Specialty Pull-Through (It’s Not The Pull-Through We Grew Up With!)

As pharma companies continue to fight a more generic market and strive to maximize their access, the one term you hear time and time again in brand marketing circles is “pull-through.” For the past 15 years, pharma has viewed pull-through as the art of maximizing preferred tier status at a health plan—usually the result of a lucrative contract with the health plan. But now that the market for common chronic conditions such as branded ARBs, HMGs, PPIs and SSRIs has all but dried up, pharma companies are moving into new areas of rare cancers and orphan diseases where the traditional rules of pull-through do not apply. In the case of specialty markets, the focus is on identifying access opportunities and improving the “quality” of your access.

Quality of access is measured by factors such as:

  • Extent of PA (or SE in orals) [suggest expanding the acronyms]
  • Medical criteria
  • “Hassel factor” as perceived by office staff
  • Reimbursement support services (when all else is equal, providers will look at this)

In traditional pull-through, identifying the opportunity is relatively simple: you contract for a preferred position and announce your lower co-pay to providers by means of formulary grids and shelf-talkers. It’s not so simple in the world of specialty products that are often reimbursed as a medical benefit and not a pharmacy benefit. In this case, tier status may not apply, or all brands may be subject to coinsurance.

We generally divide pull-through in the specialty space into 4 steps: Step 1 – Opportunity Identification; Step 2 – Plan Development; Step 3 – Execution; Step 4 – Assess, Evaluate, and Refine

Although opportunity identification is fairly obvious in traditional pull-through, this step is the most challenging one in the specialty market space. Opportunities in the specialty market are more difficult to tease out. They include areas such as the following:

  • Your brand has moved up on a clinical pathway
  • A benefit design change that results in lower OOPs [suggest expanding[ for your brand
  • A change in indication that now expands the use of your brand
  • Additional clinical data become available that further differentiate your brand
  • Improved SPP [expand] services become available for your brand
  • Enhanced reimbursement HUB [expand] offerings further differentiate your brand
  • A change in medical policy benefits your brand
  • A price change makes your brand more affordable for the patient or the plan
  • Your competitor now requires companion diagnostic testing

Plan Development in specialty pull-through further demonstrates how this process differs from traditional pull-through. In the case of specialty pull-through, aspects of timeline development and success-metric formulation are not as clear. Traditional data resources (e.g., IMS, MediMedia) are not available for infused or provider-injected products. In addition, the traditional selling cycle is much longer in the specialty market and the number of patients is usually much smaller than in the primary care market.

Finally, the area of assessment, evaluation, and refinement is different in the specialty market. Due to the general lack of data mentioned earlier, assessment is not as straightforward. Areas such as number of benefit verifications, “time to fill,” and “time to reimbursement” for the provider are metrics often used in the specialty market.

As pharma manufacturers move into the specialty market, they will need to approach pull-through from a different perspective in order to compete. The traditional methods of pull-through do not fully apply. Furthermore, as the specialty market continues to become a mix of both orals and infused/injectable therapies and the lines between what is a medical benefit and what is a pharmacy benefit become more blurred, manufacturers will need to be able to quickly adapt their approach and message matrix to accommodate a rapidly evolving market.

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One Comment

  1. Sping
    Posted April 13, 2012 at 3:47 am | Permalink

    Electronic Data Interchange allows marketers to know exactly what providers are doing, and gives them the opportunity to educate providers within closed private networks–a sleeping opportunity and highly efficient approach that can enhance the standard of care–a win all the way around.