ManagingManagedCare.com
Learn and discuss how to improve Manged Care

home > Rx Pharmaceutical Industry

Pharma Friend

The Pharmaceutical Manufacturing and Research industry (pharma) asks, when rebates aren't enough, "How can we make inroads to managed care?"

My answer is not easy, but it is very possible--Partner; help those managing care, do their job better. The win-win of all time is a trusting and collaborative relationship that improves prescribed treatment adherence.

In other words, the pharmaceutical industry will likely sell more product in the world of managed care if they can go beyond sampling, DTC advertising, and contracted discounts.

This notion has recently been restated by Ira Studin, PhD, MPH: "To the degree health plans start building sophisticated long term strategic partnerships with pharma into their business models, managed care will gain the capacity to advance beyond its vendor stage, and make good on its original mission of promoting preventive health, improving individual outcomes, and realizing sustainable cost containment. For this to happen, it is suggested that healthplans address 'total cost of care savings' in their budget process, and pharma establish a "consultative service function" in their managed care divisions." [Studin I. "Reframing the Pharmaceutical Manufacturer -- Healthplan Relationship" in Managed Care. February 2001:46-54]. Often (and there's proof in this article about OTCs), MCOs can be penny-wise and pound-foolish.

Interested? Here's what can you do:

First, understand that what MCOs are interested in is a positive bottom line; their m.o. is to pay for necessary care-the right care at the right time and place.

1. Question: Do you provide support for compliance programs? That is, do you help doctors reach out to thier patients with education and support? If so, are you involved in identifying opportunities?

2. Question: Do you specifically support variance analysis, drug use evaluations, and outcome measurement?

3. Question: If not, are you willing to provide needed information about opportunities and obstacles in care management?

4. Question: If #1-3 are answered in the negative, do you agree to the importance of MC learning why your product would be better to use?

5. Question: To prove your product is better, are you willing to leverage your expertise in research, statistics and communication?

6. Question: Do you agree that the one certain way to open formularies is to improve clinical outcomes?

Healthplans will build long-term strategic partnerships with pharma and can involve them in rational treatment or utilization decisions. However, the perceived conflict of interest: financial support implying formulary positions are being "sold" must be addressed, early and openly.

Also, to produce the real added value, consider working with 3M Health Information Systems; they offer CRGs and possibly CRxGs (slide show in PowerPoint, especially for the Pharmaceutical industry). These case-mix and grouper tools have become a new language of communication; they give an unprecedented level of understanding about resource use and benefit (R.O.I.) in health care. 3M HIS will integrate available data and produce, without taxing internal resources, clinically interpretable, HIPAA compliant information.

Pharmacoeconomics

PBM--Pharmacy Benefit Management - Value & Propriety

Grant

Additionally, we seek organizations who have access to enrollment and claims data for a grant (MS Word document), designed to demonstrate evidence-based approaches and prove that the administrative data set is sufficient to measure disease progress, outcomes and to do disease and case management. ("Sufficient" means that chart abstraction is obviated by using grouper/risk-adjustment instruments, run on SmartCare, a data mining tool.)

Tools

For Sales Reps (click left and go to the bottom of the page)