In this #ChalkChat, Tiffany Ryan, VP, Account Services at Palio shares 4 tenets to cultivating strong agency/client relationships.
#ChalkChat is a weekly video series that brings you insights on branding, marketing and multichannel integration within the pharmaceutical industry. Follow us at #ChalkChat. Follow up with Tiffany at TRyan@palio.com.
Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.
In this episode of #ChalkChat, Leah Warner, Account Director at Palio, provides a 101 on orphan drugs and the challenges associated with successfully marketing these products.
#ChalkChat is a weekly video series that brings you insights on branding, marketing and multichannel integration within the pharmaceutical industry. Follow us at #ChalkChat. Follow up with Leah at ljwarner@palio.com.
Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.
By Micahlyn Whitt-Flicker, Copywriter, Managed Markets at Palio, micahlyn.whittflicker@palio.com
Putting Your Money Where Your Health is in 2013: Plan-Sanctioned Wellness Programs and Member Incentives
It’s no surprise that the most popular New Year’s resolutions still revolve around making healthy lifestyle choices and smarter financial decisions. But it may raise a few eyebrows to learn that in 2012, US commercial healthcare plans spent upwards of $60 billion dollars on wellness programs designed to encourage members to turn annual health-related resolutions into long-term commitments. That’s some serious money to ensure that we hit the gym, eat our broccoli, and get regular checkups.
In previous years, beginning in 2009 and then increasingly more following ratification of the healthcare reform bill, plans rewarded enrollment in wellness programs mostly through financial incentives ‒ usually 1-time payouts made directly to members through their employers. The impact on enrollment statistics has been positive, with 61% of employees enrolled in plan-sanctioned wellness programs vs 26% enrollment for similar programs without incentive bonuses attached.
Though these statistics are impressive and demonstrate that members (consumers, in general) respond very well to cash incentives (rebates for gym memberships, enrollment in smoking cessation programs, etc), many plan managers feel that meaningful outcomes for plans and their members have not improved enough to justify the money invested in the development and administration of wellness programs. For example, 1 study showed that the percentage of wellness visits logged by members enrolled in wellness programs has not improved significantly for many plans. So, it seems enrollment in these programs is not working to inspire better preventative care practices. Also, costs associated with direct and indirect treatment for wellness program enrollees are, in many cases, comparable to members who are not enrolled.
Despite underwhelming ROI, it seems that plans are still very keen on making wellness programs work. According to a recent article in Managed Healthcare Executive, incentivizing consumer participation in wellness programs will become an even bigger priority for health plans in 2013, but the way in which programs and associated incentives are designed and managed will change to drive ROI and promote long-term behavior changes in member beneficiaries.
Plan managers now believe that more tailored, personalized wellness and incentive programs designed to suit individual member needs are the key. The hope is that this approach will create and perpetuate a true paradigm shift for better living that leads to better outcomes for all.
Incentive programs will now be geared toward connecting rewards to long-term outcomes and to encouraging the emotional affinity felt by participants toward those earned rewards. One way this emotional bond to wellness may be achieved is with what has been called the “gamification” of wellness program design ‒ incorporating employee challenges that infuse healthcare education, competition, fun, and a sense of community recognition into the experience. Gamification will likely be adopted more widely by healthcare networks and plans.
Cash rewards aren’t going away, but will likely be linked to member performance and outcomes instead of a single payout upon initial engagement of a health-related product or service.
Rewards and recognition may also be tailored to individual member needs, as defined by employers and individual employees on an annual basis.
Does all of this mean that if a person enrolled in a wellness program loses 25 lb and/or quits smoking over a 1-year period, he or she may be eligible for a year-end wellness bonus and additional vacation time? Maybe. But he or she may also have to jump through a few hoops as well, literally.
Managed Markets Monday is a weekly series that provides insight into what we think it takes to meaningfully and effectively communicate in the managed markets space. Follow up with Micahlyn at micahlyn.whittflicker@palio.com.
Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.
By Jon Haas, VP, Managed Markets, Palio
Buy-n-bill has not gone away as some had predicted. Specialty drugs are still feeding the growth of specialty distribution.
