Successful market / customer access is a primary objective in healthcare marketing. This presentation provides the insight to successfully position, price and promote your pharmaceutical, medical device or clinical service in leading healthcare market segments. This presentation is from www.healthcaremedicalpharmaceuticaldirectory.com, no subscription is required. Please visit us to see more presentations about the latest marketing trends in the healthcare industry. John Baresky Healthcare Marketing Leader, Pharmaceutical Marketing, Digital Marketing Strategy, Content Marketing Strategy, Market Access Strategy, Healthcare RPA Software Marketing Strategy www.healthcaremedicalpharmaceuticaldirectory.com John G. Baresky https://www.linkedin.com/in/johngbaresky #baresky

1. Healthcare Brand Management
Market Access Concepts
Healthcare
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www.HealthcareMedicalPharmaceuticalDirectory.com

2. Healthcare Brand Management
Market Access Concepts

3. What is Access?
• The degree to which a healthcare product is:
– Easily prescribed/used by providers
– Reimbursed by health plans
– Effectively promoted/sold in a market segment
– Available through a variety of contractual arrangements
and supply chain sources

4. Access And Reimbursement
• If payers do not reimburse for the product, it is less likely
caregivers and patients can use it
– Marketing and sales initiatives of manufacturers will be much
less effective
– The product will not be able to generate enough revenue to be
commercially viable
– Competitors will gain an advantage through their market access
initiatives

5. Planning Access
• The product must be correctly positioned with primary prescribers and
provide clear clinical value in patient treatment
• Identify channels or market segments the product will be used most in
and where it realizes greatest revenue potential
– Target the predominant prescribers and payers in the channel
– Develop and implement a contracting strategy for each channel,
account for enduser customers and leading payers
– Fortify the product’s position through physicians, pharmacists, nurses
and other clinicians, define marketing strategy and accelerate growth
with sales tactics, ongoing promotion and pull-through
– KOL support establishes a deeper conduit of influence into clinical
decision makers and their peers

6. Planning Access
• A direct customer contract can be undermined if product is
available at a lower price through a GPO contract
• Distributors, wholesalers and other reseller contracts
need channel alignment to protect agreements and maintain
profit continuity in other market segments
• Discounts, rebates and other financial features need to be
accounted for throughout agreements to assure margin and
true profit is realized before transactions are underway
• Commercial contract pricing needs to be reconciled against
government contracts requiring “best price”

7. Planning Access
• Sole awards and preferred product positions provide
premium access but require the steepest discounts and
garner the most competitive attention
•
Rebates based on volume contracts need clear definition
and dedicated resources to maximize access and accurately
manage rebates through sales tracings, chargeback data
•
It is necessary for pharmaceutical companies to balance
direct contracting strategies with healthcare clients versus
GPOs; healthcare entities engage various arrangements
depending on their procurement preferences

8. Planning Access
•
Customer supply chains featuring distributors, wholesalers,
specialty pharmacies and other sources vary, contracting
strategy needs to account for these
•
Maintaining/expanding access requires a budget to open
new initiatives and provide marketing/sales resources to
propel them
•
Access requires selectivity, fortifying/expanding access
should be based on customer need, reimbursement
potential, available resources and long term ROI
•
The product must be correctly positioned with primary
prescribers and provide high clinical utility

9. Pull-Through Reinforces Access
• Establishing a leading contractual arrangement and/or preferred
status is just the beginning…
– Caregivers and patients need to know they have access to the
product, be familiar with the product’s attributes and establish
the processes to procure it through
– Sales uptake and ongoing momentum is driven by a wellsupported sales force and strong marketing initiatives to fortify
and expand share/revenue
– New competitors will launch pull-through initiatives to penetrate
the market, established competitors will widen share and
prevent newcomers from getting traction
– Payers need to be continually engaged and cognizant of the
product and its manufacturer’s value

10. Connectivity Coordinates Access
• Access is driven by connectivity and throughput of information:
– Healthcare plans and PBMs make data-driven decisions based on
care/cost outcomes, claims reporting and member utilization
– Pharmaceutical companies rely on blended data to effectively
contract, maintain compliance, determine share, assess
marketing/sales ROI
– CMS/Federal and state sponsored plans are data dependent to fund
programs such as Medicare, Medicaid, 340B, reimburse providers and
pharmaceutical companies, as well as maintain patient eligibility files
– ACOs are hugely dependent on electronic information flow to manage
their protocols and assess performance
– Social Media propels clinical and promotional messaging to
healthcare professionals, patients and consumers

