CASE STUDY !#$%&'()*$+,$ -(.&()/$0#11(2342$ 5#&+6(7$+4$ … · 2018-06-14 · CASE STUDY Launch...

CASE STUDY

The Impact of Pharmacy Messaging Removal on Partner Brand Performance

© 2018 CoverMyMeds LLC | go.covermymeds.com/messaging-impact

5: Pharmacy loss calculated using PA volume difference (projected vs. actuals), average dispense rate, WAC and number of refills

6: Calculation based on combination of pharmacy loss (total fills) and Q2 decline in unique NPIs and average NRx/NPI (total fills)

Streamlining the PA process creates a positive perception of access and prevents unnecessary switches.

While prescribers remained supported within the CoverMyMeds portal, a critical element of rejection support was removed.

The brand showed symptoms of negative perceptions of access and decreased script writing momentum right at the point of messaging removal.

First FillAverage Total Fills From Q2

Revenue Lost from Decreased Prescribing Momentum and Fewer NPIs

$2.4MM $16.9MM

Revenue Lost from Q2 Volume Decrease $9.9MM $69.2MM

Total Lost Revenue Opportunity6 $12.3MM $86.1MM

The impact on the partnered brand’s revenue was more than $86MM in three months due to lost support at the pharmacy.

LOST REVENUE5

KEY TAKEAWAYS


Q1 2017: The brand’s partnership supported pharmacists and providers alike with a streamlined, electronic workflow for initiating PA requests at the time of rejection at the pharmacy, and at the point of prescribing for the provider.

APRIL 1, 2017: The brand turned off support messaging at the pharmacy, eliminating the pharmacist’s ability to initiate a PA request in one click.

PARTNER BRAND LANDSCAPE

The brand is a highly written, commercially distributed drug in a plan rejection heavy drug class. Generics within this class also require PA review.

WHOLESALE ACQUISITION COST: $250-300

AVERAGE REFILLS: 5+

TIMELINE

Seventy percent of providers’ offices do not have a formal prior authorization (PA) process in place,1 and

therefore are more reactive to prompts from the pharmacy. Partnership provides support messaging in

dispensing systems that enables providers to easily keep patients on the originally prescribed medication.

1: CoverMyMeds Industry Provider Survey, conducted November 2016. n=1000, comprised of CoverMyMeds users and non-users.


PA VOLUME LOSS2

PRESCRIBING MOMENTUM

Unique prescribers fell 10 percent below seasonal expectations4 in Q2 versus Q1.

Prescribers wrote 8 percent fewer prescriptions for the partnered brand in Q2 versus Q1. In addition, average monthly NRx per NPI fell from 1.47 to 1.36 in Q2 versus Q1.3

MESSAGING REMOVED

Actuals (Full Program) Actuals (No Messaging)

Projections (Full Program) Projections (No Messaging)

24%less overall PA request volume

49,000+fewer PA requests in Q2 2017

21% decrease in paid rate

2: Comparison of average PA volume from February-March 2017 against volume April-May

3: With messaging (January–March) CoverMyMeds user n=2,294. Without messaging (April–June) CoverMyMeds user n=1,582.

4: CoverMyMeds users unique prescriber cohort fell 45 percent with a seasonal expectation of 35 percent from non-CoverMyMeds user cohort.

CASE STUDY

Brand Partnership Leads to a 28 Percent Increase in Paid Rate

© 2017 CoverMyMeds LLC | go.covermymeds.com/partnership

BRAND BACKGROUND

SOLUTION

This open distribution therapy is in a crowded class with many established clinical alternatives. The goals were to increase market share and approval rate, and to reduce switches at the pharmacy.

WAC: $175-200 AVERAGE REFILLS: ±6

Partnering with CoverMyMeds for PA support and form optimizations allowed the brand to maximize its formulary potential and achieve a higher paid rate. The brand was able to achieve its goals of increasing script writing momentum, reducing switches and improving market share overall.

Partnered brand prior authorization (PA) requests are ushered through the process, improving provider

awareness of coverage support and increasing prescribing momentum. Streamlining the PA process

creates a positive perception of access among providers and can prevent switches at the pharmacy.

TIONPRIOR

AUTHORIZAAUTO-STARTED


PAID RATE1

SWITCH PREVENTION1

• CoverMyMeds users wrote 10 percent more prescriptions for the brand than non-CoverMyMeds users

• The average NRx/NPI doubled

• The paid rate was 27.5 percent higher for PA requests submitted through CoverMyMeds versus those resolved elsewhere

1: Pharmacy outcomes data. Pre-partnership: May 2016- December 2016, n=4,242. PriorAuthPlus partnership: January 2017 to August 2017, n=7,087.

2: Paid rate pre- and post p=.0029. Paid rate stayed with brand p=.058.

After Partnership

CoverMyMeds PA Paid Rate2

47.8%

60.2%

Before Partnership

PRE-PARTNERSHIP

PARTNERED

Stayed with Brand

Switched to Generic Competitor

Switched to Brand Competitor

0% 20% 40% 60% 80% 100%

Unresolved or Abandoned

36%more patients

stayed with the original brand after

claim rejection

54%reduction in switches to

generic or branded alternatives

67%increase in PA volume

following rejection notification removal

0%

20%

40%

60%


“We don’t know what changed, but your product became so easy to write. Before we would just change the medication to something that was

covered or just provide samples. Now patients can

get the medication they want and need.”

