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Presented at the World Congress Pharmaceutical Division Conference, Philadelphia, May 17, 2103
Citation preview
© 2013 All rights reserved.
The statements and opinions expressed herein
are those of the speaker and Jencen Field Medical
Consulting LLC, and not necessarily those of any
past employer.
No financial interests to disclose.
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© 2013 All rights reserved.
MCL = Managed Care Liaison, or “liaison”
Competencies & current value proposition
Changing landscapes as opportunity for
the MCL ◦ Healthcare reform
◦ Biopharmaceutical industry
◦ Customer segments
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© 2013 All rights reserved.
“Medical science liaisons…partner the business
side of the equation (managed care) with the
corporate clinical expertise in order to achieve a
true value proposition offering.”1
“MSL contributing to reimbursement discussions
and formulary committee presentations has
increased from less than 10% ….in 2010 to 42% in
2012.”2
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1 “Role of the Pharmaceutical Company in Managed Care”, in Managed Care Pharmacy Practice, R. Navarro (ed), p 348, (2009).
2 “Harnessing KOL Relationships for Optimal Clinical Support”, Cutting Edge Information, (2012).
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© 2013 All rights reserved.
Maintains working account knowledge
◦ Clinical decision-makers’ product thought processes
◦ Formulary review and approval process
◦ Various clinical / pharmacy touch points within account
Integrates clinical value proposition with overall
account plan ◦ Meets payer’s medical need
◦ Meets internal account objectives
◦ Executive presence at the podium
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© 2013 All rights reserved.
Operates independently across multiple networks ◦ Maximizes opportunities for customer interaction
Locally (identification of influential account customers)
Regionally (healthcare business coalitions, AMCP chapters)
Nationally (AMCP, ASHP, PCMA)
Recognizes evolving contacts within account ◦ Quality department
◦ Case mgmt
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© 2013 All rights reserved.
Account managers ◦ Effective relationship is a key to MCL success
◦ Build collaborative, strategic partnership
Business updates ◦ Regional ML teams, as group and individually
Communicate insights in both directions ◦ Brings account’s early thinking back into Company
◦ Tests Company’s insights with the account
◦ Facilitates advisory boards (PCMA)
Easily incorporate HEOR responsibilities
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© 2013 All rights reserved.
Budget
◦ Dedicated or ‘mixed’ (w/KOL responsibilities)?
◦ Add HEOR responsibilities?
Map MCLs to commercial MC team geographies ◦ Maximum effectiveness when independently accessing
account
A good starting point ◦ Provide continuous medical support for strategic,
national accounts
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© 2013 All rights reserved.
Increasing emphasis on value
◦ New(er) unmet needs
◦ Demand for real-world data
◦ Need evidence of value “It is no longer simply about the cost of the drug but total cost of care
to demonstrate a product’s value”3 --Vice-President, WellPoint
Driving quality ◦ Connecting quality to performance to compensation4
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3 “Pharma and Payers—Building Better Relationships”. First Word, Sep 2012. Accessed 5/11/13 at
http://www.reportlinker.com/p01021205-summary/Pharma-and-Payers-Building-Better-Relationships.html
4 T Esse, O Serna, A Chitnis, M Johnson, N Fernandez. “Quality Compensation Programs: Are They Worth All the
Hype? A Comparison of Outcomes Within a Medicare Advantage HF Population”, JMCP, 2013;19(4):317-24.
© 2013 All rights reserved.
A Challenge for ACOs
Develop quality measures
acceptable to both plans and providers5
MCL--‘Advisor’ on design of quality metrics ◦ Diabetes (HbA1C, cholesterol)
◦ Pulmonary (appropriate use of antibiotics)
◦ MTM (monitoring of specific drugs)
Coordinate KOL providers with regional ML
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5 “Accountable Care Organizations for PPO Patients”. Integrated Healthcare Association (2011), accessed 4/30/2013 at
http://www.iha.org/ACOWhitePaper_PPO_final.pdf
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© 2013 All rights reserved.
Scientific / technical → increasing complexity
◦ Large molecules and biologics manufacturing
◦ Genome-based therapies / personalized medicine
◦ Increasing use of technology
Companion diagnostics
◦ MCL—educate clinical decision makers & staff
Economic → decreasing revenue streams ◦ Ongoing generic erosion
◦ Thinner and more expensive pipelines
◦ “New” pharma business model
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© 2013 All rights reserved.
Blue ocean6
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6 W. Chan Kim and Renee Mauborgne. Blue Ocean Strategy.: How to Create Uncontested Market Space and Make the Competition Irrelevant.
Harvard Business School Press (2005).
© 2013 All rights reserved.
Blue ocean6 → Pink ocean
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6 W. Chan Kim and Renee Mauborgne. Blue Ocean Strategy.: How to Create Uncontested Market Space and Make the Competition Irrelevant.
Harvard Business School Press (2005).
© 2013 All rights reserved.
