Get their act together

April 1, 2006
Nadine Evans

Pharmaceutical Representative

Representatives need to be familiar with the basics of Part D so they can have credible conversations with their physicians.

It's been hard to miss. For months now, there have been articles, editorials, commercials, billboards and more regarding the Medicare drug benefit instituted under the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003. With all the hoopla surrounding the implementation, how do you – as a pharmaceutical sales trainer – figure out what your sales force needs to know to prepare for Medicare Part D's potential impact on their territories and market share?

The bottom line is, for most pharmaceutical sales representatives, the implementation of Part D amounts to nothing more than an additional set of formularies in their marketplace. However, for Medicare beneficiaries and for physician and pharmacist customers, Part D has been somewhat overwhelming and has created a lot of confusion. This confusion presents an opportunity for representatives to serve as a resource for their customers, strengthening relationships and ultimately increasing sales and market share.

What reps should know

The basics. For starters, representatives need to be familiar with the basics of Part D so they can have credible conversations with their physicians. This includes understanding Medicare eligibility guidelines, the different benefits covered by Medicare parts A through D, the types of plans offering Part D benefits and the standard benefit designs for Part D plans.

Online resource

Where to begin? There are a number of available resources that cover this basic information. In addition to a variety of multimedia resources created by private sales training vendors, both the Centers for Medicare & Medicaid Services and the Menlo Park, CA-based Kaiser Family Foundation have published fact sheets on their Web sites that outline this information.

Territory-level impact. Since the impact of Part D varies greatly at the territory level, representatives can learn the majority of what they need to understand by researching:

  • Which of the prescription drug plans (PDPs) and Medicare Advantage prescription drug plans (MA-PDs) operating in their territory have enrolled significant numbers of Medicare beneficiaries.

  • Where their product(s) and competitors' products are positioned on those PDP and MA-PD formularies.

  • How much of their top customers' payer mix has shifted to Medicare Part D.

The number of PDP and MA-PD options (and formularies) available to Medicare beneficiaries in the marketplace has far exceeded predictions. Some markets provide more than 100 options from which beneficiaries can choose. It would be almost impossible for sales representatives (or their physician customers) to keep this number of formularies straight, so it's important that representatives focus their attention on the largest plans with the most enrollees.

How can you help representatives determine which plans have the greatest numbers of enrollees? Counsel representatives to:

  • Start with the PDPs in their area that have been assigned "dual-eligibles" (those who qualify for both Medicare and Medicaid and have been automatically switched from receiving Medicaid drug benefits to receiving Part D drug benefits). While enrollment in the Part D benefit is voluntary for the majority of Medicare beneficiaries, over 6 million dual-eligibles have been assigned to various PDPs.

  • Check the local press and local retail pharmacists for enrollment trends in their area.

  • Check with their account manager or district manager.

Formulary position. Once representatives know which PDPs and MA-PDs in their territory have the highest enrollment, they need to determine where their product and their competitors' products are positioned on these formularies. Armed with that knowledge, representatives can approach physicians in the same way they do now when formulary position may affect market share: leverage a favorable position or work with physicians to show the value of prescribing their product despite an unfavorable position.

How can representatives learn about the formularies of Part D plans? Counsel them to explore the Medicare Web site ( It provides an abundance of information on the major plans and formularies in each area so representatives can get a handle on the access and reimbursement challenges physicians may be facing. Key tools on the site include:

  • "Landscape of Local Plans": Use this to find out which plans are providing benefits in each sales territory.

  • "Compare Medicare Prescription Drug Plans": Use this to research benefit designs.

  • "Formulary Finder": Use this to research formulary status and placement of representatives' products as well as competitive products.

Payer-mix shifts. Medicare patients enrolled in Part D plans will be migrating from numerous coverage arrangements. Some will have previously paid out-of-pocket for outpatient drugs, while others will have been enrolled in Medicare Advantage or employer-sponsored plans offering some reimbursement for outpatient drugs. And, as mentioned previously, dual-eligibles have also changed plans. It is very likely that the payer mix for the customers your sales representatives call on will change. This means that formulary access may change, and sales representatives will need to adjust their selling strategies accordingly. For example, products that have been covered for dual-eligibles under a state Medicaid preferred drug list may no longer be covered for those patients on their PDP formulary. Or, patients who previously paid out-of-pocket (with no formulary restrictions) will now have coverage, but with formulary restrictions.

Counsel your representatives to speak with the physician office staff to learn about shifts in payer mix.

A new opportunity

The implementation of Medicare Part D does not require representatives to radically change the strategies they use to encourage physicians to prescribe their products. Representatives will still need to base their selling primarily on clinical features and benefits, and then follow with access and reimbursement issues relative to placement on Part D formularies.

As is the case now, representatives will leverage a favorable placement and try to find ways to overcome an unfavorable placement by working with physicians to highlight value and to persuade them to write the product. In addition, they should be prepared to respond to physician questions or objections regarding changes to formulary position and reimbursement scenarios.

With Medicare Part D, sales representatives have been given a new opportunity to become a valued resource to their customers. They can differentiate themselves, their products and their companies by becoming "local experts" on Medicare Part D. Representatives can become a valued resource for physician customers by providing them with updates on PDP/MA-PD formularies and their products' position on those formularies. Moreover, sales representatives can give their customers the tools they need to address questions and concerns brought to them by patients and their families. By pointing out available resources, representatives can provide a real service to their customers and their customers' "customers" at the same time.

Take advantage of this opportunity to help your representatives understand the implications of Medicare Part D. Helping physician customers get the information they need will go a long way toward developing solid relationships and increasing market share over the long term.

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