Mary Jo Laffler: All right. Thank you for joining us today. This webinar is the third in a series. So if you haven’t had a chance to watch the recording of the last one, Reducing Risks Five Steps for a Fearless Launch, you can access that recording on the registration page for this webinar, catch up. My name is Mary Jo Laffler. I’m the US Executive Editor of Script and I’ll be serving as your moderator today. I’m joined by two market access experts, Jason Sarber, who is a member and team leader with our client partnership group and Carolyn Zelli, one of our senior solution consulting advisors. Today we will be focusing on what to expect during your launch year. First of all, we know that you won’t be sitting back and waiting until the end of the year to understand how your brand performed. These months will no doubt be full of a lot of tracking and evaluation.
Carolyn, what’s the most important focus for the first year of launch?
Carolyn Zele: Thanks, Mary Jo. One of your top priorities is your ability to accurately track your uptake. You’ve done all of the planning up to this point, right? Really well and you’re now running full speed toward your goals. If you watched our last webinar webinar, you might remember YOLO. You only launch once. You get one shot to kill it in your first year so that you can get that promotion. Now you want to be able to measure actual uptake, actual utilization, actual sales, and actual profit. It’s no longer just a waiting game. Your plan is actually in place. It is happening right now. If something goes wrong and it will. If something unexpected happens and it will, you need to fix it before it affects your forward momentum. That’s really important. Make sure you have the tools in place to examine and report on progress at any time.
Monthly tracking probably isn’t enough in your first year. Weekly tracking is what you need right now. So you can stop and say, “We’re not meeting our goal. What’s wrong? Let’s quickly diagnose it and take action before we measure again. Right now, treat your drug like a patient. Know how it’s progressing. Be able to diagnose problems and setbacks and come back to your team with answers and additional treatment if needed. Sometimes the problem you face is going to be promotion. Your promotion didn’t hit the mark to whichever group you’re promoting to at the time and the demand you expected hasn’t materialized. You may see that your payer strategy didn’t hit the mark and now you’re sitting behind some restrictive utilization management. Maybe doctors aren’t prescribing because of real or perceived excess challenges. What do you do? How do you combat that? Sometimes every building block was put in place correctly, but physicians just simply aren’t prescribing.
There’s a reason they’re not prescribing. Now you’re going to have to go find it.
Jason Sarber: Yeah, that’s a great point, Carolyn, and specifically around the access piece. Long before PDUFA, the entire team and organization has been monitoring payers, monitoring IDNs, looking at pathways, trying to build and set up a strategic plan and goals to achieve in the first year post-launch. And for many manufacturers, much success is achieved. And in some cases, as you mentioned, sometimes success is not achieved. And your ability to react quickly to different market variables and different decisions is really the key to ensuring that first year of launch is successful. As a former account director, I can remember launching a product being first to market. We thought we had a great value store. We thought we knew exactly the pillars in which we needed to present to payers and to garner the access that we needed. We had early success, but we had a competitor right on our heels.
That competitor launched. They took a little bit different of a strategic tactic. They contracted for different utilization metrics. They were faster to react to the market and surpassed us and we never were able to change our value story quick enough. We were never able to really regain that market share. And it just illustrates that you have to be looking and watching and monitoring and tracking, whether it’s payers, the IDNs, your HCPs, all of that at once and then being able to react very quickly and change your value story so that you can change maybe a trajectory of less than what is expected to greater than what is expected.
Carolyn: Jason, at the risk of repeating myself, you only launch once. You better know what you’re doing and you lived that. Better know what you’re doing and have the tools in place to be able to diagnose it and help. You’re right, you could have the best plan and the best strategy in the world, but if you’re not measuring every step of the way during that first year, chances are you’re going to fail. Something you didn’t expect is going to happen. That competitor brand that you thought wasn’t going to come out for two years, guess what? They got fast tracked and they’re now coming out after phase two next month because it’s breakthrough medication and there’s a huge unmet need. You’re no longer the shiny new drug in the market. Your competitor is now and you need to be able to quickly adjust to that competitive pressure.
