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Announcing OTCs Drugs in Managed Care: Taking the Pulse of MCOs and PBMs. This report will provide a detailed independent appraisal of complex issues related to promotion and coverage of OTC drugs in U.S. in the managed care setting. Research will be conducted by Kline’s analysts with executives at MCOs, PBMs, self-insured employer groups, OTC companies, public health advocates, attorneys, and consultants.
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Report #Y575A | © 2013 Kline & Company, Inc.
www.KlineGroup.com
HealthcareHealthcare
OTC Drugs in Managed Care:Taking the Pulse of MCOs and PBMs
To Be Published 2nd Quarter 2014Base Year: 2013
Regional Coverage: United States
This report will provide objective insights on complex issues surrounding promotion of OTCs among
managed care organizations (MCOs) and pharmacy benefit managers (PBMs) including how these
groups handle Rx-to-OTC switch brands, strategies for successful partnering between OTC companies
and MCOs/PBMs, OTC promotion programs among MCOs/PBMs, and impacts of the Affordable Care Act
on these plans and OTCs going forward.
This Report Will Help Subscribers to:
n Understand MCO’s/PBM’s perspective onOTCs and Rx-to-OTC switches
n Learn about successful OTC/managed carepromotional programs for OTC brands andpotential pitfalls of such programs
n Benchmark OTC companies can use toevaluate their current approach withmanaged care against that of theircompetitors
n Gauge the impact managed care plans canhave on OTCs, such as potential coveragefor OTC brands, use of tiered copayments,coupons for OTC purchases, or use of FSAsto pay for OTCs
n Help facilitate dialogue between yourcompany and MCOs/PBMs
3rd Edition
Report #Y575A | © 2013 Kline & Company, Inc.www.KlineGroup.com
HealthcareHealthcareOTC Drugs in Managed Care:
Taking the Pulse of MCOs and PBMs
Tentative Report Contents*
Introduction
Executive Summaryn An Overview of key findings
n Forecasts and assessments
Managed Care Overviewn Background on managed care environment
n Membership estimates for MCOs and PBMs
n Estimates on self-insured employers
n Rising costs of drugs for MCOs, PBMs, and self-
insured plans
n Impacts of Affordable Care Act on managed
care plans and OTCs
n Key companies
Rx-to-OTC Switchesn Changing Rx-to-OTC switch landscape
n Categories MCOs/PBMs view as potential switch
candidates
n NSURE and FDA initiatives
n Programs that promote Rx-to-OTC switch
brands in managed care settings
Promotional Programs n Free-standing programs initiated by managed
care plans
n Programs conducted in collaboration with OTC
marketers
n Successful programs
n Pitfalls of such programs
n Perception of OTCs among MCOs and PBMs
n Strategies OTC companies can adopt to create
win-win situations
n Variables to measure relative success or failure
of such programs
Coverage of OTC Drugsn Issues to consider
n Formulary issues and tiered copayments
n Member incentives
n Reduction in prescription drug utilization
n Levels of OTC coverage
* Subject to charter subscriber input
Report #Y575A | © 2013 Kline & Company, Inc.www.KlineGroup.com
HealthcareHealthcareOTC Drugs in Managed Care:
Taking the Pulse of MCOs and PBMs
Scope
n MCO’s/PBM’s perspective on OTCs and Rx-to-
OTC switches
n Details about successful OTC/managed care
promotional programs for OTC brands and
potential pitfalls of such program
n Analysis of the impact managed care plans can
have on OTCs such as potential coverage for OTC
brands, use of tiered copayments, coupons for
OTC purchases, or use of FSAs to pay for OTCs
n Strategies for successful partnering with MCOs
and PBMs in the future
Key Benefits
This report will assist OTC companies in identifying opportunities to promote their brands
in the managed care setting. It will also serve as an invaluable tool in the strategic planning
process.
n Develop smart business strategies by
understanding the trends and developments that
are driving OTC/managed care partnerships
n Benchmark your organization’s programs in
managed care with those of your competitors
n Facilitate discussions between your organization
and MCOs and PBMs
n Identify key managed care companies that may be
most receptive to promotional programs for your
OTC brands
n Capitalize on learning about pitfalls that may have
happened in the past and how to avoid them
n Ability to be dynamic and responsive to managed
care groups by identifying trends expected to
drive future trends and how these partnerships
may evolve in the future
OTCs Drugs in Managed Care: Taking the Pulse of MCOs and PBMs will provide a detailed
independent appraisal of complex issues related to promotion and coverage of OTC drugs
in U.S. in the managed care setting. Research will be conducted by Kline’s analysts with
executives at MCOs, PBMs, self-insured employer groups, OTC companies, public health
advocates, attorneys, and consultants. From these interviews, we aim to provide:
Report #Y575A | © 2013 Kline & Company, Inc.www.KlineGroup.com
HealthcareHealthcareOTC Drugs in Managed Care:
Taking the Pulse of MCOs and PBMs
MethodologyKline’s approach places principal emphasis on primary research techniques to ensure that the foundation ofbusiness intelligence and insight is accurate, current, and reliable. Building on our 50-plus years in the businessand leveraging our worldwide network of offices, our teams of seasoned professionals draw upon pragmaticindustrial and commercial experience to understand and interpret global impacts and local perspectives.
Primary Research
We Know Who to Talk to. We Know How to Listen.
A high number of in-depth discussions are conductedby each analyst. All interviews are done with trueindustry insiders.
Our interviews engage experts across all pertinentfields and sectors including:
n Managed care organizations (MCOs)
n Pharmacy benefit managers (PBMs)
n Self-insured employer groups
n OTC companies
n Regulatory agencies
n Public health advocates
n Attorneys and consultants
Secondary Research
We Know Where to Look – Mining the Details.
Analysis is further supplemented by secondaryresearch, consisting of constant tracking of annualcompany reports, national statistics bureaus, trade/industrial/professional associations, and the like.
Relevant developments are diligently followed andtheir impact closely monitored. Reports also drawupon non-confidential data from Kline’s internaldatabase, consisting of over half a century’s syndi-cated research.
Comprehensive Market Intelligence
We Know How to Verify.
Data are rigorously analyzed, cross-checked, distilled,and validated. Kline’s proven methodology allowsexceptionally effective, precise, and reliable market
intelligence procurement and assessment, givingsubscribers a solid foundation on which to grow,refine, and expand their business with confidence.
Kline CredentialsKline is a leading global management consulting andmarket research firm offering the complete spectrum ofservices. The firm has served the management consult-ing and market research needs of organizations in thechemicals, materials, energy, life sciences, and con-sumer products industries for over 50 years.
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