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Emerging Importance of the Managed Care Liaison
 

Emerging Importance of the Managed Care Liaison

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Presented at the World Congress Pharmaceutical Division Conference, Philadelphia, May 17, 2103

Presented at the World Congress Pharmaceutical Division Conference, Philadelphia, May 17, 2103

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    Emerging Importance of the Managed Care Liaison Emerging Importance of the Managed Care Liaison Presentation Transcript

    • © 2013 All rights reserved. The statements and opinions expressed hereinare those of the speaker and Jencen Field MedicalConsulting LLC, and not necessarily those of anypast employer. No financial interests to disclose.2
    • © 2013 All rights reserved. MCL = Managed Care Liaison, or “liaison” Competencies & current value proposition Changing landscapes as opportunity forthe MCL◦ Healthcare reform◦ Biopharmaceutical industry◦ Customer segments3
    • © 2013 All rights reserved. “Medical science liaisons…partner the businessside of the equation (managed care) with thecorporate clinical expertise in order to achieve atrue value proposition offering.”1 “MSL contributing to reimbursement discussionsand formulary committee presentations hasincreased from less than 10% ….in 2010 to 42% in2012.”241 “Role of the Pharmaceutical Company in Managed Care”, in Managed Care Pharmacy Practice, R. Navarro (ed), p 348, (2009).2 “Harnessing KOL Relationships for Optimal Clinical Support”, Cutting Edge Information, (2012).
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    • © 2013 All rights reserved. Maintains working account knowledge◦ Clinical decision-makers’ product thought processes◦ Formulary review and approval process◦ Various clinical / pharmacy touch points within account Integrates clinical value proposition with overallaccount plan◦ Meets payer’s medical need◦ Meets internal account objectives◦ Executive presence at the podium6
    • © 2013 All rights reserved. Operates independently across multiple networks◦ Maximizes opportunities for customer interaction Locally (identification of influential account customers) Regionally (healthcare business coalitions, AMCP chapters) Nationally (AMCP, ASHP, PCMA) Recognizes evolving contacts within account◦ Quality department◦ Case mgmt7
    • © 2013 All rights reserved. Account managers◦ Effective relationship is a key to MCL success◦ Build collaborative, strategic partnership Business updates◦ Regional ML teams, as group and individually Communicate insights in both directions◦ Brings account’s early thinking back into Company◦ Tests Company’s insights with the account◦ Facilitates advisory boards (PCMA) Easily incorporate HEOR responsibilities8
    • © 2013 All rights reserved. Budget◦ Dedicated or ‘mixed’ (w/KOL responsibilities)?◦ Add HEOR responsibilities? Map MCLs to commercial MC team geographies◦ Maximum effectiveness when independently accessingaccount A good starting point◦ Provide continuous medical support for strategic,national accounts9
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    • © 2013 All rights reserved. Increasing emphasis on value◦ New(er) unmet needs◦ Demand for real-world data◦ Need evidence of value “It is no longer simply about the cost of the drug but total cost of careto demonstrate a product’s value”3 --Vice-President, WellPoint Driving quality◦ Connecting quality to performance to compensation4113 “Pharma and Payers—Building Better Relationships”. First Word, Sep 2012. Accessed 5/11/13 athttp://www.reportlinker.com/p01021205-summary/Pharma-and-Payers-Building-Better-Relationships.html4 T Esse, O Serna, A Chitnis, M Johnson, N Fernandez. “Quality Compensation Programs: Are They Worth All theHype? A Comparison of Outcomes Within a Medicare Advantage HF Population”, JMCP, 2013;19(4):317-24.
    • © 2013 All rights reserved.A Challenge for ACOsDevelop quality measuresacceptable to both plans and providers5 MCL--‘Advisor’ on design of quality metrics◦ Diabetes (HbA1C, cholesterol)◦ Pulmonary (appropriate use of antibiotics)◦ MTM (monitoring of specific drugs) Coordinate KOL providers with regional ML125 “Accountable Care Organizations for PPO Patients”. Integrated Healthcare Association (2011), accessed 4/30/2013 athttp://www.iha.org/ACOWhitePaper_PPO_final.pdf
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    • © 2013 All rights reserved. Scientific / technical → increasing complexity◦ Large molecules and biologics manufacturing◦ Genome-based therapies / personalized medicine◦ Increasing use of technology Companion diagnostics◦ MCL—educate clinical decision makers & staff Economic → decreasing revenue streams◦ Ongoing generic erosion◦ Thinner and more expensive pipelines◦ “New” pharma business model14
    • © 2013 All rights reserved. Blue ocean6156 W. Chan Kim and Renee Mauborgne. Blue Ocean Strategy.: How to Create Uncontested Market Space and Make the Competition Irrelevant.Harvard Business School Press (2005).
