Direct to Consumer: Payers as Partners - Pharmaceutical Executive

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Direct to Consumer: Payers as Partners
Need help speaking to patients? Managed care could be the answer.


Pharmaceutical Executive



Lisa B. Bair
Consumer-centric healthcare has been the buzz for years. But today there are signs that its time has finally come, and that we're about to see the arrival of market-driven healthcare.

Look at some recent trends: Employers have begun shifting the burden—and the choice—of higher-cost prescription products to employees. The average company health plan now offers a menu of options, from flexible spending accounts to defined contribution plans and multi-tiered networks.

The federal government, meanwhile, has signaled its support of consumer-centric healthcare. During his re-election campaign, President Bush endorsed consumer-driven healthcare plans (CDHPs) as a way to control rising healthcare costs. And, following managed care's lead, Medicare is now placing the consumer firmly at the center of the healthcare decision-making process as well.


Evolution of program strategies
These make healthcare decision-making increasingly complex. For example, multi-tier co-pay designs force consumers to bear the cost when they opt for branded therapies, pushing cost-conscious consumers toward generics. On the other hand, the skyrocketing popularity of lifestyle therapies, for which consumers bear most or all of the cost, proves that consumer demand for prescription products is growing despite rising co-pays and premiums.

Two Birds with One Stone Brand managers can adapt to the changing times by developing a multifaceted approach designed specifically for patient-centric healthcare and its primary players—patients and managed market customers.

Brand managers and managed markets have many goals in common:

  • sharing in the healthcare decision-making process
  • increasing consumers' knowledge of treatment options
  • increasing patient adherence and compliance
  • increasing productivity

These shared goals create the opportunities for partnerships between pharmaceutical companies and managed market customers. Instead of using a mass-market approach such as DTC, companies can work with managed markets to develop initiatives that target employees who are at risk for, or have been diagnosed with, chronic conditions. Outcomes-focused programs such as health fairs, worksite healthcare education, and predictive modeling research can build brand loyalty with a large customer base in a way that is much more targeted than advertising.

Anecdotal feedback from employers that have rolled out CDHPs indicates that their participants actively seek healthcare information. Physicians, however, do not have the time or resources to provide all the information they demand. Enter pharma. Patient-friendly healthcare information distributed in partnership with managed market customers has the potential to significantly influence the purchasing decisions of a newly empowered group of consumers. Brand managers can capitalize on this by delivering unbranded patient education and disease-management tools at the worksite or at employer-sponsored health fairs.

Case study After analyzing its situation using predictive healthcare modeling, the global mailing technology provider Pitney Bowes took the drastic step of reducing its employees' co-pays for diabetes and asthma medications. The results: Increased usage of the drugs by employees. Emergency room visits decreased by 35 percent among diabetic patients and by 20 percent among asthmatic patients. What's more, Pitney Bowes estimated that overall annual drug spending among its diabetics and asthmatics decreased by 10 percent (compared to an 11 percent increase for the rest of the population), resulting in a savings of $1 million. Once their primary disease was properly treated, these patients used fewer healthcare resources, a benefit to the employer. And in this instance, GlaxoSmithKline benefited from the lower co-pays for Advair (fluticasone), from the acquisition of a new base of loyal customers, and from additional market-share gains.

Lifetime Customers Recent trend reports from the Health Inequalities Research Collaboration (HIRC) indicate that, in response to OIG and HIPAA guidelines, pharma and managed markets have begun forming partnerships to provide disease-management offerings such as appropriate-use and compliance programs. There are opportunities for both pharma and managed market customers in programs that educate patients about their chronic diseases or that use patient intervention strategies to improve disease outcomes.


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