Medicare Part D is expected to be a catalyst for change across the broader payer environment, and managed-markets group leaders
should focus on predicting the magnitude of these spillover effects, determining what they mean for their companies, and making
the needed adjustments. In doing so, they'll need to address the following key questions:
- How are the Medicaid and long-term care environments likely to evolve vis-á-vis the transition of the dual-eligibles to Part
- What degree of confluence should we expect between Medicare Part D and commercial managed care?
- What is the potential financial impact for our company and products?
- How should we adjust our strategy in these other segments?
POSITIONING AND MESSAGING Brands will need Part D-specific value propositions, positioning, and messaging; developing them will be an important task
in the months ahead. Managed-market teams should conduct market research with MCOs, PBMs, and other Part D stakeholders (such
as long-term care and retail pharmacy) in order to develop an accurate forecast of market dynamics and support. This research
will also help channel marketers understand the unique needs of different types of plans and stakeholders under Part D, as
well as the resultant marketing opportunities.
PRICING AND CONTRACTING While the dust has settled a bit from the sprint to develop product-specific contracting strategies for Part D, manufacturers
need to assess the results of their initial contracting approaches and adjust accordingly. Some questions they will need to
- How successful have our initial approaches been, and what adjustments—including innovative contracting approaches—might be
- How might spillover effects affect our business in commercial managed care?
- How should our approach to contracting vary by type of customer (for example, PDP versus MA-PD)?
- How might we need to adjust our approach to contracting with states in the Medicaid segment?
TACTICS, PROGRAMS, AND MATERIALS Certainly new Part D-specific promotional materials will need to be developed to communicate products' value proposition and
to support account executives' interactions with Part D sponsors. But one of the most intriguing opportunities for manufacturers
is the possibility to support Part D sponsors as they develop and implement their medication therapy management programs (MTMPs).
These programs, which Part D sponsors are required to execute, are intended to improve patient outcomes by promoting appropriate
use of medications and reducing adverse events associated with the use of multiple medications. MTMPs are expected to target
beneficiaries who have multiple chronic diseases, take multiple medications, and are likely to incur costs of more than $4,000
annually for covered drugs.
CMS guidance on MTMPs is still vague. Nevertheless, manufacturers need to evaluate the potential for supporting Part D sponsors.
Companies should gather feedback from prospective Part D sponsors on their expected approach to MTMPs and the role manufacturers
could play. Internal legal and regulatory groups can provide guidance on what the company deems acceptable and appropriate.
Although a government program, Part D is designed to be administered by private entities—MCOs and PBMs—that are already key
customers for manufacturers in the commercial managed care segment. Hence managed-markets sales (or account management) needs
to address a number of Part D readiness items.
ACCOUNT PRIORITIZATION AND TARGETING Manufacturers need to reassess how they prioritize and segment MCOs and PBMs, within and across Part D and commercial managed
care. Prior to Part D, for example, some manufacturers placed less emphasis on PBMs. Now, several PBMs are expected to serve
as national PDP sponsors—and their importance is expected to increase. In addition, the new geographies established under
Part D will require manufacturers to view their businesses in a whole new way. In particular, companies must decide how to
segment and prioritize Part D PDP and MA-PD regions for individual products and across the portfolio.
ACCOUNT PLANNING AND MANAGEMENT The relationships between MCOs, PBMs, and manufacturers are changing as the same parties begin to interact across two different
books of business—Medicare Part D and commercial managed care. Many plans would like to realize efficiencies by managing these
two books similarly. As a result, pharma companies need to determine if the evolving dynamics of Part D create the need for
changes in account management. For example, some manufacturers have taken a more aggressive approach to pricing and contracting
in Part D than they have in commercial managed care. The Part D sponsor is likely to see the transparent difference in pricing
offered by the manufacturer and could attempt to demand a similar rebate for commercial managed care. Some manufacturers may
decide to establish a separate account team for Part D.