Pharma Has a Pull-Through Problem—The Answer is Data

Most market access teams at pharmaceutical and biotech manufacturers have the same problem: evidence of clinical effectiveness isn’t always enough to affect prescribing behavior, often due to—accurate or misperceived—access and affordability concerns. The inability to “pull through” a prescription, despite healthcare provider (HCP) field team engagement and educational efforts, stubbornly remains a top client concern after 15 years of working in the market access space.

“Pull through” doesn’t have an official definition in the pharmaceutical space, but I define it as: communicating relevant cost, coverage, and support information to HCPs and their office staff to help them make appropriate prescribing decisions for their unique patient populations.

Pull-through is often best understood via real-world examples. My Uncle Scott has a rare disease that affects less than 1% of his physician’s patient population. A medication is available that can effectively treat Scott’s disease, but his physician is unwilling to prescribe it because he lacks confidence that Scott’s insurance will cover the drug. Why? Because his physician had tried to prescribe the product once before, and it wasn’t covered by that specific patient’s employer, causing patient stress and a delay in initiation of therapy. The other patient was insured through a small payer, and their decision not to cover the drug was an outlier rather than the norm. However, the physician’s negative experience ultimately influenced his prescribing behavior for all the other patients with the same condition.

Identifying Pull-Through Barriers and Opportunities

Misperceptions about medication cost and coverage is only one barrier to pull-through. Others include:

  • Lack of time and resources at the HCP office to navigate coverage determinations for all patients
  • Mistrusted or inaccurate coverage information that has led to delays in treatment or unpleasant cost conversations for patients
  • Inconsistent or ambiguous messaging from manufacturers and payers about what is covered and for whom

Uncle Scott’s tale may sound familiar—we all have loved ones with horror stories about the cost and coverage of medications. For pharma, it can sometimes feel like a situation beyond their control. But it doesn’t have to be that way; leveraging good data can be a game changer.

To begin addressing the pharma pull-through problem, it is first essential for market access teams to understand that where there is variability, there’s room for a solution. Medication clinical profiles and effectiveness are consistent—that information doesn’t change from provider to provider. Coverage and cost, on the other hand, can vary significantly by individual. Targeting that variability and committing to alleviating confusion in order to inspire prescribing confidence is an opportunity to flip pull-through from a problem to a differentiator. That’s where my passion lies—the ability to directly impact patient lives by leveraging data to drive access to prescribed medications.

Pull-through opportunities are often first identified by the target prescriber base during brand market research, where cost and coverage are named barriers to product adoption. Sometimes, this reveals accurate perceptions around where payer coverage is lacking that market access teams can address through alternate payer engagement strategies. Often, though, there are misperceptions about product coverage, like in Uncle Scott’s case, which can be corrected through strategic, data-driven communications efforts.

5 Strategies to Improve Pull-Through

Whether the product coverage barriers are real or imagined, try these five essential strategies for pull-through success.

1. Seamless integration with core data and systems. This means that whatever pull-through tool is implemented at a manufacturer, it has to work within the existing daily workflow of field teams, or adoption will be low. Platforms such as Veeva are widely incorporated into existing field team operations and can be integrated into pull-through solutions to meet the reps where they already are.

2. Understanding the true opportunity and informational needs of each HCP practice. Good data can inform market access teams on which providers treat the most patients with certain conditions and which practices have the most patients covered for that particular therapy. Then, the right tool will allow field teams to communicate with those practices in a way that’s uniquely right for them.

3. Simple, user-friendly, accurate, and custom communications that address HCP concerns. Nearly every market access marketer worries that field teams could be sharing branded communications that veer off message, but a well-designed pull-through solution can put guardrails in place that help ensure accuracy while allowing for customization. These communications should also align seamlessly with other HCP marketing messages and outreach.

“Market access teams invest too much time and effort in developing impactful messages for HCPs and payers to see those go unused by field teams,” notes my Entrée Health colleague, Megan Hall, EVP, Executive Creative Director. “With well-built pull-through tools, marketers can gain much-needed control over messaging while still giving users the flexibility to customize where, when, and how those messages are shared.”

4. Advanced analytics guided by deep market access knowledge. It’s common in the pharmaceutical industry to have multiple datasets that don’t fit cleanly together. That can be remedied with the right approach. Still, an extensive understanding of the ins and outs of the market access space is required to mold the data into a truly accurate, usable format with the intelligence to support field teams in meaningful ways.

5. Robust performance monitoring that drives market access optimization. Pull-through solutions should never be designed with a “set-it-and-forget-it” mentality. Market access is constantly evolving, and so should pull-through solutions. Keeping a close watch on pull-through analytics can inform field team strategies, payer engagement, and overall brand messaging as well.

A Win for Patients

While these strategies can impact HCP willingness to prescribe, the real win is for patients like Uncle Scott. In his case, an effective pull-through strategy would have informed his physician in advance of the coverage situation for all his patients who might meet the clinical criteria for the product so that Scott would have experienced a seamless prescribing and treatment journey.

I’ll let my colleague, Cora Meese, EVP, Director of Growth and Client Services at Entrée Health, have the final word on pull-through: “Ultimately, if the patient doesn’t even know all this is happening in the background because they haven’t experienced any disruption and it’s quick and seamless, that’s a win for everyone. We know we’ve done our job right when patients not only get access to the medications they need, but they, and their HCPs, have a positive experience along the way.”


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