HawkPartners Perspective on Payer Research


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If done right, payer research can offer important insights for your enterprise.

To learn more about HawkPartners, visit hawkpartners.com

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HawkPartners Perspective on Payer Research

  1. 1. HawkPartners Perspective on Payer Research Discussion Document Fall 2012 For more information contact: Scott Wilkerson Scott.wilkerson@hawkpartners.com 301 951-7046
  2. 2. 2 The US health insurance landscape includes a mix of private commercial plans and government payers Avg. Annual Spending Growth, 2005- 2010 Estimated Total Spending, US$B (2011) 2% Relative size of circle represents total covered lives Medicare Medicaid Private Health Insurance Age of Covered Under Age 18 Age 65+ Age 18-65 $500 Other Gov’t Programs 4% 0% 8% Out of Pocket/ Uninsured* *Estimated covered lives based on number of uninsured Sources: US Census; Congressional Budget Office; CMS.gov “National Health Expenditures 2010-2020” US Healthcare Payer Landscape 6% $750$250 $1,000
  3. 3. 3 16% 10% 8% 6% 5% 4% 3% 50% 13% 13% 10% 9% 8% 6% 5% 4% 32% US Pharmacy Benefit Managers Share of Members (2010) Express Scripts Inc. CVS/Caremark Rx, Inc Medco Health Solutions, Inc.* ICORE Healthcare, Inc. Health Information Designs, Inc. NovoLogix MedImpact Healthcare Systems Argus Health Systems, Inc. All Others UnitedHealth Group WellPoint Kaiser Permanente Humana Inc. Aetna Inc. Health Care Services All Others Highmark Inc. Largest US Private Health Insurers Share of Total Premiums Written (2010) Sources: AM Mindpower Solutions; Pharmacy Benefit Manager Institute *Acquired by Express Scripts in April 2012 Both commercial health insurance and PBM markets are consolidating, with large players increasingly dominant
  4. 4. 4 Payer influence in the pharmaceutical marketplace has risen dramatically 14% 33% 10% 17% 26% 34% 32% 18% 14% 2% Payers Specialists Key Opinion Leaders Others General Practitioners 2001-2006 2007-2011 Which pharmaceutical stakeholder is the most influential? Source: Monitor survey of 256 executives from large and mid-sized pharmaceutical companies  As health care costs continue to rise, therapeutic categories become more crowded, and products become less differentiated, payers will gain even more influence
  5. 5. 5 As they gain influence, payers are looking for a more strategic relationship with pharma companies More information about the total cost of care vs. alternative therapies Greater flexibility and transparency with pricing/contracts Providing information about their products and pipeline Value-added programs to assist patients, pharmacists and clinicians Payers Payers are looking for pharma companies to partner with them to achieve better, more cost-effective patient outcomes  Private Insurers  Medicare  Medicaid  Other gov’t programs  PBMs
  6. 6. 6 The current environment has enhanced the need for market research to understand payer needs and expectations Potential Uses of Payer Market Research Clinical Development/ Pre Launch Market Launch and Growth LOE •Value proposition testing •Customer experience research •New indications assessment/testing •Specialty pharmacy needs research • Market opportunity assessment • Clinical trial design/endpoints • Pricing and formulary tier placement • Packaging /distribution strategy •LOE strategic planning •Generic competition impact assessment •LOE messaging testing
  7. 7. 7 If done right, payer research provides significant insights 1. Reaching the RIGHT respondents • Recruiting influential respondents from the leading national plans requires a strong network and database of MCO contacts, as well as utilizing senior recruiters with payer experience 2. Mining maximum insights • Maximizing insights from payer research requires using skilled moderators with deep category knowledge, an understanding of payer dynamics, and appropriate sensitivity to payer time constraints and confidentiality issues 3. Integrating the results • Significant value can be added by integrating payer insights with data from different areas, including physician and patient research, market forecasting, customer experience tracking, and competitive intelligence Pharmaceutical Payer Research – Key Success Factors: 1 2 3
  8. 8. 8 HawkPartners has extensive experience with both private payers and other large scale health organizations  We have experience interviewing and surveying MCOs, PBMs, Specialty Pharmacies, and other payer organizations – We also have experience with other large scale health organizations, including key stakeholders from both Integrated Delivery Networks and large medical groups  Working with our field partners, HawkPartners utilizes databases of specifically targeted Medical and Pharmacy Directors in managed care organizations – We recruit using phone, fax and email information, and conduct additional desk research as needed, especially to reach larger national plans and PBMs – Telephone recruitment is conducted by trained executive interviewers with prior experience recruiting these types of respondents  HawkPartners and our field partners have recruited respondents from the largest US commercial plans and PBMs – We have also successfully recruited a wide range of payers in Europe and Asia Pacific
