The COVID-19 pandemic has triggered immediate responses and unforeseen challenges for payers and health systems across the United States. These changes create new opportunities for pharmaceutical manufacturers to enhance their existing payer relationships while also delivering for healthcare providers (HCPs) and patients faced with navigating their new access and reimbursement realities.
Health plans, pharmacy benefits managers (PBMs) and health systems have worked quickly to amend benefits and processes to address urgent member/patient and HCP needs, including:
- waiving member cost sharing, including co-pays, coinsurance, and deductibles for diagnostic testing
- encouraging virtual visits by identifying network physicians who participate in telemedicine, and creating new reimbursement codes for telemedicine appointments
- adding new reimbursement codes to pay for new services while enabling provisions for early prescription refills
- encouraging the use of pharmacy delivery services for 90-day refills of chronic medications, and waiving charges for home delivery of prescriptions
During the COVID-19 pandemic — and in its aftermath — market-access and brand marketers need to embrace the tenets of the Triple Aim and focus on improving patient experiences, reducing the per-capita costs of healthcare, and improving the health of populations overall. For this to happen, it’s critical that strategic and tactical options be considered through the lens of patients, payers, and providers.
The New Market Access Reality Is a Virtual One
It’s difficult to predict what the “new normal” will look like once the pandemic is contained, but in the short term, health plans, PBMs, and health systems are likely to be open to partnerships with biopharma manufacturers. Such partnerships can assist in effectively managing high-risk patient populations with underlying diseases such as respiratory, cardiovascular, or autoimmune conditions, or cancer. Maximizing this opportunity will require closer collaboration between market-access marketers and their professional and consumer brand teams to ensure message continuity and resource optimization. Specific opportunities and actions that can be taken include:
Tip: Engage brand team colleagues to determine if approved content already exists that can be quickly customized.
Tip: Engage digital marketing centers of excellence to explore use of existing MCM infrastructure.
Tip: Revisit current value propositions to determine if messaging exists to address new value drivers around supply chain and revised benefit design.
Tip: Revisit patient support and HUB services to ensure timely claims adjudication, seamless interactions with specialty pharmacies, and integration of COVID-19-related support.
Two pharma companies recently announced enhancements to their patient support programs in response to COVID-19.
- The Lilly Insulin Value Program allows patients with or without commercial insurance to fill their monthly prescription of Lilly’s insulin product for $35.
- Bristol-Myers Squibb has expanded its PSPs to provide access to any of its branded medicine for free, “including some of its most widely prescribed products, as well as those prescribed via telehealth services.”
We expect to see similar programs sponsored by more biopharma companies in the coming weeks.
Tip: Continuously monitor formulary and coverage policy changes to ensure strategic and tactical alignment, if course corrections are necessary.
Strategies aligned with the overarching brand strategies should take provider, patient, and payer influences and needs into consideration.
Relationships are typically forged during times of crisis and need. Market access marketers and account managers have a unique opportunity to assist their payer and health-system customers with timely and relevant resources that extend the effectiveness of their new initiatives and capabilities while driving collaboration with internal cross-functional colleagues and working to achieve the Triple Aim for patients. We must adapt to a new world that is grounded in technology and the use of non-personal communications. As we collectively embrace new platforms and ways of working, marketers and account managers can also proactively address forthcoming affordability and access issues that are likely to impact the large segment of the U.S. population who will continue to be financially stressed due to an uncertain recovery trajectory. In doing so, biopharma can move beyond transactional relationships to become a more valued and trusted partner for its health plan and hospital system customers, along with all other healthcare stakeholders.
©Intouch Group 2020
Authors: Mike Motto, SVP, Market Access and Penelope Larson, Editor