MCImpact: Developing a Complete Understanding of Payer Influence on Brand Volume
Payers' influence continues to grow. However, most approaches used to measure payer impact on physician prescribing do not provide all the knowledge required to fully leverage a brand's formulary position strengths, and also mitigate its weaknesses.
By breaking down managed care info four sequential components, MCImpact improves managed care strategy and field sales tactics, improving overall sales effectiveness, as illustrated below:
I. Formulary Position Value
Many analyses that define payer influence are based on partial views of the relationship between plan position status and product share. They run the gamut from simple average shares for each plan's tier or co-pay designation, to share analysis considering a brand's position relative to the leading brand.
Both of these approaches are incomplete. It is important to assess the impact of each plan tier/co-pay position for your brand while simultaneously considering the other positions held by all competitive branded and generic alternatives. We employ a hierarchical technique to understand how relative tier status impacts brand share, as illustrated below:
This illustration conveys a more complete view of the linkage between share and formulary dynamics.
II. Plan Control
Expected share calculations that consider all products' formulary positions provide the true basis for determining the differential level of control exerted by individual plans. A plan's control is the difference in share driven by formulary position vs. that expected for the average plan. It considers the impact of both strong and weak positions.
We illustrate this evaluation below for two pairs of plans with the same relative position for Brand A:
Plans 1 and 3 exhibit the most control, and so represent higher payer negotiating priorities than Plans 2 and 4, given equal Rx coverage.
Branded vs. generic product share is an oversimplified measure of plan control. In fact, generics impact some categories far more than others (e.g., sleep aids vs. ARBs).
Each plan's control can be determined for all brands and across multiple categories. Control comparisons for your brand vs. competitors will identify plans for which your brand under-performs, in light of the benefit those plans provide other brands. This can be used to direct development of pull-through programs and incentives.
III. Regional Plan Impact Mapping
Many areas of the country have reputations for strong managed care influence. We can evaluate payer impact for each zip code, as illustrated below:
These zip code-level measurements are aggregated to assess the relative influence of payers vs. other factors driving physician prescribing decisions in each sales territory. This mapping will help determine changes to field sales staffing levels and deployment. It will improve territory design by directing increases in field sales coverage to the areas where representatives will have more impact, with reductions in areas highly driven by managed care.
IV. Physician Level Managed Care Favorability and Adherence
Many targeting systems include physician level "managed care scores." We believe that consideration of managed care impact on physician targeting must go beyond use of these scores because individual physicians are not influenced by plan position and control to the same degree. It is important to understand Managed Care Favorability and Managed Care Adherence for each individual physician when determining how to best allocate sales and marketing resources.
- Managed Care Favorability considers both formulary position and control exerted by the plans reimbursing patients' Rxs. Managed Care Favorability defines the "expected share" in light of the underlying payer mix.
- Managed Care Adherence is the degree to which plan formularies impact each physician's prescribing decisions, across multiple categories and products. More adherent physicians will exhibit higher actual shares for most formulary advantaged products, and less to most of the disadvantaged alternatives. It is also possible to determine if adherence is driven by payer mix consisting of high control plans vs. individual physician behavior.
If your brand's formulary position is weak, then adherent physicians who strictly follow formulary positions would be placed lower in the targeting hierarchy. However, those that do not strictly adhere to payer formularies should be distinguished from those who do, since they are likely to be more responsive to your promotional activity. Avoiding wholesale abandonment of these physicians may be as important as directing additional resources to adherent physicians with strong managed care positions. Physician adherence can be combined with Managed Care Favorability to direct targeting and tailor messaging, as highlighted below:
Managed Care Favorability and Adherence can also be evaluated for each territory to enable development of fair, "same-stretch" goals for incentive compensation.
COMPLETE MANAGED CARE MANAGEMENT SYSTEM
MCImpact delivers a thorough and comprehensive analysis of payer impact on physician prescribing. It provides a complete line of sight to link development of managed care strategies that offer brand growth potential with field sales decisions that will maximize the growth realized.
Contact us to learn more.