Report #Y575A | © 2013 Kline & Company, Inc.

www.KlineGroup.com

HealthcareHealthcare

OTC Drugs in Managed Care:Taking the Pulse of MCOs and PBMs

To Be Published 2nd Quarter 2014Base Year: 2013

Regional Coverage: United States

This report will provide objective insights on complex issues surrounding promotion of OTCs among

managed care organizations (MCOs) and pharmacy benefit managers (PBMs) including how these

groups handle Rx-to-OTC switch brands, strategies for successful partnering between OTC companies

and MCOs/PBMs, OTC promotion programs among MCOs/PBMs, and impacts of the Affordable Care Act

on these plans and OTCs going forward.

This Report Will Help Subscribers to:

n Understand MCO’s/PBM’s perspective onOTCs and Rx-to-OTC switches

n Learn about successful OTC/managed carepromotional programs for OTC brands andpotential pitfalls of such programs

n Benchmark OTC companies can use toevaluate their current approach withmanaged care against that of theircompetitors

n Gauge the impact managed care plans canhave on OTCs, such as potential coveragefor OTC brands, use of tiered copayments,coupons for OTC purchases, or use of FSAsto pay for OTCs

n Help facilitate dialogue between yourcompany and MCOs/PBMs

3rd Edition

Report #Y575A | © 2013 Kline & Company, Inc.www.KlineGroup.com

HealthcareHealthcareOTC Drugs in Managed Care:

Taking the Pulse of MCOs and PBMs

Tentative Report Contents*

Introduction

Executive Summaryn An Overview of key findings

n Forecasts and assessments

Managed Care Overviewn Background on managed care environment

n Membership estimates for MCOs and PBMs

n Estimates on self-insured employers

n Rising costs of drugs for MCOs, PBMs, and self-

insured plans

n Impacts of Affordable Care Act on managed

care plans and OTCs

n Key companies

Rx-to-OTC Switchesn Changing Rx-to-OTC switch landscape

n Categories MCOs/PBMs view as potential switch

candidates

n NSURE and FDA initiatives

n Programs that promote Rx-to-OTC switch

brands in managed care settings

Promotional Programs n Free-standing programs initiated by managed

care plans

n Programs conducted in collaboration with OTC

marketers

n Successful programs

n Pitfalls of such programs

n Perception of OTCs among MCOs and PBMs

n Strategies OTC companies can adopt to create

win-win situations

n Variables to measure relative success or failure

of such programs

Coverage of OTC Drugsn Issues to consider

n Formulary issues and tiered copayments

n Member incentives

n Reduction in prescription drug utilization

n Levels of OTC coverage

* Subject to charter subscriber input

Report #Y575A | © 2013 Kline & Company, Inc.www.KlineGroup.com

HealthcareHealthcareOTC Drugs in Managed Care:

Taking the Pulse of MCOs and PBMs

Scope

n MCO’s/PBM’s perspective on OTCs and Rx-to-

OTC switches

n Details about successful OTC/managed care

promotional programs for OTC brands and

potential pitfalls of such program

n Analysis of the impact managed care plans can

have on OTCs such as potential coverage for OTC

brands, use of tiered copayments, coupons for

OTC purchases, or use of FSAs to pay for OTCs

n Strategies for successful partnering with MCOs

and PBMs in the future

Key Benefits

This report will assist OTC companies in identifying opportunities to promote their brands

in the managed care setting. It will also serve as an invaluable tool in the strategic planning

process.

n Develop smart business strategies by

understanding the trends and developments that

are driving OTC/managed care partnerships

n Benchmark your organization’s programs in

managed care with those of your competitors

n Facilitate discussions between your organization

and MCOs and PBMs

n Identify key managed care companies that may be

most receptive to promotional programs for your

OTC brands

n Capitalize on learning about pitfalls that may have

happened in the past and how to avoid them

n Ability to be dynamic and responsive to managed

care groups by identifying trends expected to

drive future trends and how these partnerships

may evolve in the future

OTCs Drugs in Managed Care: Taking the Pulse of MCOs and PBMs will provide a detailed

independent appraisal of complex issues related to promotion and coverage of OTC drugs

in U.S. in the managed care setting. Research will be conducted by Kline’s analysts with

executives at MCOs, PBMs, self-insured employer groups, OTC companies, public health

advocates, attorneys, and consultants. From these interviews, we aim to provide:

Report #Y575A | © 2013 Kline & Company, Inc.www.KlineGroup.com

HealthcareHealthcareOTC Drugs in Managed Care:

Taking the Pulse of MCOs and PBMs

MethodologyKline’s approach places principal emphasis on primary research techniques to ensure that the foundation ofbusiness intelligence and insight is accurate, current, and reliable. Building on our 50-plus years in the businessand leveraging our worldwide network of offices, our teams of seasoned professionals draw upon pragmaticindustrial and commercial experience to understand and interpret global impacts and local perspectives.

Primary Research

We Know Who to Talk to. We Know How to Listen.

A high number of in-depth discussions are conductedby each analyst. All interviews are done with trueindustry insiders.

Our interviews engage experts across all pertinentfields and sectors including:

n Managed care organizations (MCOs)

n Pharmacy benefit managers (PBMs)

n Self-insured employer groups

n OTC companies

n Regulatory agencies

n Public health advocates

n Attorneys and consultants

Secondary Research

We Know Where to Look – Mining the Details.

Analysis is further supplemented by secondaryresearch, consisting of constant tracking of annualcompany reports, national statistics bureaus, trade/industrial/professional associations, and the like.

Relevant developments are diligently followed andtheir impact closely monitored. Reports also drawupon non-confidential data from Kline’s internaldatabase, consisting of over half a century’s syndi-cated research.

Comprehensive Market Intelligence

We Know How to Verify.

Data are rigorously analyzed, cross-checked, distilled,and validated. Kline’s proven methodology allowsexceptionally effective, precise, and reliable market

intelligence procurement and assessment, givingsubscribers a solid foundation on which to grow,refine, and expand their business with confidence.

Kline CredentialsKline is a leading global management consulting andmarket research firm offering the complete spectrum ofservices. The firm has served the management consult-ing and market research needs of organizations in thechemicals, materials, energy, life sciences, and con-sumer products industries for over 50 years.

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