Market Access and Commercial Excellence in Managed Markets

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November 2016
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Commercial strategies for successful US managed market access

Employ effective commercial strategies for optimal formulary position, pricing and reimbursement in US managed care markets.

Healthcare reforms, consolidation of health insurance markets and the rise of ever more powerful Pharmacy Benefit Managers (PBMs) has expanded the number of insured lives and exerted downward pressure on prices.  What commercial strategies can pharma employ in this fiercely competitive environment to meet the needs of all stakeholders, secure market access and still make a profit?

Report Overview

To fully understand the US managed market dynamics and successfully negotiate the many communication and commercial hurdles, turn to this expert views report Market Access and Commercial Excellence in Managed Markets.

Report Features

  • In-depth interviews with managed care experts in leading companies reveal unique insights gained from their frontline experience
  • US pharmacy distribution and reimbursement system schematic diagram
  • Chart of PBM market share by total equivalent prescriptions
  • Chart of development timeline of critical commercial excellence ‘must haves’
  • Chart of business models and formulary status for generics, branded, specialty and biosimilar products
  • Table of real world evidence sources used by Integrated Delivery Networks (IDNs), Managed Care Organisations (MCOs) and PBMs
  • Extensive secondary research that puts expert commentary into a wider market context
  • At-a-glance summaries of all the main insights

Key Benefits

  • Understand how health reforms, and particularly Obamacare, have fundamentally altered access to the US insured health market
  • Know how consolidation among health payers is impacting pricing, availability and pharma’s ability to negotiate
  • Appreciate how the trend to value based contracting is changing the conversation between pharma and payers
  • Develop multi-disciplinary managed market teams that can build lasting payer relationships and deliver the clinical messaging and meaningful evidence to support products and their use
  • Understand how business models must be adapted for specialty, branded, me-too, generic and biosimilar products
  • Gain competitive advantage by knowing the clinical, scientific and stakeholder inputs that are important to payers when making their formulary choices.

Report available for immediate download -- place your order today

Key Questions Answered By This Report

  • Fundamental change: How have health reforms driven consolidation of insurers and what have the consequences been for pharma?
  • PBMs: CVS Caremark, Express Scripts and UnitedHealth Group control over 75% of the PBM sector – what do they want if optimum formulary placement and price are to be granted? 
  • Patient Assistance: Are you making the most of patient assistance and co-pay assistance programs in the managed care space? 
  • Value based contracting: How can pharma harness real world data and outcomes evidence to support and differentiate its products when negotiating value-based contracts with payers?
  • Prescribers: How can managed market teams engage KOLs and high-value prescribers to ensure wide patient access in managed care environments?
  • The Team: What does a multi-disciplinary managed market account team look like and what are the key skills needed?

Find answers to these and many more important questions — download the report today

Expert Views

To ensure candid views were expressed, some expert names have been kept anonymous, but each has been selected for their experience and detailed current knowledge of managed market issues and challenges.
  • Jeffrey Carbone, Vice President, Payer Strategy, HealthCare Destinations
  • Don MacDonald, Senior Director, Managed Markets, Pernix Therapeutics
  • Steve Sandor, Vice President, Market Access Strategy and Policy, Acorda TherapeuticsManaged care executive, leading CRO
  • Managed care executive, leading US payer company 
  • Managed market expert, large US pharma company
  • Managed market expert, start-up pharma company
  • Managed market expert, leading pharma company

3 Key Quotes

“Hiring the right people, that's really what it comes down to. You can have the greatest strategy in the world but if you don’t have the spokesperson there to be able to verbalize and to do it competently, that makes a huge difference. We are in a money-driven business; it's all about results, meeting expectations, and being able to be the front person to say why it's right is the main thing.”
Managed market expert, pharma start-up company

“Commercial excellence is a differentiator for a company and the quality of the product. Many mid-sized pharmaceutical companies have hired some extraordinary people and they do an exceptional job and have a unique approach to this.”
Managed care executive, leading US PBM  

“We’ve seen a rise in the power of the pharmacy benefit managers, the PBMs – there’s only a few in the US managed market but essentially if you don't do business with Express Scripts, then your product's not going to be very successful. Publically they'll chastise high drug prices but behind the scenes, they're getting a percentage of the cost of the drug.”
Managed market expert, large US pharma company

Critical insights from these and many other respected experts available for immediate download —place your order here

Who Would Benefit from This Report?

