With the convergence of rising operational costs, complex utilization management (UM) requirements, and healthcare consumerization, life science manufacturers are flying blind if they are not tracking every prescription from when it’s written until it’s either dispensed or abandoned. If brands are not leveraging this information to drive patient access strategy, they are at a competitive disadvantage as failure to do so adversely impacts the patient experience and gross to net.
While most manufacturers recognize the value of such data, it’s hard to come by and challenging to translate into actionable insights. Traditionally, manufacturers have relied on the retail channel, where they send their product “into the wild '' and lose sight of key steps in the prescription fulfillment process. At retail, brands lose up to 80% of prescriptions to abandonment and substitution. Even when purchasing expensive data from 3rd party vendors, it’s onerous to map to the patient journey and translate it into actionable insights. Recognizing this, many have turned to specialty pharmacies for more control and visibility, but these brands typically find themselves at a loss with the 40% plan contract gap mail order pharmacies experience that limit visibility into payer behavior.
The bottom line is that it’s no longer possible for specialty and specialty-lite commercial teams to meet their objectives if they rely on incomplete or unactionable data provided by 3rd party partners or aggregators.
Data and metrics you should be tracking to evaluate patient access
With limited visibility into the channel, manufacturers often manage access partners based on operational “call center” metrics. However, this paradigm is ineffective in today’s complex drug channel. Access partners should be judged on the value they deliver to patients and brands. To understand the effectiveness of their strategy, forward thinking manufacturers should track:
- Number of new scripts written
- Access program enrollment rate
- Percentage of successful patient starts
- Prior authorization (PA) submission & approval rates
- Percentage of covered dispenses (vs. % of plans on formulary)
- Pharmacy reimbursement rates
- Number of refills per patient
Analyzing PA metrics can provide a critical lens into the patient experience, inform dispense workflows, and empower teams to take action to improve the likelihood of coverage. Brands that face steep PA requirements should have a firm grasp on:
- How long it takes for:
- Providers to submit a PA
- Each payer to adjudicate a PA
- The doctor to respond to a missing information request
- How often individual HCPs submit PAs
Having access to data is one thing, but understanding “the why” is vital. Sound data analytics can reveal behaviors that affect key patient outcomes. For example:
- Prescription Abandonment Data: PHIL’s Platform helps manufacturers determine when patients will abandon a prescription due to prior authorization timing or out-of-pocket costs and allows them to make granular adjustments to business rules to optimize their program.
- Field Rep Optimization: Data also offers visibility into field activity and its impact on healthcare provider (HCP) behaviors, which can help manufacturers better engage with HCPs to support PA submissions. The PHIL Platform helps brands identify sales territories with suboptimal submission rates to inform sales training and support PA gap closure.
Optimizing patient access and gross-to-net across the lifecycle
PHIL's goal is to make patient access to prescribed therapy as seamless as possible while ensuring the highest possible percentage of covered dispenses. Along the entire journey – from writing the script to dispensing the medication through refill adherence - brands have opportunities to reduce or eliminate sources of friction that are inhibiting access and to optimize gross-to-net (GTN). Thus, they should always strive to:
- Maximize patient enrollments and engage patients in ways that improve medication adherence to prescribed therapy
- Calibrate patient copays to minimize financial burden from offering uncovered options, but also ensuring that every patient has access to some affordable option
- Address bottlenecks in the prior authorization process to achieve an increase in covered dispenses without having to reduce the generosity of uncovered programs
- Manage under-reimbursement issues to effectively reduce prescription abandonment without hurting the pharmacy’s bottom line
PHIL understands a brand's needs change throughout its lifecycle. PHIL captures over 125 data points per new prescription, delivering complete visibility into the journey that allows manufacturers to build customized, data-driven programs based on their short and long-term objectives, with the capability to adjust their business rules with our software quickly.
A data-driven approach that benefits all stakeholders
Healthcare delivery continues to evolve swiftly and the market environment that life science companies operate in now is likely to be very different from what they will face in five years. PHIL’s platform facilitates a data-driven approach that helps pharmaceutical manufacturers optimize patient access both today and into the future. To learn more about how Phil can help you harness the power of your brand’s prescription data, visit https://phil.us/life-sciences.