The Movement Toward “Pill Plus”

extramileHistorically, the relationship between manufacturers and payers has been transactional in nature. Payers needed to work with many manufacturers to meet financial objectives. With markets like hypertension and cholesterol at their prime and filled with branded agents, contracts benefiting both parties were the No. 1 priority. The majority of the discussions were branded, and there was a lack of trust and transparency between parties.

That was the old world, however—and this is the new world.

In today’s healthcare market, manufacturers and payers are dependent upon each other to meet their business goals. More focus has been placed on “above brand” or “pill plus” initiatives, over and above rebates for contracted products, resulting in a more collaborative environment among stakeholders. Contracts and transactions are no longer the only indicator of a positive relationship.

This shift was due in part to market trends that have required pharmaceutical manufacturers to step up their game. They needed to move beyond a transactional relationship in order to continue to provide value and differentiate themselves and their portfolios from the competition. Because there is such a huge generic market satisfying the needs of many patients with chronic illnesses, payers are relying less on their manufacturer partners to satisfy their formularies. Such market trends include:

  • Genericization of pharmaceutical marketplace
  • New branded agents with marginal improvement over existing therapies
  • Introduction of expensive orphan and specialty products
  • Access to payers and providers being minimized as stakeholders consolidate

This new environmental dynamic presents a great opportunity for our clients to take it up a notch…and where there is opportunity for our clients, there is opportunity for us. It is becoming increasingly important for us to approach tactical planning in a different way. So…what should our clients be doing to reserve a seat at the “pill plus” table?

  • Improve quality of care—focus on patient engagement, care coordination, quality measures, and optimizing the patient experience
  • Provide real world outcomes that demonstrate the value of therapies
  • Focus on developing deeper, more meaningful relationships with payer customers by providing added value through above-brand programs

So, you see, pharma must raise the bar—they must adapt to sustain value over time…because “if you’re not at the table, you’re on the plate.”

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2 Comments

  1. Laura Kohler
    Posted June 18, 2014 at 6:40 pm | Permalink

    Brilliant!!! Could not agree more! 🙂
    Go Jamie!

  2. Elena Rivera-Cheek
    Posted June 18, 2014 at 6:46 pm | Permalink

    Great write up, Jamie! You’ve done a wonderful job describing our ever-evolving payer landscape and how it relates to the brands we serve.