–BRAND PRESCRIBER, TWO MONTHS AFTER PROGRAM LAUNCH

3: Partner data

MARKET SHARE

Market share in a select region rose from 2 percent to 30 percent within the

first few months.3

30%

CASE STUDY

SpecialtyPlus™ Partnership Increases Approval Rate 14%

© 2018 CoverMyMeds LLC | go.covermymeds.com/specialtyplus

PARTNER BRAND LANDSCAPE

SOLUTION

CLASS

Three therapies within the MS space

WHOLESALE ACQUISITION COST

$5,500–$6,000

DISTRIBUTION

Limited specialty distribution model

TARGETED TRAINING STRATEGY

High touch training supported prescribing

centers and gave critical air coverage to case managers

The brands integrated SpecialtyPlus into their patient support strategy and full-service Hub. Connectivity between SpecialtyPlus

and patient support services allowed the brands to offer a more integrated approach. They leveraged the technology and specialized support of SpecialtyPlus to create a robust

reimbursement strategy, to drive enrollments to their Hub and to increase utilization of wrap around services.

By leveraging our technology and understanding of the unique challenges with specialty products, CoverMyMeds partners

with manufacturers to create a seamless journey for patients prescribed a specialty medication.

CUSTOM OPERATING

PROCEDURES

Full transparency of prior authorization

support within the workflow of

the hub

PERSONALIZED HOLISTIC PA REPORTING

Prior authorization (PA) tracking, top form analysis and custom reporting

strategies


APPROVAL RATE

THERAPY A

+12%Approval Rate

increased from 85% to 97% for

SpecialtyPlus PA requests versus

those not shared

THERAPY B

+14%Approval Rate



those not shared

THERAPY C

+12%Approval Rate



those not shared

1: Turn Around Time: Time between when a PA request is submitted to the health plan and when the determination is received by the provider.

TURNAROUND TIME1

THERAPY A

-1.7 DAYSTurnaround time

decreased by from 3.3 days to 1.6 days for SpecialtyPlus

PA requests versus those not shared

THERAPY B

-1.8 DAYSTurnaround time



THERAPY C

-1 DAYTurnaround time




“This type of collaboration is

emblematic of what one should aspire to and I am grateful for

the efforts of everyone who has played a

role in making this initiative a success.”

–SENIOR DIRECTOR OF MS CENTER OF COLLABORATION

CASE STUDY

Launch Brand Increases Approval Rate through CoverMyMeds Partnership

© 2018 CoverMyMeds LLC | go.covermymeds.com/launchbrand

Streamlining the prior authorization (PA) process for recent launch brands creates a positive perception

of access among providers and can prevent switches at the pharmacy. For partnered brands, PA requests

are ushered through the process, improving provider awareness of coverage support and increasing

prescribing momentum.

TIONPRIOR

AUTHORIZAAUTO-STARTED

BRAND BACKGROUND

The partnered band is a dermatological drug within the first year of launch. Pharmacy claim rejection rates are higher within year one because brands are working to gain formulary access. The drug’s class has a high rejection rate for initial claim submissions — on average, 36 percent were rejected in 2017.1

Before partnership, the sponsored drug’s rejection rate was more than 20 percent higher than established competitors in its class.2

0

20%

40%

60%

80%

Sponsored Drug Competitor A Competitor B

60.2%

REJECTION RATE

40.9% 35.9%


40%

50%

60%

70%

80%

4/17 5/17 6/17 7/17 8/17 9/17

0

5%

10%

15%

20%

25%

30%

35%

5/17 6/17 7/17 8/17 9/17

SOLUTION

Partnering with CoverMyMeds at the time of launch for PA support allowed the brand to increase its approval rate and achieve a higher paid rate. The brand was able to achieve its goals of increasing script writing momentum and reducing switches.

APPROVAL RATE

PAID RATE

Six months after launch, the sponsored drug has a similar approval rate to other drugs in its class.

The sponsored drug has higher paid rates month-over-month through launch for PA requests completed with PriorAuthPlus versus those submitted through other methods.

Sponsored Drug

Competitor

With CoverMyMeds Without CoverMyMeds


CoverMyMeds users wrote 12 percent more scripts per NPI than non-users. By decreasing office noise and improving perceptions of access, partnered brands see improved script writing momentum.

SWITCH PREVENTION3

PRESCRIBING EXPERIENCE4

CoverMyMeds users completed PA requests for the originally prescribed brand instead of switching 17.2 percent more often following pharmacy claim rejection than non-users.

CoverMyMeds User

Non-CoverMyMeds User

Stayed with Brand

Switched to Generic Competitor

Switched to Brand Competitor

0% 20% 40% 60% 80% 100%

Unresolved or Abandoned

1: CoverMyMeds data on file.

2: Data from January 2017-September 2017. Rejection Rate defined as percentage of submitted claims that were rejected with codes 70,75,76 and MR (Formulary Rejects)

3: CoverMyMeds users are defined as providers who have submitted a prospective PA request for the launch drug during the same period. A 10 day look forward period after the initial claim rejection was used to determine for which drug the original provider resubmitted.

4: Data from May 2017-September 2017. Nrx per NPI calculated as Total New Scripts/Total CoverMyMeds User or Non-Users for the time period.

CoverMyMeds User

Non-User1.0

1.5

2.0

CASE STUDY !#$%&'()*$+,$ -(.&()/$0#11(2342$ 5#&+6(7$+4$ … · 2018-06-14 · CASE STUDY Launch...

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Transcript of CASE STUDY !#$%&'()*$+,$ -(.&()/$0#11(2342$ 5#&+6(7$+4$ … · 2018-06-14 · CASE STUDY Launch...