Mary Jo: Absolutely. So let’s start talking a bit about the patient journey and prescriber behavior. First and foremost, providers have to be ready and willing to prescribe your drug. What does your team need to do? What does your team need physicians to know in that first year?
Carolyn: Physicians have to know the product is ready to be prescribed. They have to know how to treat patients. What’s the dosing? They have to know that it’s available and stocked at the pharmacy or on hand in the office and they have to understand the path to access. They need to know what to do to get their patients on therapy and the more details that we can provide physicians, the better off we’re going to be. Tracking prescriber behavior is really important. We want providers to feel confident writing scripts for our new drug. And if they’re not confident, we need to know who isn’t, who specifically isn’t confident so our sales reps and FRMs can be out there talking to these physicians increasing their prescribing competence. Multiple decision makers are going to influence what therapy the patient goes on. If you look at the slide, the physician has to decide to prescribe a drug.
This is the right drug for my patient right now. The health plan has to cover the drug, which means the payer has to have already determined how they’re going to cover the drug. And we have to be able to explain to the prescriber how our drug is covered for the patient, what they need to do to get the script filled and then the member has to actually go fill the prescription. And now that we’re talking about the member, we also want to understand patient behavior as it relates to our drug. Will they be coming to their HCP to request the drug? Are they reluctant to talk about symptoms? I had a client who had a drug in the women’s health space and they couldn’t understand why it wasn’t being prescribed more. And quite frankly, at the end of the day, what they found out with it was that women were afraid to talk to their doctors about what they were experiencing because their doctors weren’t addressing their needs prior to this drug coming out.
Changing that, changing that behavior, putting maybe advertising in place to help patients feel comfortable that they’re not alone. That’s really important. Understanding the barriers. A prescription can’t be too expensive to fill either or else the patient is going to abandon the treatment and walk away from the pharmacy. And that’s the last thing you want to have happen. Looking at real world claims data may help illuminate where the barrier is in that process. There’s still plenty of manufacturers whose sales reps don’t actually provide detail on access, which unfortunately is mind-boggling to me. They assume that payers are going to cover the product anyway, so it’s not a problem. I was talking to one manufacturer who said they don’t want their reps talking about access because every prescription is going to require a prior authorization. Even if that’s true, sometimes all the doctor needs to know is how easy it is to fill that PA.
What is the ease of access? If there’s a PA that’s required, tell the doctor there’s going to be a PA required, but it’s a short form. It’s a one-pager. It’s easy to answer the questions. They don’t need to have supporting documentation. A specialist doesn’t need to do the prescribing. Knowing those details will help the physician’s office know what to expect, how much of an administrative burden to expect. And if it’s a low administrative burden, tell them that so that they can navigate the process and be more apt to prescribe.
Mary Jo: Great. Thank you. So it is important to arm your sales rep with not only the right messaging, but also the relevant coverage details for each provider. Jason, what do you need? What do you think is necessary to tell physicians in order for them to write prescriptions for your drug?
Jason: Yeah, great question. First and foremost, your sales reps have gone in and they’ve established the efficacy of the brand, the value to the patient, but the physician then as Carolyn mentioned, needs to understand how do they go about getting access for that particular patient, whether it is a prior authorization, whether it is a step edit, a double step edit. Are there specific patient lab results or BMI or other tests that they must require in order to get therapy? So there’s a lot that has to be discussed with the physician and/or the office staff, the nurse who’s helping that patient and reps need a really easy way to give themselves both confidence and the information they need to successfully have that conversation. And so with MMIT’s covered search and with MMIT’s FormTrack and Veeva, we provide two very distinct platforms for sales reps to have a confident conversation where they can walk the physician through not only the formulary status, not only what the prior authorization form maybe looks like, what are the requirements, but even potentially the policy document itself or the actual PA document itself.
