Detour to increased market share

December 1, 2002
Gwen McLean
Gwen McLean

Gwen McLean is a managing editor at Walpole, MA-based Informa Training Partners. For more information on training materials that prepare pharmaceutical sales professionals to succeed in today's marketplace, contact Informa Training Partners at (508) 668-0288 or visit Informa online at

Pharmaceutical Representative

Identify and overcome roadblocks to prescribing.

When encouraging physicians to prescribe your product, you must convince them of its clinical features and benefits. But sometimes, that's not enough. With managed care formularies being the norm and prescribing restrictions constantly changing, you need to show physicians who believe in your product that prescribing it may not be as difficult as they may think.

First, you must identify the prescribing roadblocks that restrict physicians and determine just how strong and pervasive those roadblocks are. Follow these steps:

•Â Understand the types of roadblocks in the marketplace.

•Â Profile each physician practice.

•Â Analyze the percentage of patients at each practice who are covered by each payer (payer mix) and determine the associated prescribing roadblocks that affect your product.

•Â Create a pre-call plan that showcases appropriate detours around those roadblocks.

Prepared with a pre-call plan that effectively targets the challenges faced by the physician and the practice, you will increase your chances of getting that physician to take advantage of detours, and ultimately increase sales and market share for your product.

Roadblocks based on formularies and pharmacy benefit policies can affect both physicians and patients. The sidebar on the left summarizes several potential roadblocks, listing them from the least restrictive to the most restrictive.

Profile the practice

Once you understand some of the possible roadblocks, there are still some data you need to effectively profile a physician practice.

Your company may provide you with prescribing information that is individualized by physician. For example, you may receive data that show:

•Â Market share of your product for that physician.

•Â Prescribing trends (up, down or stable) of your product for the physician.

•Â Competing products prescribed by the physician and their associated trends (up, down or stable).

•Â The payer mix of the physician's practice (i.e., the percentage of patients in that physician's practice who are covered by Medicare, Medicaid or third-party payers, as well those who pay cash or are uninsured).

•Â The percentage of the practice covered by each third-party payer.

Your data may also show specific information regarding the third-party payers, including:

•Â Formulary status of your product.

•Â Competitors' formulary status.

•Â Formulary status of your products with the pharmacy benefit managers contracted by the third-party payers.

All of this information can be invaluable when it comes to profiling a physician's practice. If your company provides these data, be sure to use them. If your company does not provide this type of information, there are ways to obtain it on your own:

Build relationships with the office staff members (receptionist, business manager, claims processor, nurses, physician assistants, etc.). While building relationships takes time, these people can provide the information you need. In the process of trying to gather the information, you may learn more than you ever expected about your customers.

Investigate the Web sites of the third-party payers. You will likely find formulary information, pharmaceutical benefit policy descriptions, prior authorization forms and guidelines, as well as a lot more information about the prescribing restrictions in your territory.

Read local and national newspapers. This will help you stay up-to-date on healthcare-related events affecting your territory.

Communicate with your colleagues. You and your colleagues can share information and avoid reinventing the wheel. When you have a question, e-mail your fellow sales representatives, district manager or account manager. They may be able to provide the answer, and you can spend your time researching other issues.

Once you've gathered the necessary practice profiling information, whether your company has provided it or you have done the legwork yourself, the next step is interpreting the data so you can identify detours around the roadblocks to prescribing your product.

Analyze the payer mix

Completing a payer mix analysis can help you interpret and use practice-profiling information to your advantage. On this page is a helpful template to use when completing a payer mix analysis. It shows the physician's name and his or her practice's payer mix, and then splits the third-party payers in terms of PBM associations, percentage of practice, and formulary restrictions (or roadblocks) associated with your product at the practice.

Studying the information in this example, you see that 75% of Dr. Nash's patients are coming to him from third-party payers. What percentage of these patients can get your product filled and at least partially reimbursed? (Hint: Find out by adding the percentages that are not under a National Drug Code block). This example shows that a total of 93% of Dr. Nash's patients can get your drug filled and at least partially reimbursed at the pharmacy.

Now let's take a look at how we arrived at that 93%. The figures show that for 5% of the practice, the formulary is completely open, so that's 5% you do not have to worry about in terms of restrictions. A significant portion, 65%, is subject to a third-tier co-payment (a relatively low-level roadblock). This is the most common roadblock affecting Dr. Nash's ability to prescribe your product. A lesser but still significant portion, 23%, is subject to prior authorization (a higher-level roadblock), the next most pervasive restriction for Dr. Nash. For the remaining 7%, an NDC block (the highest-level roadblock) is in place.

Plan your call

Now that you understand the two most pervasive roadblocks that could affect Dr. Nash's willingness to prescribe your product, devise a plan to show him and his staff how to get around the roadblocks and prescribe your product with as little difficulty as possible.

Third-tier co-payment. To overcome this roadblock, one thing Dr. Nash will probably have to do is respond to patient complaints regarding higher co-payments. Suggest to Dr. Nash that he could prevent many of these complaints by explaining upfront (before patients go to fill the prescription) that they will likely have to pay a higher co-payment, but that he thinks the extra cost is worth the clinical benefits they will experience.

Another thing Dr. Nash may have to do is deny therapeutic substitution requests from pharmacists. Although the drug is available for the highest co-payment, some pharmacists may be incentivized by healthcare plans to ask patients whether they are aware that a preferred brand drug is available to them at a lower cost and whether they would like the pharmacist to ask their physician if a therapeutic switch would be appropriate. In other situations, patients may be educated about their health plan's co-payment tiers and take it upon themselves to ask whether they can have the preferred brand drug at a lower co-pay. To assist Dr. Nash and his staff, help them to develop a streamlined process to handle these requests. Also, remind Dr. Nash that he can minimize these requests by writing "dispense as written" on the prescription.

Prior authorizations. To overcome this roadblock, Dr. Nash and his staff will likely need to make a prior authorization request. To help facilitate the process, find out what is required to get the requests approved. You may be able to get this information from the plan's Web site or your own colleagues.

More likely than not, prior authorization request forms will need to be completed and faxed or e-mailed to the payer for approval. If this is the case, see if you can provide the practice with some of the necessary information: relevant ICD-9-CM codes, clinical reasons that merit approval, etc. Determine if the practice will allow you to assist by filling in the "universal" information, which may include the physician's name, provider number, medical specialty, etc., and then making copies of the partially completed form so they do not have to fill in this information each time they complete the form. Another potentially helpful suggestion is to program the plan's fax number into their fax machine.

NDC block. The NDC block poses the strongest restriction on Dr. Nash's prescribing ability, but it only impacts 7% of his third-party practice. And if Dr. Nash is sold on the clinical benefits of your product, he may still prescribe it to patients willing to pay for it out of pocket. A long-term approach to handling this roadblock is to try to eliminate it. You will likely need to work with several physicians and gain advocates among them to reach this goal.

Increase market share

Each physician customer is different in that his or her practice is made up of patients whose care and pharmacy benefits are covered by different payers. The prescribing restrictions set forth by these payers impact prescribing habits. By understanding these restrictions, profiling and analyzing each physician's practice, and developing targeted pre-call plans, you can help physicians who believe in your product detour around roadblocks and prescribe. Once they do this, patients will fill their prescriptions, and sales and market share will increase. PR

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