What makes a good United States pricing project? I’ve had the chance to see what passes for pricing work by folks who don’t typically do payer research and it’s opened my eyes considerably. My conclusions: 1. Experience Matters, 2. Careful push-back at the right time is key, 3. Perspective and Context of results are EVERYTHING.
In order to save one pricing research (it doesn’t make sense to try to cut corners on pricing research, but that’s a blog for another day) one of my clients asked me to support their physician researcher in the payer space. What resulted wasn’t horrible, but the guide needed revision and the moderator kept asking questions that the payers had already answered. You don’t want to pay for this kind of research twice, why not hire a moderator who’s expert at interviewing payers and PBM P&T committee members, rather than one who’s doing physician interviews between calls?
2. Careful Push-Back
These days, all new products are going to be NDC blocked until P&T review. What’s harder to understand is the specific tools that payers can use to thwart access. In areas with substantial generic (Gx) alternatives, liberal use of Step Edits can be expected. At the same time, such step edits are less effective if your target population has already past the hurdle through previous treatments. Understanding these dynamics and pointing out the likely patient flow through due to previous treatment is important. See bullet #1, if you don’t have the experience and the confidence, you’re more likely to take payers statements at face value, even when they don’t match the realities of the market.
This is particularly important in areas like anti-infectives, where payers don’t always keep product stewardship in the front of their minds – and are actually too quick to suggest Gx parity when such positioning is neither clinically sensible nor profit maximizing due to physician’s restrictive use.
3. Perspective and Context Matter
In a recent study that I performed, a simple error that MOST payer researchers make would have resulted in an overstatement of 12.5% market share. While we can NEVER reveal the organizations that we’ve spoken to, nor assign responses to individuals, it’s critical to present the findings of your payer research in a manner than can easily be used in forecasting. In my last two home office positions we forecasted directly from our payer research with MONTHLY accuracy within 3% at the gross-to-net level. Can you do that from you payer research? We can’t promise that your results will be as good as these, but we can use the same methodology that’s proven to be this accurate in the past.
Discussion guides are important, but even the best discussion guide, if read by some who lacks the experience to push-back won’t get you the results that you need. Pricing in pharmaceuticals is an incredible lever. Further the recent focus on restricting annual price increases has increased the importance on Launch pricing. Chiral Logic can help you identify the price maximizing price as well as provide strategies to bridge that gap between launch and NDC block removal. We have the real world expertise to separate the wheat from the chaff and we’d be glad to help you solve your hardest pricing and market access challenges.