We really arm that rep to be successful in pulling through that access. Your teams have worked really hard to contract and negotiate the access in which you’ve gotten for your brand and you’ve got to be able to successfully pull that through. So both Covered Search and FormTrack and Veeva provide that opportunity for your sales reps in front of the physician or the office staff.
Carolyn: Yeah, Jason, that’s a great point. FormTrak in Veeva with maybe forms inclusion in there with the PA forms included with the sell sheet is a great tool to show the physician specifically what has to be done. And then it might be an easy conversation. And of course it might be with an FRM instead of a sales rep. But when the FRM is talking to the physician, look, here’s the PA. There’s only three boxes you have to check. The step requirement is standard of care over the counter product. Your patients probably already tried this before they even come see you, so that’s not a problem. Handing them the PA form could make it really easy. Let’s say you’re the ninth drug that’s launched in a market and you’re triple stepped from the top three payers. If those payers have step exceptions in place, you can explain to a provider’s office that there are ways to satisfy the step without actually having to try all three of those previous drugs.
An example is just writing on there, “My patient cannot be on these other IVIGs because of this reason can satisfy the step. That’s a step exception. There’s ways to get that approved without having to have to have the patient try a previous drug. Of course, you always want your sales reps to stay compliant. So some of these conversations don’t happen with the sales rep. They might happen with your FRM or with your medical science liaison, but all the teams can be armed with the same information so that any one of these team members can have a compliant conversation with the doctor’s office.
Mary Jo: So we’ve been talking about engaging physicians in person, but let’s also talk about non-personal promotion, which can be just as important.
Jason: Yeah, absolutely. Maybe in some respects, even more important in certain parts of the country, in certain geographical areas, certain rep territories, because as we all know, access has gotten harder and harder. Going back to my days as a sales rep and a district sales manager, access was relatively strong, but each and every year it gets worse and worse to the point now where over 50% of physicians have said they see three or less reps and that’s it. So you have to be able to get your message across to HCPs in a nonpersonal, promotional way. And as it relates to access coverage, we know that patients have more health literacy these days. We know that patients are more interested in their out- of-pocket deductible, out- of-pocket expense. They have a more awareness around their prescription coverage. So what do they do? Patients go straight to Google or they go straight to the brand website.
They want to find out, is this treatment A, right for me? And if it is and my physician agrees, then what’s it going to cost me? What’s it look like from a coverage perspective? And so with MMIT’s patient and HCP coverage finder tool, that can be embedded in the brand website. It can be a part of the workflow, the patient journey, the patient’s exploration as to where they’re covered and how much they’re going to pay. They can enter their insurance plan. We can pull up directly from the MMIT database on what that coverage is, maybe what prior authorization is needed. On the HCP website version, we can get very specific, again, including forms, including the prior authorization forms. So really helping both the patient and the HCP provider understand access when your rep can’t physically get in there or your FRM can’t physically get in there to help them.
This gives an alternative a way for them to get the information that’s needed.
Carolyn: That’s a great point, Jason. In addition to the brand websites, you may want to share brand updates and key information in different ways in different channels. HCPs ultimately need to know about a brand’s efficacy and safety data, whether or not their patients will be covered and any product differentiators. We find that this type of information may be best conveyed when an HCP is leaning forward looking to learn. Our sister company, Skipta, has a great collaboration tool, which is a private and secure platform where verified HCPs can collaborate. You have to have an NPI to log in. So it’s a great spot to serve up relevant contact to those HCPs while they’re already spending time in a condition specific community. When our pharma clients give us a target list, we can segment that community by prior contact. So we can stack different messages for HCPs who have not met with a sales rep versus HCPs who have met with a sales rep and be able to give them additional information and everything they need to know that that sales rep would’ve otherwise shared with them but hasn’t gotten to them yet, or this HCP isn’t a significant enough player to be part of a sales territory.
