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Role of Medical Affairs in Payer Interactions


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Medical Affairs organizations often face challenges in the planning and management of payer engagement and market access activities. This Research Report from Best Practices, LLC Illustrates how leading Pharma and Biotech companies structure and organize their payer groups and Medical Affairs’ involvement with it. It highlights strategies for building and maintaining effective relationships with payers and seeks to understand resource levels for Medical Affairs to create effective payer relationships.

This report can be used by Medical Affairs leaders for talent acquisition and training for their payer groups. It can be used to explore strategies for identifying, segmenting and prioritizing payers.

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Role of Medical Affairs in Payer Interactions

  1. 1. Page | 1 Medical Affairs’ Critical Role in Payer Interactions Best Practices, LLC Strategic Benchmarking Research & Analysis
  2. 2. Page | 2 Table of Contents  Executive Summary pgs. 3-10  Research Overview pg. 4  Participating Companies & Segmentation pg. 5-6  Key Recommendations pg. 7  Key Findings & Insights pgs. 8-12  I. Capturing Payer Insights and Partnerships with Payers pgs. 13-23  II. Field Resources for Payers pgs. 24-30  III. Talent Background and Training pgs. 31-39  IV. Knowledge Sharing pgs. 40-48  V. Payer Segmentation and Prioritization pgs. 49-54  VI. Medical Affairs and Payer Resource Ratios pgs. 55-58  VII. Medical Affairs Leadership and Structure pgs. 59-62  VIII. Demographics pgs. 63-65  XI. About Best Practices, LLC pg. 66-67
  3. 3. Page | 3 Field Research & Insight Development Twenty nine survey responses from Medical Affairs leaders at 27 biopharmaceutical companies. This report captures insights on two segments: Company Size Segments: Large (> $10B in revenue), Mid-Size ($1B-$10B in revenue) and Small (< $1B in revenue) Regional Segments: Global (Respondent works under the global Medical Affairs group) and US-only (Respondents focus is only US) regions Provide Leading Insights on: • Identifying critical requirements for Medical Affairs to be successful in payer activities • Create strategies to build and maintain strong partnerships and relationships with payers Research Objectives & Methodology Research Objectives:  Illustrate how leading Pharma and Biotech companies structure and organize their payer groups and Medical Affairs’ involvement with it  Highlight strategies for building and maintaining effective relationships with payers  Understand resource levels for Medical Affairs to create effective payer relationships  Guide Medical Affairs for talent acquisition and training for their payer groups  Explore strategies for identifying, segmenting and prioritizing payers Business Objective This research delivers current data, insights and best practices from Medical Affairs leaders at top biopharmaceutical companies. The benchmark data in this study will help companies find better ways to create strong Payer Relationships
  4. 4. Page | 4 Universe of Learning: 27 Top Companies Contributed to This Research This study engaged with 29 executives from 27 leading biopharmaceutical companies. Eleven research participants represented large biopharmaceutical organizations, while 9 participants represented medium companies and the remaining benchmark class emerged from small companies. Also 17 companies form a US-only segment, while 12 companies form a Global segment. Benchmark Class
  5. 5. Page | 5 Study Analyzes Two Main Segments % Respondents Benchmark Class Regional Segments Company Size Segments US-only Global Large Companies: Revenue > $10B Medium Size Companies: Revenue $1B – < $10B Small Companies: Revenue < $1B N=17 N=11 N=29 N=12 N=9 N=9
  6. 6. Page | 6 Key Findings for Medical Affairs’ Role in Payer Interactions  Capturing Payer Insights: Medical Affairs plays a critical role in probing payer needs and perspectives. The top three activities that Medical Affairs groups design and manage are:  Clinical presentations and discussions with payers (used by 100% of the benchmark class)  Advisory boards / forums for payers (used by 93% of the benchmark class)  Outcomes research presentations (used by 90% of the benchmark class)  Payer Field Resources and Trends: Seventy-six percent of the participants don’t’ have specialized health outcomes liaisons to interact with payers. A majority deploys medical science liaisons to the field in order to build and maintain relationships with payers.  Regardless of company size, all companies utilize part of their MSL teams to communicate with payers.  While larger companies have more focus on specialized resources for payers, smaller companies rely more on managed care liaisons.  About one fourth of the participants expect more than 30% growth in the staff that works in the area of payer relationships. Few of the key findings and insights from this study:
