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Don’t Forget the Payer in Your Digital Strategy:WHAT PAYERS NEED AND WANT FROM PHARMA
AgendaChallenge the status quo – does a digital strategy for payers make sense?
Do YOU have a
seat at the
table inside
your company
re digital
media?
The Stakeholders - WHO?2/3 Total Rxs Covered by Private Payers1
Cash
7%
Medicaid
8%
Private
Payer
63%
Medicare
22%
Industry Trends - WHY Payers?
When Pharma overpays incentive dollars to those territories with favorable MCO environment, then
company is paying more with getting less;
Conversely there are territories where individuals are
underpaid, causing incentive plan to lose
motivational value
Pharma-Payer Partnership Trends:
Then vs. Now
Traditional Partnerships
No Financial Drivers Attached
Good Ole DaysUtilization-Based
Partnerships
“Light” Financial Drivers Attached
Value-Based Partnerships
Price, Reimbursement, Access Negotiations
Attached
Performance Guarantees
Rebates for not meeting criteria
Today
Movement:
• FROM Access-based contracting to Value-based contracting
• TOWARD flexible risk-sharing and cost management mechanisms
Payer + Pharma = “Frenemies”?
The 1st 6 months of product intro are crucial. Missteps
along the way are the difference between commercial success
and failure.
Payer and Market Access strategy are
CRITICAL.
When the Gap Isn’t Filled…
"[I]f you are organized around the physician, you are
missing the key influencer,"
~Joe Jiminez, chief of Novartis' pharma division,
to The Wall Street Journal.
Merck has been running pilot programs in which reps are
assigned to spend more time with third-party payers.
"We think the focus should be on the Medcos of the world,"
~Ken Frazier, chief of Merck's global pharma
Payer Involvement – WHEN?
•
•
•
••
What does this mean
for a digital strategy?
Poll Question:
Pharma e-Promotion: Far from “Digitally
Mature”
140212
368156
270
452
57
52
59
2010 2011 2012
USA e-Promotion Investment Trends, 4Q MAT
e-Detailing e-Mailing e-Meeting
$353 M
$534 M
$879 M
+ 14 %
+ 68 %
+ 74 %
2012 vs. 2011 % Change
Pharma are “Beginners” in Digital
Do Pharma Execs“Get” Payers or
Digital Marketing?
Market
Access –
Biggest Pain
Point to
Pharma Execs
But <1 out of 5
said MCOs
were most
important
customer
Why are CEOs Reticent?
•
••
•••
•
•
Poll Question:
Virtually No Digital Spend on Payers2%
98%
Payer
All Others
~$900M Total Spend, 2012
2:1 - Physicians would
rather go online for info
than see a rep
Would Payers say this?
►
►
►
►
► ~1 in 4 direct sales force interactions are digital1
Digital – WHY? It’s Not About Digital – It’s About Customer
Engagement, Loyalty, Advocacy
“It’s all about making the brand
experience so positive that it drives
Loyalty and Advocacy.”
~Lisa Flaiz, Janssen Digital Marketing,
June 2013
•••••
Poll Question:
With any Promotion – Including
Digital, remember….
This is true for
Payers,
Doctors, and
Consumers
Payer Promotion – WHAT?
Payer Digital Promotion – HOW
Pharma Marketing
eMarketingManaged Markets
HEOR
Get Internal Stakeholders Together
But What About Regulatory Issues?
Draft Guidance for
Industry Responding to
Unsolicited Requests
for Off-Label
Information about
Prescription Drugs and
Medical Devices;
Section VI on “Social
Media”
December 2011
FDAMA Section 114
1997
AMCP Format
2008
Promotion of Health Economics Data
Physicians &
ConsumersPlans/Payers
“Substantial evidence”
Not really appropriate for HEOR
data; preference to RCTs, doesn’t
allow modeling
“Competent and
reliable scientific
evidence”
(Section 114)
Section 114 of the FDAMA states
‘‘Health care economic information
provided to a formulary committee, or
other similar entity, in the course of
carrying out its responsibilities for the
selection of drugs for managed care or
other similar organizations, shall not be
considered to be false or misleading if
the health care economic information
directly relates to an indication
approved and is based on competent
and reliable
scientific evidence.’’
How do we deal with CER?
Cost savings claim – probably ok; cost/QALY – probably not OK (under Section 114)
Non-promotional Health Economic
Information
http://amcp.org/Tertiary.aspx?id=16065http://www.healtheconomics.com/assets/downloads/spotlights/UBC/UBC-FactSheet.pdf
FDA Actions and Health
Economic Info•
•
•
•
•
•
Intense interest on “value” promotion
FDA concerns – “backdoor” clinical
claim within economic endpoint
Section 114 allows promotion of HCEI
to health plans but has restrictions
and there has been n guidance
New legislation extending 114 to CER
may help
FDA Guidance on Digital Media
iPad Budget Impact Model & App
BaseCase
Collaborative Real-World Evidence
Arrangement, AstraZeneca and WellPoint
There’s lots of Big Data out there with not a lot of robust insight,” says Marcus Wilson, president, HealthCore. “There’s a limit to what you can get from it without it being effectively integrated.”
Social Networks to Assess Treatments and
Recruit for Clinical Trials, Merck and
PatientsLikeMe
“It’s a surprise to no one that as an industry, we’ve really lagged behind in terms of engaging with end users of our medicines and patients, so social media creates new kinds of opportunities for us to understand, from the patient perspective, what the relative value of our medicines are in the real world,”
Sachin Jain, MD, chief medical information and innovation officer at Merck.
Innovative Web-based Technologies.
Would it work for Payers?
Common: Website section
describing coverage by various payers
Novo Nordisk NovoPayerLink
SummaryTips To Remember
Poll Question:
Payer Digital Promotion
What are the Needs of
Payers?
Payers Interested in:
• Aligning with Customers and Employers
• Improving patient outcomes• Budget Impact• Adherence• Cost-effectiveness• CER• Real-world studies (participation,
recruitment, results)
• ACOs• Contracting
Don’t Forget the Payer in Your Digital Strategy:WHAT PAYERS NEED AND WANT FROM PHARMA
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