Blue ocean6 → Pink ocean → Red ocean
◦ Formerly uncontested market space becomes crowded
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6 W. Chan Kim and Renee Mauborgne. Blue Ocean Strategy.: How to Create Uncontested Market Space and Make the Competition Irrelevant.
Harvard Business School Press (2005).
© 2013 All rights reserved.
Blue ocean6 → Pink ocean → Red ocean
◦ Formerly uncontested market space gets crowded
Example: Hepatitis C virus ◦ Pursuing “Holy Grail”, i.e., oral, interferon-free, qd therapy
◦ 10 companies conducting 83% of clinical trials7
◦ 14 Phase III trials completing Q1 2014
◦ Likely lacking head-to-head data
◦ Cure rates and safety profiles roughly similar
◦ Above suggests minimal product differentiation
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6 W. Chan Kim and Renee Mauborgne. Blue Ocean Strategy.: How to Create Uncontested Market Space and Make the Competition Irrelevant.
Harvard Business School Press (2005).
7 Doro Shin. “The race toward an interferon free world: The current field of HCV treatment research, including recent financial deals “ Citeline (2012)
Accessed May 7, 2013 at http://www.citeline.com/wp-content/uploads/HCV-Competitive-Treatment-Lansdcape.pdf
© 2013 All rights reserved.
Orphan drug market ◦ 22% of all new drugs in development are for rare diseases8
◦ 70% of above are considered first-in-class
Example: Juxtapid ® and Kynamro ® ◦ Approved within 4 weeks of each other for HoFH
◦ ~300 US patients
◦ Labels nearly identical
◦ Annual cost: $235,000-$295,000 (J); $176,000 (K)
◦ “…payer-decision making will most likely be shaped by
each product’s individual clinical profile.”9
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8 “Orphan Drugs to Create Paradigm Shift in the Pharmaceutical Industry! “ Frost & Sullivan April 6, 2013. Accessed April 15, 2013 at
http://www.prnewswire.com/news-releases-test/frost--sullivan-orphan-drugs-to-create-paradigm-shift-in-the-pharmaceutical-industry-89979267.html 9 J. Pecherer.” Competitive Headwinds: the Beginning of the Kynamro and Juxtapid Story.” Decision Resources. Feb 2103, accessed May 10, 2013 at
http://decisionresources.com/trackback/6c021a04-3f6b-4490-82d3-80b868baf168/Competitive-Headwinds--the-Beginning-of-the-Kynamro-and-Juxtapid-Story.aspx
© 2013 All rights reserved.
Unsustainable pricing models
◦ Zaltrap®--refused by Memorial Sloan-Kettering10
◦ Provenge® --cost, benefit, demand issues prompt re-think11
Result ◦ Lack of product differentiation
◦ Manufacturers competing on price
A solution ◦ MCL: possesses skill set for identifying discreet areas of
clinical / economic / humanistic differentiation
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10. R. Conti and E. Berndt. “Winner and Loser from the Zaltrap Price Discount: Unintended Consequences? “ Health Affairs Blog , Feb 20, 2013,
Accessed May 8, 2013 at http://healthaffairs.org/blog/2013/02/20/winners-and-losers-from-the-zaltrap-price-discount-unintended-consequences/
11. M. Herper. “The Key Question for Dendreon: Is There Demand for Provenge? “ Forbes.com , Jul 23, 2102. Accessed May 9, 2013 at
http://www.forbes.com/sites/matthewherper/2012/07/31/the-key-question-for-dendreon-is-there-demand-for-provenge/
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© 2013 All rights reserved.
Government
Employers
Integrated Delivery Networks / Integrated
Health Systems
Group Purchasing Organizations
Retail Pharmacy Chains
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© 2013 All rights reserved.
Government
Employers
Integrated Delivery Networks / Integrated
Health Systems
Group Purchasing Organizations
Retail Pharmacy Chains
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© 2013 All rights reserved.
State health insurance exchanges
◦ Consumers: significant knowledge gap
◦ Plans: changing coverage policies
◦ Industry: need to adapt payer strategies
MCL value-adds ◦ Network to identify clinical decision makers
◦ Interact with policy makers to differentiate products
◦ Enhance broader corporate educational efforts
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© 2013 All rights reserved.
68.5 percent of workers in firms with 50 or more
employees were in self-insured plans12
Changing payer dynamic ◦ Plans and servicers taking on more of claims admin role
MCL value-adds ◦ Acct mgmt & networking: identify clinical decision makers
◦ Scientific mastery: educate diverse stakeholder groups
12 P. Fronstin, Ph.D., ”Self-Insured Health Plans: State Variation and Recent Trends by Firm Size”. Employee Benefit Research
Institute, Nov 2012.
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© 2013 All rights reserved.
The MCL
◦ Independently delivers value at intersection of medical
science and business
◦ Role anticipated to evolve in response to larger
changes
The new biopharma industry business model
Need for innovative clinical differentiation in
increasingly crowded product markets
Shift in payer demographics
Payers increasing demand for value-adds across the
care continuum
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Life is a learning experience;
only if you learn.
--Yogi Berra
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