    • © 2013 All rights reserved. Blue ocean6 → Pink ocean166 W. Chan Kim and Renee Mauborgne. Blue Ocean Strategy.: How to Create Uncontested Market Space and Make the Competition Irrelevant.Harvard Business School Press (2005).
    • © 2013 All rights reserved. Blue ocean6 → Pink ocean → Red ocean◦ Formerly uncontested market space becomes crowded176 W. Chan Kim and Renee Mauborgne. Blue Ocean Strategy.: How to Create Uncontested Market Space and Make the Competition Irrelevant.Harvard Business School Press (2005).
    • © 2013 All rights reserved. Blue ocean6 → Pink ocean → Red ocean◦ Formerly uncontested market space gets crowded Example: Hepatitis C virus◦ Pursuing “Holy Grail”, i.e., oral, interferon-free, qd therapy◦ 10 companies conducting 83% of clinical trials7◦ 14 Phase III trials completing Q1 2014◦ Likely lacking head-to-head data◦ Cure rates and safety profiles roughly similar◦ Above suggests minimal product differentiation186 W. Chan Kim and Renee Mauborgne. Blue Ocean Strategy.: How to Create Uncontested Market Space and Make the Competition Irrelevant.Harvard Business School Press (2005).7 Doro Shin. “The race toward an interferon free world: The current field of HCV treatment research, including recent financial deals “ Citeline (2012)Accessed May 7, 2013 at http://www.citeline.com/wp-content/uploads/HCV-Competitive-Treatment-Lansdcape.pdf
    • © 2013 All rights reserved. Orphan drug market◦ 22% of all new drugs in development are for rare diseases8◦ 70% of above are considered first-in-class Example: Juxtapid ® and Kynamro ®◦ Approved within 4 weeks of each other for HoFH◦ ~300 US patients◦ Labels nearly identical◦ Annual cost: $235,000-$295,000 (J); $176,000 (K)◦ “…payer-decision making will most likely be shaped byeach product’s individual clinical profile.”9198 “Orphan Drugs to Create Paradigm Shift in the Pharmaceutical Industry! “ Frost & Sullivan April 6, 2013. Accessed April 15, 2013 athttp://www.prnewswire.com/news-releases-test/frost--sullivan-orphan-drugs-to-create-paradigm-shift-in-the-pharmaceutical-industry-89979267.html9 J. Pecherer.” Competitive Headwinds: the Beginning of the Kynamro and Juxtapid Story.” Decision Resources. Feb 2103, accessed May 10, 2013 athttp://decisionresources.com/trackback/6c021a04-3f6b-4490-82d3-80b868baf168/Competitive-Headwinds--the-Beginning-of-the-Kynamro-and-Juxtapid-Story.aspx
    • © 2013 All rights reserved. Unsustainable pricing models◦ Zaltrap®--refused by Memorial Sloan-Kettering10◦ Provenge® --cost, benefit, demand issues prompt re-think11 Result◦ Lack of product differentiation◦ Manufacturers competing on price A solution◦ MCL: possesses skill set for identifying discreet areas ofclinical / economic / humanistic differentiation2010. R. Conti and E. Berndt. “Winner and Loser from the Zaltrap Price Discount: Unintended Consequences? “ Health Affairs Blog , Feb 20, 2013,Accessed May 8, 2013 at http://healthaffairs.org/blog/2013/02/20/winners-and-losers-from-the-zaltrap-price-discount-unintended-consequences/11. M. Herper. “The Key Question for Dendreon: Is There Demand for Provenge? “ Forbes.com , Jul 23, 2102. Accessed May 9, 2013 athttp://www.forbes.com/sites/matthewherper/2012/07/31/the-key-question-for-dendreon-is-there-demand-for-provenge/
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    • © 2013 All rights reserved. Government Employers Integrated Delivery Networks / IntegratedHealth Systems Group Purchasing Organizations Retail Pharmacy Chains22
    • © 2013 All rights reserved. Government Employers Integrated Delivery Networks / IntegratedHealth Systems Group Purchasing Organizations Retail Pharmacy Chains23
    • © 2013 All rights reserved. State health insurance exchanges◦ Consumers: significant knowledge gap◦ Plans: changing coverage policies◦ Industry: need to adapt payer strategies MCL value-adds◦ Network to identify clinical decision makers◦ Interact with policy makers to differentiate products◦ Enhance broader corporate educational efforts24
    • © 2013 All rights reserved. 68.5 percent of workers in firms with 50 or moreemployees were in self-insured plans12 Changing payer dynamic◦ Plans and servicers taking on more of claims admin role MCL value-adds◦ Acct mgmt & networking: identify clinical decision makers◦ Scientific mastery: educate diverse stakeholder groups12 P. Fronstin, Ph.D., ”Self-Insured Health Plans: State Variation and Recent Trends by Firm Size”. Employee Benefit ResearchInstitute, Nov 2012.25
    • © 2013 All rights reserved. The MCL◦ Independently delivers value at intersection of medicalscience and business◦ Role anticipated to evolve in response to largerchanges The new biopharma industry business model Need for innovative clinical differentiation inincreasingly crowded product markets Shift in payer demographics Payers increasing demand for value-adds across thecare continuum26
    • Life is a learning experience;only if you learn.--Yogi Berra27