  7. 7. Page | 7 Critical Elements: Payer Needs, HEOR, Internal & External Communication Critical Elements of Strong Payer Communications Building and Maintaining Strong Relationships with Payers Understanding Payers’ Needs Health Economics & Outcomes Research Internal Knowledge Sharing Conveying the Value Understand the current trends in the market as they pertain to payers Communicate with payers at the product development process to address their needs better Translate clinical benefits to payers’ value discussions Communicate real world evidence showing a positive health impact Create a Dedicated HEOR team for key customer accounts Acquire experienced talent: Seek employees from competitors and payers Plan face-to-face meetings between payer groups and Medical Affairs Create cross-functional training programs to help employees understand each others strengths and weaknesses
  8. 8. Page | 8 N=29 Medical Affairs Leads Activities that Require Scientific Communication Q4. Capturing Payer Insights: What roles do your Medical Affairs professionals play in carrying out activities designed to probe payer needs and perspectives? Ninety percent or more of the Medical Affairs groups lead: Clinical Research, Advisory Boards and Outcomes Research communication. It’s critical for Medical Affairs to manage activities that require scientific interactions. BenchmarkClass 100% 93% 90% 82% 79% 72% 69% 61% 57% 55% 52% 52% Clinical presentations & discussions Advisory boards/ forums for payers Outcomes research presentations Executive exchanges Competitor analysis Focus groups targeting payers Virtual advisory boards Acquisition of input from payers Segmentation stratification of payers Discrete-choice modeling of payer decision-making Behavioral economics research Conjoint studies probing payer decisions Capturing Payer Insights % Respondents Leading and/or Supporting
  9. 9. Page | 9 N=29 Medical Science Liaisons Lead Payer Relationships Other: Not part of the medical function % Respondents More than half of the respondents deploy MSLs without any specialization to manage payer relationships. Health outcomes liaisons and specialized MSLs are favored only by one-fifth to one-fourth of the participants. BenchmarkClass Q6. Payer Field Resources: What type of field-based resources have your Medical Affairs organization deployed to support payers? 3% 7% 10% 10% 10% 21% 21% 24% 52% Other Part of HOL team without specialization Nurse educators Specialized managed care liaison groups We don’t provide any field-based resources for payers Managed care liaisons (MCLs) without any specialization Specialized medical science liaisons (MSLs) for payers Specialized health outcomes liaisons (HOLs) for payers Part of MSL team without specialization Payer Field Resources
  10. 10. Page | 10 N=29 Scientific Background is Critical for Payer Interactions Other: PhDs in HEOR, MPH % Respondents More than 90% of the companies find two educational backgrounds highly effective or effective for staffing payer-oriented activities: Pharmacy or Medical (MD). BenchmarkClass 25% 4% 4% 20% 50% 70% 13% 24% 29% 36% 42% 22% 12% 13% 12% 4% 4% 63% 60% 54% 32% 4% 4% Other Chemistry Biology Nursing Medical (MD) Pharmacy Talent Background Highly Effective Effective Ineffective Don't Employ Q15a. Effectiveness of Educational Background: Rate the effectiveness of staff with the following educational backgrounds for your payer services.
  11. 11. Page | 11 Best Practices®, LLC is an internationally recognized thought leader in the field of best practice benchmarking®. We are a research, consulting, benchmark database, publishing and advisory firm that conducts work based on the simple yet profound principle that organizations can chart a course to superior economic performance by leveraging the best business practices, operating tactics and winning strategies of world-class companies. 6350 Quadrangle Drive, Suite 200 Chapel Hill, NC 27517 (Phone): 919-403-0251 Learn More About Our Company: