A midsize pharma company launched an oncology therapy with a novel drug delivery mechanism to reduce tumor toxicity. As the company’s market access team had secured favorable formulary placement with most major payers, it expected a steady uptake curve. However, adoption rates remained low.
The manufacturer needed a better understanding of how IDNs might be negatively impacting its brand’s utilization. The company wanted to know:
Challenge
Although the brand was included on many clinical pathways, the company’s leadership suspected that IDN-specific coverage restrictions were blocking its use. But without knowing more about when IDNs employed such step therapy and prior authorization protocols, they couldn’t determine if this was actually an access barrier—or if the problem lay elsewhere.
While the manufacturer had a source of real-world EMR data, it was difficult to interrogate this data in order to track the full patient journey, from testing to treatment. Before it could improve utilization, the company needed actionable IDN formulary data on how its brand was perceived and treated.
Solution
The company sought out MMIT for its industry-leading panel of IDN decision-makers, which provides real-world information on how coverage and access function within these complex organizations. MMIT’s IDN Formulary Insights solution gave the manufacturer a comprehensive overview of how IDNs were currently managing oncology therapies in this space.
At a glance, the manufacturer could see factors like the percentage of IDNs using separate regional formularies, the frequency of P&T committee reviews, and the typical steps involved in formulary implementation for an oncology product. These high-level insights gave the company a synthesized view of systemic processes and adoption challenges across IDNs.
The solution also provided rich, IDN-specific profiles. These included details of each IDN’s formulary and nonformulary ordering processes, feedback on how they perceived the company’s brand, and information on which roles could submit requests to the IDN’s P&T committee.
Outcome
Armed with this new knowledge, the oncology manufacturer was able to refine its IDN targeting and prioritize accounts that were currently impeding access. The company’s account leads received detailed data on each IDN’s processes and systems, giving them the inside scoop on which members of the P&T committee they should meet with to encourage brand adoption. The team’s advocacy successfully moved its brand from non-formulary to formulary status at three IDNs.
At four IDNs where the brand was on formulary but underutilized, the company found that several different roadblocks were impeding adoption: separate patient stratification paths within the EMR; competing order sets; and requirements for additional lab testing. When possible, the company’s account managers worked with the appropriate stakeholders at each IDN to rectify these access barriers. Overall, the manufacturer was able to improve utilization of its brand by 17% over a six-month period.
IDN formulary insights help manufacturers uncover health system-specific barriers that may limit product adoption, even when payer coverage is favorable. By understanding formulary processes, decision-makers, and prescribing workflows, teams can target interventions that improve utilization.
IDNs may implement unique restrictions such as step therapy requirements, prior authorization protocols, competing order sets, patient stratification workflows, or additional lab testing requirements. These health system-specific processes can significantly impact prescribing and patient access.
Using IDN Formulary Insights, the manufacturer identified key access barriers, prioritized high-impact accounts, influenced formulary decisions at multiple IDNs, and removed workflow obstacles—ultimately increasing oncology brand utilization by 17% within six months.
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