11. Examples of Market Channels
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Dialysis
Long Term Care
Home Infusion
Hospitals
Infusion Clinics
Military Treatment Facilities/MTFs
Oncology Clinics
PBMs/Mail Order Pharmacy
Physician Practices
Retail Pharmacies
Specialty Pharmacies
Surgical Centers/Outpatient Surgery,
Veterans Administration/VA Hospitals & Clinics
Each channel
requires its
own market
access plan…

12. Leading Pharmacy Entities
Retail Pharmacy
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CVSCaremark
Rite Aid
Target
Walgreens
Wal-Mart
PBMs*
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ARGUS
BioScrip
Catamaran
CVSCaremark
Express Scripts
…In addition to contracting with pharmaceutical manufacturers, PBMs contract with
retail pharmacies to fill prescriptions for pharmacy plan customers
*PBMs: Pharmacy Benefit Managers

13. A Note About PBMs
• PBMs contract with brand and generic manufacturers for better
pharmaceutical pricing and actively manage utilization of prescription
medication by customer plan members
• PBMs manage their own formularies and those of health plans or selfinsured employers, they assertively negotiate for rebates based on
volume/preferred status with pharmaceutical companies
• Some PBMs like CVSCaremark, Express Scripts and Catamaran operate
their own mail order pharmacies, others like ARGUS, outsource it
• PBMs manage prescription plans for employer, government (Medicaid,
Medicare, TRICARE, etc.) and other sponsors
• PBMs offer clinical programs to manage some therapies/patients more
closely, these provide access opportunities for manufacturers

14. A Note About Mail Order Pharmacies
•
Mail order pharmacies dispense maintenance therapies (cholesterol, diabetes,
contraceptives, hypertension, etc.) in 90-day supplies, it is key for manufacturers
of maintenance therapies to have contracts with mail order pharmacies
•
They charge plans/patients less, the concept is patients are getting their
medications “in bulk” 90-day supplies versus 30-day retail increments
•
Mail order pharmacies typically operate specialty pharmacy units as well to
dispense injectable products to support advanced patient care
•
CVSCaremark, Walgreens, Rite Aid and Wal-Mart operate mail order pharmacies
in addition to their retail pharmacy operations
•
Health plans with their own mail-order operations include Cigna (Tel Drug),
Humana (FutureScripts), BCBS (Prime Therapeutics) and United HealthCare
(Prescription Solutions)

15. Leading Payer Plans
Commercial Plans
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Aetna
BlueCross BlueShield plans*
Cigna
Humana
Kaiser
United Healthcare
WellPoint (14 BCBS plans)*
Government Payers
– Medicaid (state-based,
federally subsidized)
– Medicare
– TRICARE (active/retired
military)
– 340B Plans
*There are over 30 BlueCross BlueShield plans affiliated with the
BlueCross BlueShield Association

16. A Note About 340Bs
•
340B is a Federal drug discount program established in 1992, it requires drug
manufacturers to provide outpatient drugs to eligible health centers, clinics and
hospitals at a discounted/negotiated rate (average 50% below retail)
•
The 340B market segment has been growing due to issues with the economy and
larger numbers of uninsured persons but margin is lower as 340B is price driven
•
340B is also known as "PHS pricing" or "602 pricing“, patients discounts are
created by contractual arrangements between the care provider and a pharmacy
•
Entities eligible to participate in 340B include:
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Black Lung Clinics
Disproportionate Share Hospitals (DSHs)
Family Planning Clinics
Federally Qualified Health Centers (FQHCs)
Federally Qualified Health Center look-alikes (FQHCLAs)
Hemophilia treatment centers
HIV / Ryan White Clinics
Sexually transmitted disease and tuberculosis clinics
State-operated AIDS Drug Assistance Programs
Urban Indian organizations

17. GPO and Healthcare System Leaders
GPOs
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Healthcare Systems
Amerinet
Gerimed
Epic
HealthTrust Purchasing
Group (HPG)
Innovatix
ION (M
MedAssets
MHA
Novation
PDM
Premier
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Dept. of Veteran Affairs/VA
HCA Inc.
Community Health Systems
Trinity Health
Partners Healthcare
NYC Health & Hospitals Corp.
Kaiser Permanente
Universal Health Services Inc.
Catholic Healthcare West
Adventist Health System
Tenet Healthcare Corp.
…GPOs are frequently a part of the Healthcare System access formula

18. A Note About GPOs
• Group Purchasing Organizations (GPOs) contract with manufacturers of
brand or generic pharmaceutical products, medical devices, equipment
and other items used in healthcare settings
• Healthcare entities pay a membership fee to “join” a GPO to get access to
discounted pricing GPOs negotiate with manufacturers, GPOs also collect
1-3% margin from drug products and provide other services to gain
• Some GPOs are business units of distributors/wholesalers but do not
take possession of products, they are purely contracting entities
•
HPG, MedAssets, Novation and Premier are larger independent GPOs
• Wholesaler operated GPOs include INN, ION (AmerisourceBergen),
VitalSource (Cardinal Health), Onmark, U.S. Oncology (McKesson)
• An array of customer groups use GPOs including healthcare systems,
hospitals, oncology clinics, home infusion, surgical centers, dialysis
clinics, physician groups and long term care companies

19. Nursing and Assisted Living Facilities
Nursing Facilities
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HCR ManorCare
Golden Living
Life Care Centers
Kindred Healthcare
Genesis Healthcare Corp.
Sun Healthcare Corp.
SavaSeniorCare
Extendicare Health Services
ELGS
Skilled Healthcare Corp.
Assisted Living
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Emeritus Corp.
Brookdale Senior Living
Sunrise Senior Living
Altria Senior Living
Five Star Quality Care
Assisted Living Concepts
Merrill Gardens
HCR ManorCare
One Eighty-Leisure Care
Life Care Services
…Once highly fragmented, consolidation among nursing and assisted living facility
operators continues which will greatly concentrate revenue sources in the future

20. Long Term Care Pharmacy and Home Infusion
LTC Pharmacies
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Guardian Pharmacy
Millenium Pharmacy
Omnicare
Partners Pharmacy
PharMerica
Senior Care Pharmacy
Home Infusion Providers
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Apria
AxelaCare Home Solutions
CarePoint Partners
Healix
Home Solutions
Infuscience
Lincare
OptionCare/Walgreens
Vital Care
…The home infusion provider market continues to evolve through consolidation of
existing providers and hospitals expanding their services into home infusion offerings

21. Surgical Centers and Dialysis Clinics
Surgical Centers
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Dialysis Providers
Amsurg
HVP
Meridian Surgical Partners
SCA
Surgical Care Affiliates
Symbion
United Surgical Partners
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…GPOs are frequently a part of the Surgical
Center access formula
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American Renal Associates
Centers for Dialysis Care
DaVita
Dialysis Clinic Inc.
Fresenius
Innovative Dialysis
Systems
Renal Advantage
Renal Care Partners
Satellite Healthcare
U.S. Renal Care
DaVita and Fresenius control two-thirds of the U.S. dialysis market, consolidation in
the channel is frequent and driven by cost controls to generate revenue under
Medicare patient care performance standards and reimbursement limits…

22. Access Summary
• Each market channel requires its own access strategy
• Fully account for primary payers in each channel to position, price and
promote product successfully
• Contracting may involve direct-to-customer, distributor, GPO, PBM,
wholesaler, payer and other arrangements to succeed in the channel
• Competitors are selectively stronger/weaker in different channels, exploit
channels they are weakest in to grow product sales
• Contracts open the conduit to market access, contract management, pullthrough and connectivity are necessary to maintain/expand product and
profit performance
• Be selective, fortification/expansion of access requires the customer base
to demonstrate true need, acceptable reimbursement levels, suitable
resources to sustain initiatives and confirmation of long term ROI

23. For ongoing business and clinical healthcare industry
resources, please go to:
www.HealthcareMedicalPharmaceuticalDirectory.com
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