Specialty distribution is a key supply-chain partner for drug manufacturers in the growing specialty drug segment. Specialty drugs accounted for $77.5 billion or 24% of the total $320 billion prescription drug sales volume in 2011 and grew by 17%, according to Express Scripts’ latest drug trend report.
Specialty distributors serve various customers including hospitals, hospital-owned clinics, specialty pharmacies, and other distributors. But the vast majority, or 73%, of total sales from a specialty distributor are to independent physician-owned clinics* who use the traditional buy-and-bill business model. This is where the doctor buys the drug (oncology drugs represent the largest volume) from the specialty distributor, treats the patient, and bills the patient’s insurance company for reimbursement of the cost of the drug. The majority of claims are covered under the patient’s medical benefit processed through a paper claim submitted by the physician’s practice. After oncology, other physician specialties utilizing buy-and-bill, or “buy-n-bill” as it’s commonly called, include rheumatology, gastroenterology, ophthalmology, and dermatology.
According to a recent Specialty Pharmacy Times article, payers and oncology practice managers have claimed that they would like to see buy-n-bill end in favor of third-party specialty vendors. In reality, buy-n-bill has declined, but ever so slightly. There is some growth in specialty vendor handling of specialty drugs through payer contract policies and mandates. These policies and mandates require specialty drugs to be acquired through a designated entity such as a specialty pharmacy. When a patient acquires a drug from a specialty pharmacy and then brings the drug to his physician for help in administering it, it is called “brown bagging.” While this is not typical for an infused drug, it is becoming more prevalent with injectable drugs. A specialty pharmacy may also drop-ship the drug to the patient’s physician to avoid any risk of mishandling by the patient. It is not uncommon for a physician to charge a fee to the patient for brown bagging.
Other growing trends include on-site pharmacies within large oncology clinics and specialty-at-retail (retail chains utilizing central-fill facilities for specialty drug fulfillment, then delivering the drug labeled for the patient to a retail store for pick-up). A prime example of this is the recent purchase of Axium Specialty Pharmacy by Kroger.
Reimbursement of specialty drugs for buy-n-bill
Reimbursement for specialty drug costs experienced a drastic change in 2005 with Medicare Part B moving to an average selling price (ASP) + 6% model, which was swiftly adopted by most commercial payers as well. ASP is calculated using quarterly data reported by the drug’s manufacturer. (ASP calculation is much more complicated, but this abbreviated explanation will suffice for this blog.)
Prior to this, most payers covered specialty drugs using a cost plus or average wholesale price (AWP) minus method. Both reimbursement methodologies provided reasonable profitability for the physician practice. The ASP+ model has significantly reduced profitability, especially when you factor overhead costs into the model.
In the past, specialty distributors dictated pricing to physicians, allowing physicians to shop around for best pricing, which drove physicians to engage with a GPO (group purchasing organization) to have contracted discount pricing available to them. Over the last few years, some manufacturers (most non-oncology) have developed direct physician purchase contract models to protect a physician, thus taking away the ability for specialty distributors to set pricing and/or terms (length of time to pay). When contract pricing is in place for a drug, the specialty distributor is mandated to sell to the physician at the contracted price, and thus can only attempt to win new business based on service, relationship, and in some cases, terms. Of course, some manufacturers launch new specialty drugs with a closed or limited distribution model allowing the chosen specialty distributor to realize an exclusive or semi-exclusive opportunity for a period of time.
Many or most drugs have a no-return or limited return policy, thus drug waste (mistakes in reconstitution, breakage by staff) can literally cause a practice to be “upside-down” or spend more on specialty drugs than the reimbursement realized. A physician practice can also bill for the actual infusion, injection, as well as infusion nursing care. This can make up some of the overhead costs incurred of storage/inventory, refrigeration, supplies, etc.
The buy-n-bill sector is clearly a complicated, dynamic market. Because of this, many or most specialty pharmaceutical manufacturers have field-based people to help support practices, with particular attention on the practices’ support/nursing staff, focusing on the billing or office manager. These field-based representatives help the physician practice manage the reimbursement landscape and provide assistance and problem solving. Most specialty drugs are also supported by a hub or call center, which provides reimbursement assistance (benefit investigations), support for co-pay card programs, patient assistance program, prior authorization, educational programs, nursing/clinical and other patient- and practice-targeted programs. A customer-focused, highly functional hub service offering can make a tremendous impact on product pull-through.
So what is the future of buy-and-bill?
Specialty drug launches and overall volume will continue to grow into the foreseeable future. Many of the agents in the pipeline are self-administered or oral, but until payers make a wholesale decision to move all specialty drugs under the pharmacy benefit, there will still be a significant buy-and-bill market. Specialty distribution providers will expand their offerings of hub service programs such as call centers, reimbursement/claims support, and patient financial support programs, as well as REMS management. Although clinical differentiation messaging to HCPs and payers are of utmost importance, the right access and channel/distribution strategy can certainly drive success of a new specialty product launch.
*Source: Center for Healthcare Supply Chain research, 2012 Specialty Pharmaceutical Facts, Figures and Trends.
Managed Markets Monday is a weekly series that provides insight into what we think it takes to meaningfully and effectively communicate in the managed markets space. Follow up with Jon Haas at jon.haas@palio.com.
Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.
By Marcelle Rockwell, VP, Account Director, Palio Managed Markets
When planning a booth at a payer convention, the No. 1 tenet to remember is “plan your work, and work your plan.” Define and outline what you’re trying to accomplish and give yourself enough time by planning ahead. Planning ahead allows you to save on budget and to include additional elements that become impossible to include if you wait until the last minute. A successful booth is one that accomplishes the goals you establish prior to the event and is more likely to be achieved if you:
Set your objective. Are you launching a new product? A new indication? Are there new, compelling data being published? Maybe a new competitor is entering the market and you need to re-establish your position? Whatever the reason for your presence at the convention, be sure to clearly define that reason internally and set goals for the event. Include key stakeholders in the process to gain internal alignment. Once you set your objective, you can measure the success of the event.
Identify your target audience. Whom are you trying to reach? Which conventions do they attend? And once you’re on the floor talking to attendees, ask them about their role in their organization. If you’re targeting P&T committee members, ask if they’re part of the formulary decision-making process.
Decide the scope of your presence. This will help determine your budget, or vice versa. Do you want the largest booth possible? Do you need a separate area for medical information? Are there any components (panels, structures, materials) you can repurpose from your brand counterparts? Should you allocate budget to sponsor a breakfast or cocktail hour? What about a symposium? Are there key points about your brand you can showcase during a presentation?
Choose your partners. There are teams of people who do this for a living—tap into them. There are planners, booth designers, and creative and strategic teams that can help build your customer-facing materials. Partners can also develop timelines and be liaisons with the convention organizers, alerting you about deadlines, early-bird rates, registrant lists, and other key information. They can also participate in your weekly planning meetings to help keep everything on track.
Get the word out. This is where planning ahead becomes important. Send invitations to attendees, inviting them to come by your booth, your cocktail hour, your symposium. Account managers can also make invitations more personal by hand-delivering them. Let attendees know you have information they will be interested to hear. Consider advertising in a journal relevant to your audience or in the program guide and city guide. If you’re thinking really big, you could create bus wraps, airport presence, and other outdoor advertising opportunities.
Have a plan for your booth. What experience do you want to give your customers? Consider the perimeter and the flow of the interior. Can you create interactive screens with thought-provoking questions or information? You want to draw your audience in and create opportunity for conversation. What materials should you have on hand to detail from and to give away? Will you need Internet connectivity, a demonstration area, or any other special needs?
Train your on-site team. All the preparation in the world won’t help if your on-site team is not prepared. Outline your objectives for the booth and convention, coach your team on how to identify your target attendees, and familiarize your team with the on-site materials. Assign your team’s attendance at other events on site so you know what your competitors are doing and what industry information is being showcased at the convention. Your team’s collaboration and camaraderie contribute to the vibe of the booth, so be sure everyone understands and has the same goals for the event.
Follow up with attendees. Any leads generated during the event should have an immediate follow-up the next week. If the attendee asked for more information on a topic, be sure to provide it thoroughly and in a timely manner. Share attendee information with your local territories so that they can continue the conversation.
