focusing time and attention on these priorities. While some of these issues are specific to a given drug’s category and clinical considerations, others can be derived based on the therapy’s stage in the product life cycle.
During development stages, pharmaceutical new product planning teams must identify which therapies in the pipeline are worth bringing to market. Although there is the tendency to assume that market research is only valuable after the product has been launched and is beginning to face competitive threats, manufacturers will be best served by conducting market research earlier and integrating findings into product planning efforts. In this issue, we will briefly discuss market research that a team with a product in the developmental stage of the drug life cycle (drug discovery, Phases I, II) should prioritize.
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