  9. 9. 9 HawkPartners has successfully completed payer research in US, EU and other markets  HawkPartners has completed projects with payers on such topics as customer experience, new product evaluation, prioritization of coverage considerations in a therapeutic area, product messaging and value proposition development, as well as broader therapeutic category trends • Chronic Pain Therapy Payer Value Proposition Testing (US) • Oncology Payer Customer Experience Assessment (US)* • HDL Market Opportunity Assessment (US & EU) • Market Opportunity Assessment for New Product Formulation/Delivery (US)* • Stroke Treatment Assessment (US &EU) • Omega-3 Market Opportunity Assessment (US) • Therapeutic Category Long-Term Opportunity Analysis (US & EU)* • Chronic Pain Product Comparator Research (US) • Ophthalmology Perceptions/Trends (US & EU) • Diabetic Macular Edema Opportunity Assessment (Emerging Markets: Latin America, Eastern Europe, Africa/Middle East, Asia) • Chronic Pain Product Profile Refresh (US) • Impact of Packaging / Distribution Changes on Respiratory Medication (US) • Bone Healing Development Strategy (US, EU, & Japan) • Understanding Specialty Pharmacy Considerations for High-Risk Patient Groups (US) Examples of HawkPartners Payer Research *see case study
  10. 10. 10 Case Study: Measuring customer experience drivers among payer account customers  HawkPartners’ Approach: Utilized a quali-quant research approach with pharmacy and medical directors from HMOs, PBMs and specialty pharmacy to obtain a baseline read on key customer experience metrics as well as rich insights on CE drivers.  Results: Client is using the results to develop value-added programs to assist clinicians, pharmacists and patients in partnership with payer organizations.  Challenge: Client seeks to establish a baseline measure of payer account customers’ experiences to understand how well their needs are being addressed through partnerships with pharmaceutical companies. 32% 15% 22% 5% 6% 33% 37% 14% 25% 20% % Ranked #2 and 3 % Ranked #1 36% 23% 65% 52% 30% Most Important Pharma Company Attributes % Ranked in Top Three n=45 Fair pricing Listens to needs of managed care Resources to assist patients Info for health economic analysis Resources to assist physicians/ pharmacists *Note: data has been disguised to protect confidentiality Attribute A Attribute B Attribute C Attribute D Attribute E
  11. 11. 11 Case Study: Scenario planning for an existing medication facing new category entrants  HawkPartners’ Approach: Conducted qualitative research with specialist physicians, pharmacy directors and other payers, exposing them to a product profile and eliciting their feedback on their perceived evolution of the market and decision making criteria.  Challenge: Pharmaceutical client recognizes the changing market landscape (new class of agents that is easier to use and the availability of a generic formulation of the market leader) and needs to proactively address to these issues.  Results: Feedback confirmed that the agent will indeed face challenges but identified several potential strategies and tactics for the client to explore to retain share and deepen existing relationships with pharmacy and medical directors. Perceived Benefits Questions / Drawbacks Pharmacy Directors • Reduction in costs with lack of monitoring • Easier to administer • Cost • All concerns expressed by physicians Physicians • Ease of Admin • Increased compliance • No need to monitor • How will we know if it is absorbed? • Dosage adjustments for BMI? • Reversibility? • Metabolization? • How to measure efficacy? • Indications? Managed Care Decision Makers • Reduction in costs with lack of monitoring requirements • Easier to administer • Cost – will most likely be Tier 3 (with the potential for one new agent on Tier 2) • Will not impact coverage of current branded meds as the expectation is that all will already be Tier 3 when new mechanism agents are introduced • All concerns expressed by physicians
  12. 12. 12 Case Study: Leveraging payer feedback to assess the market opportunity for a new product  HawkPartners’ Approach: Conducted qualitative research with payers and KOLs. Augmented these findings with secondary market research, including case studies of analogous agents.  Results: Findings revealed that payers will play a critical role in shaping the category’s treatment paradigm due to the agent’s expected high price and payers’ doubts regarding generics and other substitutes.  Challenge: To inform its development strategy for a new agent, a pharma client needed insights into the category’s evolving treatment paradigm, the role of both current and emerging treatment options, and unmet needs of payers. Category Coverage Decision Considerations GuidelinesCostEfficacy Safety Administration  Cost of entry  Most important but not really differentiating now  Better efficacy alone may not drive displace- ment of older treatments  Does drive coverage • Especially if no other advantage  Total cost matters, includes admin- related, e.g. office visits for (Procedure)  Rebates/contracts can be vital in status decisions  Given expense of (Treatment Type), Payers want evidence will work in population • Or would prefer agents which have that data  Helps drive step decisions  Associated costs are key – so (mechanism A) is preferred to (B)  Frequency is less important (but less often can help with better compliance)  Cost of entry  Second in importance but not really differentiating today  Superior safety alone would not drive preferred status  But less safety is a big problem