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Products & Services Managed Care Managed Care Organizations and Winning Practices

Report Summary: Best Practices in Formulary Success: Key Payer Responsibilities and the Information & Qualities they Seek from Field Medical Teams

ID: PSM-350A


Features:

39 Info Graphics

51 Data Graphics

410+ Metrics

44 Narratives


Pages: 11


Published: 2018


Delivery Format: Online


 

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Download FREE Excerpt

 

919-403-0251

  • STUDY OVERVIEW
  • BENCHMARK CLASS
  • STUDY SNAPSHOT
  • KEY FINDINGS
  • VIEW TOC AND LIST OF EXHIBITS
For report summary, click "Download Free Excerpt".

With the growing influence of payers in the healthcare industry, a drug’s formulary inclusion is now as important for pharma as its reception among prescribers and KOLs. Considering the significance of field medical team (FMT) interactions with payers for formulary success, pharma has been arming its field medical teams with data from clinical studies, real world experiences, and other sources to not only justify formulary positioning but also to seek preferred status for their products.

However, many organizations are still struggling to identify the most critical information types that drive payer decision-making and how these information sources are used by payers.

Best Practices, LLC undertook this benchmarking research to explore the most important types of information for managed care organizations in formulary decision-making and how they are using these information types for formulary placement decisions. Also, this report presents payers’ perceptions and experiences with pharma companies’ field medical representatives.

Industries Profiled:
Health Care; Insurance; Medical


Companies Profiled:
Aetna; Anthem; Ascension; Cleveland Clinic; CVS Health; DaVita; Express Scripts; Inc.; HCA; Humana; Kaiser Permanente; MedImpact; St. Joseph's Health; Tenet Healthcare ; UnityPoint Health; University Hospitals; WellSpan Health

Study Snapshot

Best Practices, LLC engaged 23 formulary leaders from 16 Managed Care Organizations through a benchmarking survey. Five formulary leaders participated in deep-dive interviews.

Key topics covered in this report include:

  • Primary activities
  • Key information or data used
  • How information or data is used and why it is useful
  • Interaction level with FMT members from 11 pharmaceutical companies
  • Primary topics discussed in FMT interactions
  • Rating of FMTs from 11 pharmaceutical companies


Key Findings

Sample key insights uncovered from this report are noted below. Detailed findings are available in the full report.

  • Comparative Data on Efficacy & Safety Holds Sway in Formulary Decisions
    • Information on efficacy/safety is still considered the gold standard for assessing new products.
    • When FMTs can provide comparative information on these key product attributes, they are fast-tracking payers’ formulary decisions. When pharma does not provide this information, payers develop their own comparative data.
Table of Contents

I.
Executive Summarypp. 5-12
Study Overviewp. 5
Methodologyp. 6
Participant Demographicsp. 7-9
Key Findingsp. 10-11
Recommendationsp. 12
II.
Primary Responsibilities of Respondentspp. 13-24
III.
Information Used for Formulary Decisions – How is it Used and How is it Useful?pp. 25-65
Overview of Top 10 Information Typesp. 26
Safety and Efficacyp. 31-33
Clinical Practice Guidelinesp. 34-35
Comparative Datap. 36-38
Meta-Analysesp. 39
Compendiap. 40
Health Technology Assessmentsp. 41
FDA Approval Datap. 42
Clinical Pathwaysp. 43-44
Product Pricing Analysisp. 45-46
Managed Care Trendsp. 47
Budget Impact Modelsp. 48-49
Real World Evidencep. 50-51
Pipeline and Pre-launch Product Updatesp. 52-53
Quality of Life/PRO Datap. 54-55
Healthcare Economic Informationp. 56-57
Research Program Support for Trialsp. 58
AMCP Dossiersp. 59-60
Information for Evaluating Biosimilarsp. 61
Patient Support Programsp. 62-63
Value Frameworksp. 64
Disease Educationp. 65
IV.
Voice of the Customer: The Good, Bad and Ugly of FMT Interactionspp. 66-72
V.
Field Medical Team Interactions: Frequency and Value Metrics for 11 Pharma Companiespp. 73-97

