HawkPartners Perspective on Payer Research

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HawkPartners Perspective on Payer Research

  1. 1. HawkPartners Perspective onPayer ResearchDiscussion DocumentAugust 2012For more information contact:Scott WilkersonScott.wilkerson@hawkpartners.com301 951-7046
  2. 2. The US health insurance landscape includes a mix of private commercial plans and government payers US Healthcare Payer Landscape 8% Other Gov’t Medicare Age of Programs Covered Under Age 18 6% Medicaid Private Health Age 18-65 Insurance Avg. Annual Age 65+ SpendingGrowth, 2005- 4% Out of Pocket/ Relative size of 2010 Uninsured* circle represents total covered lives 2% 0% $250 $500 $750 $1,000 Estimated Total Spending, US$B (2011) *Estimated covered lives based on number of uninsured Sources: US Census; Congressional Budget Office; CMS.gov “National Health Expenditures 2010-2020” 2
  3. 3. Both commercial health insurance and PBM markets areconsolidating, with large players increasingly dominantLargest US Private Health Insurers US Pharmacy Benefit Managers Share of Total Premiums Written (2010) Share of Members (2010) 32% All Others 50% All Others 4% Argus Health Systems, Inc. 5% MedImpact Healthcare Systems 6% NovoLogix 3% Highmark Inc. 8% 4% Health Care Services Health Information Designs, Inc. 5% Aetna Inc. 9% ICORE Healthcare, Inc. 6% Humana Inc. 10% Medco Health Solutions, Inc.* 8% Kaiser Permanente 10% WellPoint 13% CVS/Caremark Rx, Inc 16% UnitedHealth Group 13% Express Scripts Inc. *Acquired by Express Scripts in April 2012Sources: AM Mindpower Solutions; Pharmacy Benefit Manager Institute 3
  4. 4. Payer influence in the pharmaceutical marketplace hasrisen dramatically As health care costs continue to rise, therapeutic categories become more crowded, and products become less differentiated, payers will gain even more influence Which pharmaceutical stakeholder is the most influential? 34% 33% 32% 26% 18% 17% 2001-2006 14% 14% 2007-2011 10% 2% Payers Specialists Key Opinion Others General Leaders Practitioners Source: Monitor survey of 256 executives from large and mid-sized pharmaceutical companies 4
  5. 5. As they gain influence, payers are looking for a morestrategic relationship with pharma companies PayersGreater flexibility andtransparency with  Private Insurers More information about thepricing/contracts  Medicare total cost of care vs.  Medicaid alternative therapies  Other gov’t programs  PBMsValue-added programs to assist Providing information aboutpatients, pharmacists and clinicians their products and pipeline Payers are looking for pharma companies to partner with them to achieve better, more cost-effective patient outcomes 5
  6. 6. The current environment has enhanced the need for marketresearch to understand payer needs and expectations Potential Uses of Payer Market Research Clinical Market Launch and Development/ LOE Growth Pre Launch • Market opportunity • Value proposition • LOE strategic assessment testing planning • Clinical trial • Customer experience • Generic competition design/endpoints research impact assessment • Pricing and • New indications • LOE messaging formulary tier assessment/testing testing placement • Specialty pharmacy • Packaging needs research /distribution strategy 6
  7. 7. If done right, payer research provides significant insights Pharmaceutical Payer Research – Key Success Factors: 1. 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. 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 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 7
  8. 8. HawkPartners has extensive experience with both privatepayers 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 8
  9. 9. HawkPartners has successfully completed payerresearch 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 development, as well as broader therapeutic category trends Examples of HawkPartners Payer Research • 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) *see case study 9
  10. 10. Case Study: Measuring customer experience driversamong payer account customers 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. Most Important Pharma Company Attributes  HawkPartners’ Approach: % Ranked in Top Three 65% n=45 Utilized a quali-quant research % Ranked #2 and 3 approach with pharmacy and % Ranked #1 medical directors from HMOs, 52% PBMs and specialty pharmacy 33% to obtain a baseline read on key 36% customer experience metrics as 37% 30% well as rich insights on CE 14% 23% drivers. 32% 25% 20%  Results: Client is using the 22% results to develop value-added 15% 5% 6% programs to assist clinicians, pharmacists and patients in Fair pricing Resources Listens to Resources Info for to assist needs of to assist health partnership with payer patients managed physicians/ economic organizations. care pharmacists analysis *Note: data has been disguised to protect confidentiality 10
  11. 11. Case Study: Scenario planning for an existing medicationfacing new category entrants 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. Perceived Benefits Questions / Drawbacks  HawkPartners’ • Reduction in costs with Approach: ConductedPharmacy • Cost lack of monitoringDirectors • All concerns expressed by physicians qualitative research with • Easier to administer • How will we know if it is absorbed? specialist physicians, • Dosage adjustments for BMI? • Ease of Admin • Reversibility? pharmacy directors andPhysicians • Increased compliance • No need to monitor • Metabolization? other payers, exposing • How to measure efficacy? • Indications? them to a product profile • Cost – will most likely be Tier 3 (with the and eliciting theirManaged • Reduction in costs with potential for one new agent on Tier 2) feedback on their • Will not impact coverage of currentCare lack of monitoring perceived evolution of branded meds as the expectation is thatDecision requirements all will already be Tier 3 when newMakers • Easier to administer mechanism agents are introduced the market and decision • All concerns expressed by physicians making criteria.  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. 11
  12. 12. Case Study: Leveraging payer feedback to assess the market opportunity for a new product  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.  HawkPartners’ Approach: Category Coverage Decision Considerations Conducted qualitative Efficacy Safety Cost Guidelines Administration research with payers and Cost of entry  Cost of entry  Does drive  Given expense  Associated costs KOLs. Augmented these Most important  Second in coverage of (Treatment are key – so findings with secondary but not really importance but • Especially if no Type), Payers (mechanism A) differentiating not really other advantage want evidence is preferred to market research, including now differentiating  Total cost matters, will work in (B) case studies of analogous today population  Frequency is Better efficacy includes admin- • Or would less important agents. alone may not  Superior safety related, e.g. office visits for prefer agents (but less often drive displace- alone would ment of older not drive (Procedure) which have can help with  Results: Findings that data better treatments preferred  Rebates/contracts  Helps drive step compliance) revealed that payers will status can be vital in  But less safety status decisions decisions play a critical role in is a big shaping the category’s problem treatment paradigm due to the agent’s expected high price and payers’ doubts regarding generics and other substitutes. 12

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