We provide full wraparound messaging. We can also bring your brand’s website. If you create a coverage finder on your website, your patient site or your HCP site, we can bring those into the Skipta platform. So the HCP could actually look up acces right there while they’re collaborating with other HCPs. And then we can also insert any product and coverage data specific to your brands into native instream posts or even send emails out to those NPIs. There’s a lot of different options for us to do.
A lot of times the brands that we’re launching have different reimbursement situations happening, different reimbursement or different types of coding that have to be included. And sometimes that’s really important to communicate to reimbursers and coders. So not only just payers, but anyone who’s working on a reimbursement cycle. Our payer communication program not only reaches to 80% of payers who are out in the US reimbursing for your brand, but also directly to other organizations like specialty pharmacies, hospitals, health systems, infusion providers, any group that is part of that treatment process, we could send those updates too so that at any time who’s ever working with your patients knows what to submit to get reimbursed for the brand.
Mary Jo: Thanks, Carolyn. Let’s look closer at payer coverage and access details. I know that typically manufacturers might not know what kind of coverage they’re going to get until six months after launch and that’s why setting internal expectations is so important. How do you keep a close eye on the coverage decisions being made?
Jason: Yeah, great question, Mary Jo. So first off, on probably an hourly basis post-launch, an account director is being asked about, where are we with this plan or where are we with this PBM? Did we get coverage? What did the coverage look like? They’re getting a lot of these questions. Well, that’s not an efficient way to communicate back to your organization how your uptake is going. Leadership wants to know, are we achieving our three-month goal, our six-month goal, our nine-month goal that we’ve set for access? How does that look compared to our competitors? And so we really have a couple of ways to support that and to make it efficient and make it effective in communicating those access wins and changes across your organization. So of course, our MMIT analytics platform where account directors and payer marketers can go in and in real time track what the current coverage is that’s updated nightly.
In addition to that, we can layer on what’s called PAR Insights, which is what you’re seeing here on the screen where we can map the competitors your own access and we can overlay your goals. And we can do that in a format like you see here that’s really easy to communicate back to your leadership, communicate back to your peers and your colleagues on how you’re trending towards the goals that you set early on and know where maybe you might need to pivot, whether it’s in the commercial channel or the Medicare channel, you’ll be able to see that very quickly through the PAR Insights report. So we really want to come alongside your teams provide them with the information not only that they need from a coverage perspective, but in a format that is really easy to communicate.
Carolyn: Yeah, I love that, Jason. So many of our clients are using that because most of our clients have small teams now and as your team shrinks and you don’t have time to put these together, our team is happy to work alongside. In our last webinar, we not only said the word YOLO a bunch of times, and I’m going to continue to repeat it because you only launched once we talked a little bit about getting prepared for uptake and being able to understand what to expect and set the right expectations with your leadership. The reason we do that is because almost every payer has some sort of a policy in place that shows how new drugs that are just launched are covered before P&T meets. It may be that you’re not covered. More than 50% of drugs are currently blocked at launch, 50% and nearly 60% of payers across the US block drugs prior to P&T review.
So the day that you launch, you may immediately be blocked until P&T meets. Knowing where that is is really important and some PNTs aren’t going to meet for three to six months. That means they’re going to be blocking your drug for three up to six months. The only way to get a patient on therapy is through a medical exception, which may be a lengthy process with lots of back and forth since the prescriber won’t know what the medical director needs to see to approve access. If you’ve done work with us or anyone else to create a payer segmentation based on access likelihood and timing so that you can understand which payers are blocking at launch, you probably already know this. You probably already know which payers you need to focus on right away because you may be able to get them to lift the block early or even potentially head off the block entirely.
If you don’t, please stop this webinar and call us right now because we need to do this for you fast. You’re launching in a month and you need to know this. Are there payers who you don’t expect to see the policy for six months and voila a month after launch, you have a policy? Yeah, that’ll happen. In that case, you know that your account manager has done a great job and they’ve met with the payer. Take that win and use our tools to communicate that to the rest of the organization, especially leadership because you want that account manager promoted immediately. They’ve done such a great job already and you want to instill that feeling in the rest of the account team. You want them to also be able to do a great job. So be a little competitive with them and get those guys promoted really quickly.
You want to make sure that your successes are talked about across the organization. Every accolade that you, every time you talk about somebody’s great job, it generates excitement and energy for anyone who might not think they need to go out and make things happen in their territory. One of the best reports that MMIT offers during the year of launch is that weekly update tracking through that policy and restriction insights report. We can do that in your corporate template so that you don’t even have to redo everything. You don’t even have to take a picture of it and put it in another template. You can just share it as a scorecard every single week for your organization.
Mary Jo: Thanks. So as you mentioned in the first six months, your drug will probably be under various new to market blocks. How do you get patients started on your drug then?
Jason: With those new to market blocks, that can be very frustrating. And what we know is it’s the medical exception process that Carolyn mentioned. As you think about it, once you get coverage, it’s all focused on pull through. This is what we call the push through. So your account director’s in meeting with the payer, the PBM, trying to drive contract negotiations to get acces. The payer can easily say, “Well, I haven’t seen any prescriptions. Well, why do I need to create a policy? Why do I need to even act on this? ” So you’ve got the push through, which is where sales reps are working really hard to push through the value and the efficacy for the patients and you’re getting HCPs to write that prescription, but it has to go through this medical exception process. So how do you help them?
Well, one, we can absolutely support you and your teams in understanding both in the commercial side and on the Medicare side, what does the medical exception process look like at the individual payer level? So your representatives, your FRMs are going to need to help the HCPs understand here’s what’s required. Here’s what that medical director, as Carolyn mentioned, is going to want to see. They’re going to want to know, is your drug, is it evidence-based? What do I have to show that it makes it appropriate for this patient at this time and in this particular space and why are the alternatives that are on formulary not appropriate? So you have to be able to communicate all of that to the HCP so they know what they need to provide from a notes perspective, if they’re going to have to have that phone call with the medical director, what are they going to need to share at that time?
So we can really help manufacturers understand that process. It’s laid out pretty clearly in Medicare what that process is and then it’s enforced more regularly or I guess consistently in the Medicare space. But even at that, the success rate of medical exceptions as a holds not very strong, so roughly 80 to 90%. And that’s if you only follow the process and you provide all the data that’s needed and all the notes. So it’s a tough process and we’re here to help in that situation.
Carolyn: And you know, Jason, if you’ve successfully bucketed your payers for your account managers, they should be going after those payers who have new to market blocks and getting those blocks lifted and that’s really important to track. And if you haven’t done that bucketing, I’m not kidding, stop this webinar, call us right now because we can help you and you need this. Absolutely need this. There’s no way you can get to 712 payers in your first month to get those blocks lifted. Many of you may also be thinking about patient assistance programs. Most of our clients with their new drugs that are coming on the markets put patient assistance programs in place. You might be thinking about offering a coupon or a copay card to help patients get on therapy during the first few months when the drug is blocked and your team is not successful in getting the block lifted.
I’m going to give you a little bit of advice though based on a situation that happened with one of our clients. If you offer coupons or copay cards to help patients get on and you’re really good at getting them to use those copay cards, just make sure that everyone who’s involved in the process is still looking at access because a year into using a copay card, you don’t want to be the insurance company for your patients. You want them to be able to use their insurance benefit the way it’s supposed to be used. So you’re going to need to track how patients are using these programs and these copay cards.
Do you have patients who are using it when they actually now have insurance access and how do you successfully transition those patients? One of the things that we did with this client is when they came to us and they said, “We’re tired of being the insurance company.We don’t want to be that anymore.” We put a dashboard in place where we brought in coverage and we brought in the claims data so that we could show them, “Here are your patients who are using the copay card, but based on all these other claims, we know their insurance and we know that they’re covered for your drug on their insurance.”
And we were able to triangulate this and point them to three specialty pharmacies who are continuously using copay assistance and not processing the insurance card. And once they went out to those three SPs, they were able to get that changed so that now more insurance was used than their copay assistance. And that was really important. I don’t know that they would’ve ever known that without being able to put that coverage and claims database together and being able to triangulate where the problem was actually occurring the most.
It didn’t mean that they still didn’t have coupon use that they had to correct, but at least they got the three big ones right away. So being aware of changes in access and card utilization all along the way so that I can say to my team, “Okay, this is a good time for you to stop talking about the copay card because we now have really good access.” We could have helped them prevent two years of Copay assistance that they didn’t have to spend.
Mary Jo: Since so many coverage decisions are going to be delayed at the start, how can you get a handle on whether or not you have a payer problem? What are the red flags you should be looking for?
Carolyn: I love that question. I love that question because it’s all about knowing what you don’t know. One of the things that’s really important to do is to stay up-to-date on coverage policies to know exactly when coverage changes, when is that uptake actually happening and did it meet your predictions? Remember, once you’ve done the planning, you’ve already made prediction for every single payer more than likely. And if you haven’t, stop this webinar and call us right now. We can help you, but you have an expectation of when each of these payers is going to have a new policy in place. We have a product that we recently launched called Searchlight. It’s an alerting tool and it’s really helpful for understanding the policies and being able to diagnose a problem with policies before they become a trend. Before that policy is even in place, let’s say a payer publishes a restrictive policy and it’s not effective for two months, but they’re publishing it anyway.
Searchlight will pick it up and we’ll show you what the policy says and we’ll tell you that it’s going to be a restrictive policy. It may not even be effective for the next two months, but you already know it’s going to be restrictive to your label and I need to go talk to that payer. I need my account manager to go talk to that payer to see if I can get it rewritten. It’s really hard to get a policy rewritten once it’s written. So it’s always easier to have that account manager head that off by having the conversation before they even write a restrictive policy, but having that policy before it’s even effective is really helpful to have those hard conversations that you have to have. The other thing that Searchlight will give you is Searchlight will also give you new policies that may be written to your label.
That’s great to have because let’s say for instance, I’ll use one of my favorite payers, Aetna. Aetna publishes a policy that’s two labeled, that’s two year label and your account manager is going to go out and talk to their other payer accounts, not just Aetna. They may take the Aetna policy. In Searchlight, we give you the link to the payer website so they don’t even have to pull down the policy. They can just provide a link to the payer website and say, look, this is a policy that was written to label. More often than not, the payer that gets that other payer’s policy may just copy it. It’s easier. You’ve got these clinical pharmacists who are responsible for tracking 20,000 policies. Isn’t it easier to copy someone else’s policy than it is to write one from scratch? If I can show them a policy that’s written to label and they just copy it, now I’ve won two payers, not just one.
I’ve won two payers in my territory. Payers are people too. If we can save them time and give them something to copy, they very likely will. When I was a payer back in the day over 10 years ago now, I loved getting copies of other payers’ policies because then I didn’t have to write one from scratch. I could just hand that to the clinical pharmacist and have a policy tomorrow.
Mary Jo: That does sound very useful. Looking back, what kind of insights do pharma companies need at this point about how payers are perceiving their drug or reacting to your messaging?
Jason: Yeah, I think at this point I would say you need these insights well before you’ve even launched for sure. And we’ll get to the tracking here in just a second, but from a payer reaction, how are payers perceiving your value story and how are payers perceiving the conversations in which your account directors are having? Our MMIT payer message monitor tool is an amazing resource. So as a former account director, you go in, you meet with a payer, you’ve got probably your HEOR person with you, you tell the value story, you tell the efficacy story, you talk about where your brand really fits with the current formulary and what advantages you have. Of course, you’re talking about contracting and what you’re willing to offer for different access or utilization criteria. Sometimes you’re coming out of there, those types of meetings and you feel like they went really well.
