Market Access in Today's Healthcare Environment: Successfully Navigating the Payer Landscape
Pharmacy Coverage is administered by a select few payers. As a result, Pharmacy Benefit Managers (PBMs) control the prescription drug reimbursement marketplace and can place barriers to the distribution and/or reimbursement of any pharmaceutical product. In this white paper, we will address how to successfully navigate these challenges to help the C-suite management team and other company brand champions put in place an effective payer strategy with tactics based on research, data and payer relationships.
We will discuss how relying on a strategic market access partner can help established and emerging pharmaceutical clients get a foothold and grow with US payers. In so doing, we will address such challenges as:
How the consolidation of US payers is impacting formulary access. Four large Pharmacy
Benefit Manager payers (PBMs) CVS/Aetna, Express Scripts/Ascent/Cigna, United
Health/Optum Rx, Prime Therapeutics represent 78 % of the total market for prescriptions.
Addressing inflexible contract terms by large PBMs.
How to deal with cost pressures from minimum guaranteed rebates (Gross to net pressure).
Overcoming unrealistic vs. realistic formulary position within the first year.
Prevailing over new to market blocks.
Rebate processing and government reporting needs.
Establishing the strategy and tactics to win with payers.
Armed with this information, you can consider the cost and timing of building an internal payer team versus outsourcing to an experienced market access team to successfully navigate the payer landscape.