At Stotle, we often work with brands that have a large number of managed care contracts. These brands invest substantial Gross-To-Net dollars to secure the appropriate formulary access.

When contracts are signed, there is an expectation that the account teams will generate sufficient pull-through to justify the investment.

Appropriate account-level goals are critical to this process, but this is no easy task and frequently results in spirited discussions within the managed markets teams, primarily about goals, accountability, and timelines.

One overlooked dynamic during in these discussions is the impact of the distribution channel on payer performance

There are 3 primary ways in which the distribution channel impacts payer account performance:

  • Varying impact of pharmacy call-back and patient reminder programs on Rx pick up and refill rates. In our analysis, for the same brand, we have seen reversal rates range from 2%-20% across a number of pharmacy chains. For a chronic disease drug, this can have a tremendous impact on account performance even if the account teams execute their pull-through plans flawlessly
  • The quality of patient education resources. Chains that invest in recruiting and training highly skilled pharmacists often have better disease education and counseling tools that have a major impact on patient adherence and ultimately brand performance
  • Finally, misalignment between benefit design and channel efficiency can have a broad effect on account performance. For instance, under benefit designs with preferred pharmacy networks, the cheapest pharmacy partner from the payer perspective may not be the most effective when it comes to patient education or Rx refill process management

In the past, it was difficult or expensive to obtain reliable metrics about channel performance. Recently, with the availability of more channel data and the emergence of technology solutions to mining this data, incorporating channel dynamics into account planning is no longer a pipe dream.

At Stotle, we take a 3-step approach to addressing the problem:

  • Mine channel data to tease out chain-outlet mix at the account level
  • Evaluate chain and outlet level trends on reversals, adherence, and patient engagement
  • Incorporate findings into a robust closed loop contract ROI analysis framework

Tell us how your teams incorporate the understanding of the channel into account strategy and contract planning. We would love to hear from you.