After spending millions on R&D just to get a product to market—and millions more to promote a product—there is nothing worse than when a launch falls completely flat. Kelly Wilder, Executive Vice President of Precision for Value, and her team have identified several critical mistakes that pharma companies make that can reduce the perceived value of a product on the marketplace. But the three most common are:
- Failing to demonstrate economic outcomes data: Are you effectively generating evidence?
- Presenting weak value propositions: Are you leading with the strongest value argument?
- Overlooking challenges to pull through: Did you investigate market perceptions of access?
PM360 spoke with Wilder about how to avoid these common mistakes, what you can do to ensure your product’s launch is a success, and how the recent pricing controversies should affect your approach to presenting value to patients.
PM360: In terms of demonstrating economic outcomes data, what kind of data should companies be using to show value? Is it a case by case basis for each product?
Kelly Wilder: When we think about the right economic data, there are a range of options out there and what manufacturers really have to do is get out of the box of just creating economic studies.
It’s definitely case by case. You really have to understand what the key issues are for the drug, the size of the population that is impacted, and if there are societal issues that are being dealt with from a policy perspective. An example of that is curing someone with a contagious disease—that has a value to society and reimbursement policies should align accordingly.
Our group has three key areas that they look at when they’re considering economic data. One is the more traditional evidence strategy in which you determine what specific studies you need to develop to meet the objective of the manufacturer and the marketplace.
The second area is meta-analysis. With clinical trials, when you’re looking at one drug versus another, it’s hard to make direct comparison. This is a way of looking at trial data to build an apples-to-apples-like comparison across products, which is called a network meta-analysis (NMA).
And then the last one is related to policy-centric health economics that seeks to advance healthcare by evaluating creative, but data-driven, perspectives on value. Precision Health Economics specializes in developing these robust studies that shift the value conversation nationally or in a certain therapeutic area. They are able to effectively advance the conversation by publishing key findings and analysis in various peer-reviewed publications.
An example would be in analyzing the social value associated with product innovation. When manufactures invest in life changing innovation, all stakeholders, including payers, will benefit from knowing how the clinical benefit translates to a wider value in the United States and how a manufacturer pricing should represent fair return to the innovator to invest in future medical advances, from which we all benefit.
Building off of that, once you have the right data for your products, how you do you properly present that to payers?
Bolstering your argument with good health economic data, which we just talked about, is only one subset of a value proposition. We’ve developed an internal process to think about how you create a winning value proposition by starting with what’s going to be important to a payer customer.
For example, when I’m working with manufacturers, they are coming to the table with their own strategic imperatives. While those can’t be disregarded, what they often forget is that the payers have their own objectives that they’re trying to meet. And that’s actually our entry point. What do payers care about right now? Not some random question that pharma wants to answer, but really directly engages the payer where they are.
We really try to identify key domains of information that should be considered when you’re building a value proposition. In the past, the emphasis exclusively focused on clinical information. In the present, it’s clinical information, health economics data, distribution practices, patient support programs, etc. Those can all be part of your value message, especially if you’re doing something that’s unique. Don’t make the mistake of concentrating a singular message that is clinically focused—find a holistic message that really looks at the overall value of the brand through the lens of those domains and answers key questions of payers.
Then do you have to create a plan depending on what kind of payer you are talking to, or do you just create the best value proposition for your brand?
It’s a great point. When you’re creating the message you look for all the points that resonate, and you have to keep the different channels in mind. An example would be a drug that is mainly for a Medicare population, in that case, a payer will be very concerned about the potential for adverse selection. So if they provide very rich coverage in a particular area then they’re going to be concerned that more of those unhealthy members in the Medicare book of business are going to gravitate towards their plan.
That changes their whole risk equation—the algorithm that their actuaries are working through. Thinking about the various channels is a best practice when considering the messaging. They all want something a little bit different based on the kind of members that they serve. You might have one overarching message and then connected sub-messages that start to resonate for different channels.
Your third critical mistake was about market perceptions from HCPs and patients. In this regard, how should companies present value or price to HCPs and patients? It is through DTC campaigns, sales calls for HCPs, patient access programs, or something else?
Companies are doing all of the above that you mentioned, but one of the big opportunities we’ve seen is crafting messages that work on the local level—not just a national level. Two of our pharma clients have recently seen a 15% bump in HCP prescriptions within 90 days of switching to local messaging. The best part: We were able to tap into HCP and formulary data they already had. Actually most pharma companies already have this data but aren’t extracting the value they should.
Here’s why broad messaging isn’t moving the needle. Let’s say a particular drug has 80% national coverage on commercial plans. Often times that’s the message communicated in the sales call regardless of the HCP’s actual patient population. Yet this overarching message doesn’t get to the nuance or the complexity of what coverage really looks like for a particular HCP.
For example, one doctor has a mix that is 50% Medicaid, and 50% commercial. That is just the complexity of the insurance market. But if I just told her that we have 80% coverage in my broad message, it’s not what the doctor is experiencing for her Medicaid patients. What that doctor is actually seeing on the ground is that she’s prescribed your drug for her Medicaid patients, but then those patients are coming back from the pharmacy because the prescription wasn’t covered or the price was too high.
Now this doctor’s whole perception of what coverage looks like is off because we’ve over indexed this global national view of coverage versus really thinking about the specifics of what the doctor is dealing with in their local population. So now you’ve lost a decision maker who is unlikely to write a script for her patients that are covered. It makes all of that time and money spent getting the access you desired for your product a lost and futile effort.
My advice to pharma companies: Keep it local. The good news: They probably already have the data they need to help their sales force be more effective.
From the patient perspective, are any of the recent pricing controversies that have been in the press affecting how they’re seeing drugs? Are they asking more about price?
The pricing stories in the media continue to make patients more frustrated with their perceptions of pharma. The reality is that they’ve always been frustrated with the cost of drugs, but the recent controversies are just layering on additional frustration with pharma.
It’s part of why we are seeing a rise in generic use. Even healthcare practitioners are pushing generics because it has been easier for them to get those through at the pharmacy level. The problem with that whole thing is that means that we’ve completely discounted the idea of innovation in medicine.
They’re generics because they are based on brands that have gone off patent. They’ve been out in the marketplace for a long time, which means that many of those generics—not all of them—come with higher side effect profiles, challenges with tolerability, and oftentimes are not as good on efficacy. So now we have this heightened sense of price, and I get it. But we’ve also discounted this whole idea of a value of a brand—the value that innovation brings to individual patients.
That gets back to the other reasons I mentioned before about looking at the real economic argument for the value of both the price that a manufacturer is setting and the value that the product provides overall. My advice to pharma: Ensure there is evidence to what you’re saying whether it is a message from pharma to patients, providers, or payers, keep it grounded in true healthcare economic evidence versus just making it a nice story to tell. That takes us full circle to why evidence is important.
Then just to wrap up, do you have any other advice in this area for pharma that you haven’t mentioned yet?
One of the things that I would caution them against is not to present your information to payers the same way that you do for doctors. They’re very smart and clinical individuals, but they’re in roles serving a corporation—so it’s business-to-business engagement.
Use clean infographics for presenting information, not long, heavy clinical decks. There’s a place for that information, but when you’re trying to tell a message to a payer, keep it simple, keep it short, keep it direct, and, of course, keep it evidence based.