    List of Charts & Exhibits

    I. Primary Responsibilities of Respondents
    • Top two activities that constitute the primary responsibilities of payers and interview narratives explaining how pharma helps support these activities
    • Time spent on key listed activities
    • Key responsibilities of MCOs and PBMs
    • Time spent on reviewing clinical data and making recommendations; and the role of pharma companies in helping payers in conducting these activities
    • Time spent on developing formulary policy decisions; and the role of pharma companies in helping payers in conducting these activities
    • Time spent on ensuring compliance with healthcare delivery programs; and the role of pharma companies in helping payers in conducting these activities
    • Time spent on developing or implementing pathway decisions; and the role of pharma companies in helping payers in conducting these activities
    • Time spent on modifying programs due to changes in law (federal or state); and the role of pharma companies in helping payers in conducting these activities
    • Time spent on reviewing healthcare economic data and making recommendations; and the role of pharma companies in helping payers in conducting these activities
    • Time spent on performing healthcare economic analysis; and the role of pharma companies in helping payers in conducting these activities
    • Time spent on other key activities; and the role of pharma companies in helping payers in conducting these activities

    II. Information Used for Formulary Decisions – How is it Used and Why is it Useful?
    • Top 10 information types, importance rank, usage and importance
    • Importance of information provided by outside sources for formulary decisions
    • Usage vs. Importance of different information types
    • Importance of different information types for MCOs and PBMs
    • Importance of product efficacy/safety information and how this information is used
    • Pharmacy director at a medium managed care organization shares his viewpoint on product efficacy and safety
    • Pharmacy director at a large managed care organization shares his perspective on product efficacy and safety
    • Importance of clinical practice guidelines and how this information is used
    • Benchmark partners’ narrative on clinical practice guidelines
    • Importance of comparative data and differentiating factors, and how this information is used
    • Benchmark partners’ narrative on comparative data
    • Perspective of pharmacy director from a large managed care organization on comparative data
    • Importance of meta-analyses or systematic reviews and how this information is used
    • Importance of compendia and how this information is used
    • Importance of published health technology assessments and how this information is used
    • Importance of FDA approval data and how this information is used
    • Importance of clinical pathways information and how this information is used
    • Interview narrative of a senior manager from a PBM organization on why clinical practice guidelines are more important to them than clinical pathways information
    • Importance of product pricing analysis and how this information is used
    • Benchmark partners’ perspective on the impact of pricing on product comparisons
    • Importance of managed care trends and how this information is used
    • Importance of budget impact models and how this information is used
    • Pharmacy director at a medium managed care organization talks of the nuances of using economic data
    • Importance of real world evidence and claims data, and how this information is used
    • Pharmacy director at a large managed care organization shares his perspective on the importance and use of real world evidence and claims data
    • Importance of pipeline and pre-launch product updates, and how this information is used
    • Pharmacy director at a large managed care organization gives recommendations for pharma companies to improve interactions with managed care
    • Importance of quality of life/patient reported outcomes data, and how this information is used
    • Benchmark partners’ viewpoint on the various parameters considered for approval of new products
    • Importance of healthcare economic data and how this information is used
    • Pharmacy director at a large managed care organization shares whether MCOs consider pharma organizations’ pharmacoeconomic analysis trustworthy or not
    • Importance of research program support for trials and how this information is used
    • Importance of AMCP dossiers and how this information is used
    • Senior manager at a PBM organization shares the importance of ACMP dossiers
    • Importance of information for evaluating biosimilars and how this information is used
    • Importance of information received from patient programs and how this information is used
    • Pharmacy director at a medium managed care organization shares the importance of patient programs
    • Importance of value frameworks and how this information is used
    • Importance of disease education and how this information is used

    III. Voice of the Customer: The Good, Bad and Ugly of FMT Interactions
    • Benchmark partners shared what they liked about their interactions with field medical teams form pharma organizations
    • Benchmark partners shared the reasons for low rankings given to certain pharma companies in terms of their FMT interactions
    • Benchmark partners shared their pet peeves regarding FMT visits
    • Benchmark partners’ perspective on where pharma is falling with the information they provide
    • Benchmark partners share the kind of information that is important for decision-making in the oncology therapeutic area
    • Senior manager at a PBM organization mentions the differences between informational needs of MCOs and PBMs

    IV. Field Medical Team Interactions – Frequency and Value Metrics for 11 Pharma Companies
    • Payer ratings of field medical teams at listed pharma companies
    • Frequency of personal interactions with any medical field representative from the eleven mentioned companies, and the primary topics discussed during these interaction(s)
    • Quality rating of field medical interaction(s) from the eleven mentioned companies on a 5-point scale, and the reasons for the given rating
    • Ideal traits of field medical representatives