A panel of eight MCO medical directors recently convened to answer that question and evaluate the influence of consumers, physicians, pull-through programs, and outcomes studies. MedPanel, Inc., an online market intelligence company, asked eight US medical directors to comment on the influences that affect whether a drug is included on a typical formulary and what criteria are used to evaluate a new drug entry.
The panel was convened online over a two-week period, and participant identities were concealed from each other to foster more candid responses and maximize the interaction. (See "Panelist Profile," ) This article highlights the study group's findings—which may come as a bit of a surprise to some product managers.
Although DTC advertising may be what influences consumers most, health plans tend to dismiss the information provided in consumer advertising and focus on science.
Consumers also lack a unified means of asserting pressure, panelists emphasized. That's why some medical directors view employer groups, rather than individuals, as the real consumers. Although most participants expected little change in consumers' influence over formulary decisions, there were a few interesting exceptions. One medical director said, "Organizations such as AARP may be able to affect the consumer voice in the future," because they are an organized and powerful group with a public agenda. Taking on formulary decision making seems like a natural next step for AARP. As other groups form—or wake up to the formulary issue—consumers will find their influence growing. Another participant asserted that escalating costs will lead to increased consumer involvement over drug availability. Still another stated that although individuals have almost no impact, "High demand may push an earlier determination of a drug's placement than would have otherwise occurred."
"There will be more activity from the consumer, related to influencing the drugs/treatments available," said one participant.