Build Cross-Functional Support for Medicaid Pricing Activities

Sarah Ray, regulatory affairs and safety researcher
By Sarah Ray,
Senior Research Analyst

According to a Cutting Edge Information study, attaining favorable Medicaid pricing remains a key factor in life science companies’ market access preparations.  Broadly, government payer acceptance often sets the precedent for whether private payers will reimburse company products or not. Unsurprisingly, private payers are less likely to support products that fail to meet government approval. As one market access advisor explained, “Failure to receive Medicaid coverage is like a kiss of death for company products.”  Subsequently, market access teams work diligently to ensure that drugs attain Medicare and Medicaid reimbursement. Continue reading

Great Moderators Key to Pharmaceutical Advisory Board Success

Jacob Presson, pharmaceutical market access researcher
By Jacob Presson,
Senior Research Analyst

Pharmaceutical companies are evolving their advisory board strategies to keep pace with the rapid changes that the entire industry is experiencing. As payer demands increase in complexity, the importance of engaging payers to understand their needs is growing. The depth of outcomes data that payers need requires precisely targeted clinical trials to be effectively developed to meet these needs. As such, when a team is able to gather a roomful of experts together, the benefits from that time need to be maximized for both the participants’ and the company’s sake. One significant — and relatively simple — step that companies can take is to ensure that the moderator or co-chair is up to the task. Continue reading

Ideal Criteria for Finding Top-Notch Health Outcomes Liaisons

With the expanding emphasis on building payer relationships and demonstrating product value, health outcomes liaison and managed care liaison teams are more important than ever.  The first step to building a strong payer liaison team is to find the right HOL candidate. However, finding these candidates is difficult due to the unique combination of skills necessary to this role.  Companies must focus on the right blend of education, experience and training to ensure they have a strong payer liaison team. Continue reading

Want Top Formulary Postions? You’ll Need a Well-Armed Payer Liaison Team

Payer meetings are crucial to drug success.  Payer liaison teams, whether they consist of health outcomes liaisons (HOL), managed care liaisons (MCL), or any other medical/economic expert team, must convince payers of their drugs’ superiority to achieve top formulary positions and maximum patient access.  If they’re lucky, these teams will be allowed to visit with payer organizations once per quarter and often for only about an hour.  Facing such a pivotal reimbursement decision, the liaison teams must come well-armed. Continue reading

Managed Care Liaisons Provide Growing Support to MCOs

By David Richardson,
Research Manager

At the recent World Congress event, “Thought Leader Engagement, The Role of Medical Affairs and Medical Science Liaisons in the Era of Healthcare Reform,” one of the topics of conversation revolved around how many pharmaceutical companies now deploy managed care liaisons to meet the specific needs of managed care organizations (MCOs).  These groups increasingly serve a role similar to MSL relationships with doctors and health outcomes liaisons (HOLs) with payers – providing medical and health economics support to MCOs that they generally cannot get from commercial teams. Continue reading

Advisory Board Functions Expanding in Pharma Industry

By Jacob Presson,
Research Analyst

Advisory boards have been part of the pharmaceutical landscape for a long time, providing companies with valuable expert opinions on topics ranging from ensuring thorough regulatory submissions to clinical trial protocols.  This role does not look to fade anytime soon, as regulatory requirements get tougher and payers look for ever more clinical data and health outcomes to prove the value of products on the market.  Many companies are working to create a cohesive advisory board strategy that encompasses which groups are best suited to handle the responsibility of coordinating advisory boards and how to achieve a useful deliverable out of a board meeting. Continue reading

Projected Impact of ACA Legislation on Unpaid Hospital Bills

According to the American Hospital Association, hospitals nationwide remain liable for up to $41.1 billion in unpaid healthcare costs annually.  This cost is up from the recorded amount of outstanding costs in 2010 ($39.3 billion).  Currently, Jack Hadley, senior health services researcher at George Mason University, estimates that the government ultimately foots the bill for up to 75% of hospitals’ uncompensated care costs. Continue reading

New Product Planning Adapts to Payer Demands

Before prospective pharma products are even knee-deep into development, new product planning teams are tasked to start thinking about their commercialization. Tightening payer budgets and shifting reimbursement requirements are forcing teams to emphasize the value and cost effectiveness of a drug.  FDA approval isn’t the primary criterion anymore — a new drug must be markedly better, both clinically and economically, than drugs already on the market.  New product planning teams must update their strategy if they want their drug to nab a superior spot on formularies.  One new product planning executive that we interviewed asks himself, “What can new product planning add to get market authorization, market access and also market differentiation?” Continue reading

HEOR Valuable from Lab to Launch

In this harsh reimbursement environment, payers are looking beyond a drug’s efficacy and to its cost-effectiveness when approving drugs for their formularies.  To adapt to new payer demands, pharma companies are incorporating health economics and outcomes research (HEOR) early in clinical development, gathering valuable data they use when submitting their products for reimbursement.  Right now, payers are in the driver’s seat when it comes to reimbursement discussions.  Pharma companies must consider both the medical and economic value of drugs as early as possible during development to present a convincing case—which is where HEOR teams come in. Continue reading

The Global Expansion of Medical Science Liaisons

Significant changes to medical science liaisons’ roles and expectations in the past 15 years have underscored the value MSLs bring to their organizations. MSLs not only provide access to highly influential physicians and medical researchers, but they also bring exposure to key healthcare decision-making bodies, such as payers. Our latest research into MSL operations found that the payers’ role in healthcare decisions is one factor fueling MSLs’ global expansion. Continue reading