Being organized and having a plan will go a long way toward a successful convention. Define what you want to accomplish and use your resources. Ultimately, you want to create opportunities for your target customer to hear your message, and then, you want to continue the conversation beyond the convention. Plan properly and you’ll be more likely to succeed.
Managed Markets Monday is a weekly series that provides insight into what we think it takes to meaningfully and effectively communicate in the managed markets space. Follow up with Marcelle Rockwell at marcelle.rockwell@palio.com.
Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.
By Jennifer Reilly, Account Supervisor, Palio Managed Markets
It’s time to put the rumors to rest and help provide clarity about common misconceptions regarding marketing in the Managed Markets space. Here are a few things we hear over and over again:
PROFESSIONAL vs PAYER
A common misconception about Managed Markets marketing (MMM) is that it is not as essential or important as marketing to physicians (who prescribe the drug) and patients (who take the drug). In fact, marketing to the “payer” (or formulary decision maker [FDM]) is important to ensure the client’s drug is provided open or broad access, or has the desired benefit you want. It is also important to help advocate acceptable utilization management and to influence the FDMs not to disadvantage a drug with prior authorizations or step edits, which ultimately impacts the physicians, patients, and pharmacists.
Professional vs payer marketing is not all that different at the core. If you have ever compared a branded visual aid vs a Managed Markets visual aid you will see many similarities. Managed Markets branding may be distinct, but our core messages are typically universal with minimal diverse discussion points tailored specifically to the target audience. A physician- or patient-focused piece may emphasize adherence and efficacy, while a payer-focused piece will tend to highlight cost and outcomes data. The payer audience is generally data-driven and not influenced by catchy headlines but rather by how the cost of the drug will impact their plan. The professional (brand) side prefers graphics of people and patient profile examples to make an empathetic connection with their audience.
One of the reasons Managed Markets work so closely with our professional brand team counterparts is to maintain consistency in how we represent the client’s key story (brand message) across business units, while also taking into consideration the tonality, language, and additional messaging our Managed Markets clients need/want to hear. One type of marketing isn’t better or more important than another; they’re just unique in certain areas while remaining tied to the same goal of positively and effectively educating or promoting the key brand message.
PAYER? WHAT’S A PAYER?
Payers, or FDMs, are the customer target within the Managed Markets space, and they comprise a vast audience. There are 5 core audience types we work with, but many stakeholders. Below is a quick snapshot of our 5 main targets:
Pharmacy directors are responsible for delivering dollar value to the organization and managing formulary. Pharm Ds are one of the most common called-on payers and one target that many account managers don’t get beyond.
Medical directors are responsible for the medical product that the health insurance company is delivering to their members. They are interested in clinical differentiation and sit on the formulary committee to evaluate what type of access the drug or therapy will have.
Quality directors are responsible for NCQA (National Committee of Quality Assurance) initiatives.
Utilization managers assess the impact of a particular therapy or class. They want to know how big, how many, and how much. How big is the class, how many of my members/patients will be affected, and what is the bottom-line per-member per-month impact on the plan.
Case managers make sure therapies are going to the right patients. They also are involved with access and compliance.
Additional stakeholders include priority accounts, health plans, PBMs, specialty pharmacy providers, employers, state Medicaid programs, Medicare PDPs, Medicare MA-DPs, payer opinion leaders, and other MCO commercial audiences.
For more in-depth information on FDMs, please watch our video by John Guarino, SVP of Managed Markets. Click here to watch.
DEFINE CREATIVE?
From an outsider’s perspective it’s easy to assume that the Managed Markets space does not allow for diverse creativity when it comes to marketing a client’s drug or service. After all, it’s often stressed that payers do not like glossy; they are generally data-driven and care more about numbers and dollars.
However, there are opportunities to be impactful and impress customers without all the bells and whistles in look and feel. With topics such as comparative effectiveness research (CER), FDAMA 114 messaging, and access and reimbursement, our clients are provided the value/cost information and data they need to make important decisions when it comes to putting a drug on formulary, deciding whether or not to institute prior authorizations or step edits to therapies, or continuing education on a drug or therapy class. Our goal is to focus on topics of importance and influence to our target audience and provide clinical information backed by solid evidence-based claims. It’s not all about the colors and graphics; Managed Markets pieces are clinical in nature and that is what resonates with our audience.