I can actually give a real world example of where I met with a PBM that exact situation. I had my senior director, I had my HEOR person. It was in rare disease, and so our product was relatively expensive. We went in and we really focused in on what we thought was the right value story at the time to justify the price of our brand and where we were from a contractual perspective and the we were looking for. Coming out of that, I felt great. A month later we got our message monitor for that exact call and that is not at all how the payer saw it. The payer felt like we didn’t justify the price, that our contracting approach wasn’t really the approach that they were looking for. And so by having that MMIT payer message monitor feedback, we were able to sit down, not only the account director team, but our HOR team, our payer marketing team.
We were able to look at that feedback. What was their perception? What did they think was strong? What did they think wasn’t strong? What actions were they maybe going to take based on that conversation? We were able to discuss that as a broader market access team and make adjustments to our value story. And that is really the benefit of payer message monitor. And I would say again, it goes all the way back to you should have this when you start your pie presentations because you want to see if you’re even hitting the mark before you hit the market with your brand. And then all through your launch and post launch, you want to continue to get those insights to see not only how your story is resonating, how is your competitor’s story resonating versus yours? And it’s really a unique tool where the fly on the wall gets to hear the whole conversation and you get to see what the reaction was from the payer.
It’s really invaluable insights.
Carolyn:
Jason, I love that story. It’s so important to know because there are very few times in life when you can walk away from talking to somebody and understand what’s happening in their head after you’ve talked to them or be able to understand what was said by your competitor in their meeting and know how the payer reacted to them before you even talk to them. Think of Message Monitor as a report card for your value story. If it’s not resonating, knowing that after two conversations is better than knowing that after your first year because you didn’t get the results you expected. What are payers thinking about and remembering after you walk out of the room? The fact that you get that information within 48 hours of a meeting is a big part of why it’s so valuable because you can step in and change your narrative almost in real time depending on the feedback you’re seeing.
And if you’re using it to track your competitors, what are your competitors saying about your drug? What are my competitors saying about their drugs and how are they positioning themselves their drug against my drug? A lot of times you’ll see feedback that makes you think, oh, I think I have to change something about my payer marketing to be more competitive or to address a concern. Being able to do that fast as you go will only increase your effectiveness. And what am I going to say now? It’s all about YOLO. You only launch once. So measure, measure, measure early
Mary Jo: Indeed. So let’s circle back to the beginning and you guys have talked a lot about measurements and tracking and that to make quick decisions or quick changes to your strategy, you’re going to need near constant evaluation of prescriber behavior, patient behavior and payer coverage details. So that’s a lot of information. How do you balance all that and figure out what your drug uptake and utilization looks like on a day-to-day basis?
Carolyn: That’s another great question, Mary Jo. You’ve got to track utilization and demand to find out if your patient population is being served appropriately or if you have to change something. And it can be hard to put together access and utilization data. It’s hard to take the health plan and formulary and your access data and match it up with the plan in your real world data to see everything at once. It’s a little bit overwhelming and it’s quite difficult, but we do this every day for our clients. We create customized dashboards that bring together claims and coverage and allows us to show you a picture of the physicians who are prescribing or not prescribing your drug for their patients who are being diagnosed. It shows you where the patient is picking up their medication. What pharmacy is it coming from? Is it coming from a set of specialty pharmacies that you need to go contract with?
And it shows you the payer. Are payers paying for the prescription? Are they rejecting the claim? Being able to se payer, prescriber, pharmacy, treatment location, being able to triangulate what’s happening in that patient process and understand who the big players are is a huge step in investigating and resolving barriers. We can reveal access barriers that you wouldn’t typically think about like distribution strategy issue. If you don’t have a payer problem or a prescriber problem, you could have a pharmacy problem. Physicians might be writing prescriptions for your drugs, but pharmacists aren’t filling it. This happens a fair amount with biosimilars. So if you have a biosimilar, know this. The pharmacy may not have stock of the biosimilar that’s prescribed and they may tell the patient they can fill their script with another interchangeable product and all of a sudden you’ve lost that sale to another drug.