  • Teams spearheading managed market access programmes
  • HEOR professionals building evidence and proving product value
  • MSL teams needing to communicate clinical benefits to KOLs and prescribers
  • KAM teams charged with presenting inclusive commercial propositions to payers 
  • Health insurance, PBM, IDNs and managed care organisations assessing, influencing or controlling formulary selection and drug usage.

Report available for immediate download — place your order here

Content Highlights

  • Executive summary
  • Setting the scene
  • How do we define managed markets?
    • Key players in the managed markets
  • Impact of healthcare reform on the managed markets
    • Growth in managed care
    • Consolidation in the industry
    • Power of the PBMs
    • Rise in specialty pharma
    • Affordability
  • Commercial excellence in managed markets
    • Commercial excellence
    • Relationship building
    • Multidisciplinary account management teams
    • Medical affairs reaches beyond MSLs
  • Targeting providers
  • Adaptable business models
    • Generic drugs
    • Branded and ‘me too’ drugs
    • Specialty pharma
    • Biosimilars
  • Managing stakeholder expectations
    • Market research
    • Risk-sharing agreements
    • Value-added services
  • The future: challenges and opportunities
    • Factors impacting the delivery and costs of healthcare
    • Adoption of new disruptive technologies
    • Value-focused pipelines and diagnostics
    • Pay-for-performance for long-term benefits

This critical intelligence is available for immediate download —order your copy here

Need more information? Contact a consultant for an executive summary and sample pages from the report.

Get this report now

Commercial strategies for successful US managed market access

Employ effective commercial strategies for optimal formulary position, pricing and reimbursement in US managed care markets.

Healthcare reforms, consolidation of health insurance markets and the rise of ever more powerful Pharmacy Benefit Managers (PBMs) has expanded the number of insured lives and exerted downward pressure on prices.  What commercial strategies can pharma employ in this fiercely competitive environment to meet the needs of all stakeholders, secure market access and still make a profit?

Report Overview

To fully understand the US managed market dynamics and successfully negotiate the many communication and commercial hurdles, turn to this expert views report Market Access and Commercial Excellence in Managed Markets.

Report Features

  • In-depth interviews with managed care experts in leading companies reveal unique insights gained from their frontline experience
  • US pharmacy distribution and reimbursement system schematic diagram
  • Chart of PBM market share by total equivalent prescriptions
  • Chart of development timeline of critical commercial excellence ‘must haves’
  • Chart of business models and formulary status for generics, branded, specialty and biosimilar products
  • Table of real world evidence sources used by Integrated Delivery Networks (IDNs), Managed Care Organisations (MCOs) and PBMs
  • Extensive secondary research that puts expert commentary into a wider market context
  • At-a-glance summaries of all the main insights

Key Benefits

  • Understand how health reforms, and particularly Obamacare, have fundamentally altered access to the US insured health market
  • Know how consolidation among health payers is impacting pricing, availability and pharma’s ability to negotiate
  • Appreciate how the trend to value based contracting is changing the conversation between pharma and payers
  • Develop multi-disciplinary managed market teams that can build lasting payer relationships and deliver the clinical messaging and meaningful evidence to support products and their use
  • Understand how business models must be adapted for specialty, branded, me-too, generic and biosimilar products
  • Gain competitive advantage by knowing the clinical, scientific and stakeholder inputs that are important to payers when making their formulary choices.

Report available for immediate download -- place your order today

Key Questions Answered By This Report

  • Fundamental change: How have health reforms driven consolidation of insurers and what have the consequences been for pharma?
  • What are the commercial benefits? Are there key metrics to have in place to keep track of progress? What does success look like?
  • How is the concept of patient centricity similar to ethics within pharma? What can be learned from reviewing how an ethical stance is accepted and embedded across the business?
  • When does the patient become most important? At what point in the product lifecycle should pharma seek to engage patients? How should engagement take place?