Hopefully this quick snapshot gives you further insight into the world of MMM and will put some common misconceptions to rest! For more information and insights on MMM, please reach out to one of our Managed Markets payer experts or come back to our blog every Monday!
Managed Markets Monday is a weekly series that provides insight into what we think it takes to meaningfully and effectively communicate in the managed markets space. Follow up with Jennifer at jennifer.ball@palio.com.
Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.
In this episode of #ChalkChat, Gina Figler, junior copywriter at Palio, shares 4 ideas for finding creative inspiration.
#ChalkChat is a weekly video series that brings you insights on branding, marketing and multichannel integration within the pharmaceutical industry. Follow us at #ChalkChat. Follow up with Gina at gina.figler@palio.com.
Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.
In this Managed Markets Monday, Jon Haas, VP, Managed Markets at Palio, shares insights and strategy on Managed Care contracting.
Managed Markets Monday is a weekly series that provides insight into what we think it takes to meaningfully and effectively communicate in the managed markets space. Follow up with Jon at jon.haas@palio.com.
Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.
In this week’s #ChalkChat, Krystina Smith, research analyst at Palio, shares 4 key insights to conducting social listening research for pharmaceutical and healthcare products.
#ChalkChat is a weekly video series that brings you insights on branding, marketing and multichannel integration within the pharmaceutical industry. Follow us at #ChalkChat. Follow up with Krystina at Krystina.Smith@palio.com.
Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.
By Steve Toman, Account Director, Palio Managed Markets
Medicare is a federal healthcare plan run by the Centers for Medicare and Medicaid (CMS), and it is available to Americans aged 65 and older and to those with particular disabilities. It is divided into Parts A through D, each of which helps cover specific services:
Medicare Part D was enacted as part of the Medicare Modernization Act of 2003 and went into effect on January 1, 2006. Most Part D drug plans have their own formularies that define their drug benefits. Part D plans are required to include at least 2 drugs in each category and class covered by the plan, and CMS may require plans to cover more than 2 drugs for certain categories and classes.
There are 4 stages of Medicare Part D coverage for 2012. Depending on which stage a Medicare patient is in, the amount he or she pays varies substantially. It’s important for patients to understand and to be aware of the cumulative out-of-pocket (OOP) costs that they accrue as they move through the stages, particularly those patients who are on expensive therapies.
To illustrate the ins and outs of Part D, let’s consider Maude, a fictitious Medicare patient who works her way through the system by requiring brand-name drug therapies that total $20,000 in 2012. Her Medicare Part D plan provides a “typical” set of benefits.
So if Maude had no prescription coverage, she would have had to pay the full $20,000 for her medications. What is her responsibility under Medicare Part D? About $5560. And that includes her Part D plan premium of $30/month. No wonder Maude is a big fan of Medicare Part D!
Fortunately, most common medications, especially generics, are relatively inexpensive. But what if Maude doesn’t have $5560 a year for the medications she needs? Medicare does offer low-income subsidies for patients who qualify. In addition, some Medicare patients are eligible for charitable programs offered by foundations such as the National Patient Advocate Foundation and the National Organization for Rare Disorders. Additional information is available at http://www.medicare.gov/, and at the websites of individual charitable foundations.
But for Americans who can afford the standard benefits of Medicare Part D, there are changes on the horizon. The discounts that are applied to drug costs in the “donut hole” are scheduled to rise, courtesy of the Affordable Care Act. In 2013, the discount will rise from 50% to 52.5%, and by 2020, the “donut hole” is scheduled to close completely. By then, the memorable words of Ty Webb from the movie, “Caddyshack,” are projected to come true: “A donut with no hole, is a Danish.”
Managed Markets Monday is a weekly series that provides insight into what we think it takes to meaningfully and effectively communicate in the managed markets space. Follow up with Steve Toman at stoman@palio.com.
Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.
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