A pharmacy may prefer one drug over another because they get a higher rate of reimbursement from the payer, which means they may prompt the patient to ask their doctor for a different drug and now the patient is second guessing and doesn’t want to walk away with that original drug. You don’t want the pharmacy to market against you. The claim can actually reveal a discrepancy between the drug that was initially prescribed and the drug that was actually dispensed because both are listed on the claim. If you have the ability to understand that directly from your claims data, you should because you might find a pharmacy that is consistently changing prescriptions and contracting with them may solve that.
Mary Jo: So what about investigating what payers are actually doing versus what they say they’re doing? Payers don’t always follow their own policies.
Jason: That’s very true, Mary Jo. The payer says versus what the payer does. And Carolyn just talked a lot about looking at your utilization, your claims and all the different data points that you have. And we at MMIT can really bring together your claims and access to data together in a very digestible way as you can see here are some of the example dashboards that we have on the screen because really in the end, what you’re trying to do is you’re trying to understand where do we have a coverage that’s we’re not getting the utilization we should, or where do you need to put your resources? Where are the places that you’ve contracted for specific but yet those claims aren’t going through? Well, why aren’t they going through? Being able to see claims and coverage, abandonment, rejection rates, all of that in a really user-friendly format makes it easier for you to make decisions on where to put your resources.
Is it a pull-through issue? “Hey, we’ve got great coverage. We don’t have good utilization.” Is it a push-through situation where, “Hey, we don’t have coverage here yet. We need to garner more utilization.” Is it, I need to send my FRM into this area to help minimize rejection rates or abandonment rates, help get those prior authorizations through. So it’s really about understanding where you need to invest your resources to be successful and really claims and coverage together is invaluable. You have to have that.
Mary Jo: Thank you, Jason. We’ve covered a lot of ground today, but we just want to leave you with this final slide. No matter what you’re going through during that first year, MMIT can help you. Caroline and Jason, do you have any final thoughts for our audience?
Carolyn: Yeah, so there’s a lot on this slide, but I like it because it shows that you need more than just foundational data to measure uptake, follow along with access changes and become a winner during your first critical launch year. Again, you’ll only launch once. To make sure you’re meeting your goals, you need market research, tools like Message Monitor that we discussed earlier to uncover insights into what payers are thinking and feeling and what they might do in the future. You need integrated data to help you pinpoint where your problems are to diagnose what’s going wrong and figure out what to do next quickly. You also need to be able to predict the future as you drive the rest of your launch your results so that at the end of your launch year, you’ve done at least as good as you predicted and hopefully have yourself well placed to get promoted.
Again, remember YOLO. You only launch once, you only get one shot to make this launch the best launch that makes all your peers jealous and all your competitors hold you up as a gold standard.
Jason: Absolutely. We all want to be promoted. My final thoughts, Mary Jo, are this we here at MMIT, we want to help smooth the pathway to access for patients. You’re working really hard as a manufacturer. You’ve set a lot of goals because you’ve got a product that you’ve developed that truly helps patients. There are so many things in between the manufacturing and the patient getting the product and seeing the benefits of that product. There’s so many ways that things can get derailed or the information they need is not there you need is not there. And so we at MMIT can really help you. We can come alongside you as a partner, help fill those business gaps and business needs that you have in the end all helping you to better help your patients get the therapy that you’ve worked so hard to develop. So we’re here to help support you and your patients.
Mary Jo: Well, thank you, Carolyn and Jason, and thanks everyone for joining us. If you have any questions, please send them our way and we’ll see you next time.