Key Questions Answered By This Report

  • Where does 3D printing belong? Is it just in R&D and prototyping or are there real opportunities in manufacturing? Ultimately, how likely is decentralisation of manufacturing in the long term?
  • PBMs: CVS Caremark, Express Scripts and UnitedHealth Group control over 75% of the PBM sector – what do they want if optimum formulary placement and price are to be granted? 
  • Patient Assistance: Are you making the most of patient assistance and co-pay assistance programs in the managed care space? 
  • Value based contracting: How can pharma harness real world data and outcomes evidence to support and differentiate its products when negotiating value-based contracts with payers?
  • Prescribers: How can managed market teams engage KOLs and high-value prescribers to ensure wide patient access in managed care environments?
  • The Team: What does a multi-disciplinary managed market account team look like and what are the key skills needed?

Find answers to these and many more important questions — download the report today

Expert Views

To ensure candid views were expressed, some expert names have been kept anonymous, but each has been selected for their experience and detailed current knowledge of managed market issues and challenges.

  • Jeffrey Carbone, Vice President, Payer Strategy, HealthCare Destinations
  • Don MacDonald, Senior Director, Managed Markets, Pernix Therapeutics
  • Steve Sandor, Vice President, Market Access Strategy and Policy, Acorda TherapeuticsManaged care executive, leading CRO
  • Managed care executive, leading US payer company 
  • Managed market expert, large US pharma company
  • Managed market expert, start-up pharma company
  • Managed market expert, leading pharma company

3 Key Quotes

“Hiring the right people, that's really what it comes down to. You can have the greatest strategy in the world but if you don’t have the spokesperson there to be able to verbalize and to do it competently, that makes a huge difference. We are in a money-driven business; it's all about results, meeting expectations, and being able to be the front person to say why it's right is the main thing.”
Managed market expert, pharma start-up company

“Commercial excellence is a differentiator for a company and the quality of the product. Many mid-sized pharmaceutical companies have hired some extraordinary people and they do an exceptional job and have a unique approach to this.”
Managed care executive, leading US PBM

“We’ve seen a rise in the power of the pharmacy benefit managers, the PBMs – there’s only a few in the US managed market but essentially if you don't do business with Express Scripts, then your product's not going to be very successful. Publically they'll chastise high drug prices but behind the scenes, they're getting a percentage of the cost of the drug.”
Managed market expert, large US pharma company

Critical insights from these and many other respected experts available for immediate download —place your order here

Who Would Benefit from This Report?

  • Teams spearheading managed market access programmes
  • HEOR professionals building evidence and proving product value
  • MSL teams needing to communicate clinical benefits to KOLs and prescribers
  • KAM teams charged with presenting inclusive commercial propositions to payers 
  • Health insurance, PBM, IDNs and managed care organisations assessing, influencing or controlling formulary selection and drug usage.

Report available for immediate download — place your order here

Content Highlights

  • Executive summary
  • Setting the scene
  • How do we define managed markets?
    • Key players in the managed markets
  • Impact of healthcare reform on the managed markets
    • Growth in managed care
    • Consolidation in the industry
    • Power of the PBMs
    • Rise in specialty pharma
    • Affordability
  • Commercial excellence in managed markets
    • Commercial excellence
    • Relationship building
    • Multidisciplinary account management teams
    • Medical affairs reaches beyond MSLs
  • Targeting providers
  • Adaptable business models
    • Generic drugs
    • Branded and ‘me too’ drugs
    • Specialty pharma
    • Biosimilars
  • Managing stakeholder expectations
    • Market research
    • Risk-sharing agreements
    • Value-added services
  • The future: challenges and opportunities
    • Factors impacting the delivery and costs of healthcare
    • Adoption of new disruptive technologies
    • Value-focused pipelines and diagnostics
    • Pay-for-performance for long-term benefits

Get this report now