Control vs. Access: Why Clinical Characteristics Should Guide Specialty Pharmacy Strategy
Biopharma manufacturers launching a specialty drug are tasked with a lengthy to-do list of priorities. Sorting through and determining the dispensing network options for their product is at the top of that list, with PBMs (pharmacy benefit managers) as the focal point. Vertically integrated PBMs with specialty pharmacies can seem to be attractive partners, given the vast number of patients to which they provide access. As a result, larger PBMs may be well positioned to produce results and have more leverage with Biopharma looking to negotiate contracts.
But should access to the largest number of patients be Biopharma's primary driver? That depends.
Another option for manufacturers is to partner with niche or independent specialty pharmacies that offer premier service to a more targeted patient population. That approach will give manufacturers greater control, more detailed data, and potential negotiating leverage with PBMs.
Greater control may be helpful at launch; however, it’s possible that a manufacturer’s product may be disadvantaged, deprioritized, or not covered at all as competing products enter the market over time.
For manufacturers, there’s a careful balance between access and control. Making the final decision on a dispensing strategy and related network should be driven by product profiles and specific clinical characteristics.
In addition to clinical characteristics, the classic 4Ps are also in play here: pharma, prescriber, patient, and payer. While the prescriber “holds the pen” for prescriptions and the product may be best for the patient, the payer “holds the purse” when it comes to reimbursement. Manufacturers must consider not only the control they gain through contracting and the ease with which patients can access their drug but also related formulary positioning and the patient’s out-of-pocket costs.
Dispensing Network Options
Exclusive network access is often ideal for novel products with unique indications targeting small or orphan patient populations, such as treatments for rare diseases or oral oncology agents. Such exclusive network access through a single pharmacy allows a manufacturer to gather patient-level data and details at every dispense. While this offers tight control, rich data, and lower vendor costs, it has a higher potential for payer coverage issues. Prescribers and patients could grow frustrated with a single point of access.
Limited network access may be best for products with small to medium patient populations with a narrow prescriber base and a need to offer patient and prescriber services along with data insights. The manufacturer’s actual level of control is dependent upon the number and types of pharmacies in the specific network they choose. These networks also support lower vendor costs. Overall, limited networks often provide a fair balance of control versus access. While these networks may provide greater access than an exclusive arrangement, limited access points may still frustrate patients and prescribers to some extent.
Preferred networks provide flexible access based on the market’s response to a manufacturer’s product. This network is often ideal for medium-to-large patient populations. Results through this approach can be mixed. On the one hand, there are nearly no barriers to access, and manufacturers will have solid data transparency through the preferred pharmacies with which they’ve contracted. On the other hand, the level of control will depend on contracting, and the patient and prescriber experience may vary from pharmacy to pharmacy, given the extensive network involved.
Open access is typically the best option for supporting large patient populations with a large prescriber base, minimal patient services, and a high volume of prescriptions. The simplicity of an open access network comes in exchange for limited data and low visibility into the patient journey.
A manufacturer’s network design can follow any number of paths but should depend on the product’s profile and clinical characteristics.
Never Stop Improving
It's important to note that a manufacturer’s network design at launch will likely need to shift over time and throughout a product’s lifecycle. For example, a product could start with limited access and then shift to preferred, or even open access, later in its lifecycle. Such decisions will still depend on the product’s profile, clinical complexity, the nature of the patient and prescriber, and the influx of competing products entering the market. Ideally, a manufacturer’s dispensing network design should be structured to evolve from the point of launch through product maturity.
As manufacturers prepare for the launch of a new product or begin to re-evaluate their current program, a highly coordinated network strategy developed by a pharmaceutical consulting company with deep industry connections is often the soundest approach. That’s where Archbow can help. Our team is available to guide strategic network decisions to maximize the patient and prescriber experience and company bottom line. Contact us today to get started.
Archbow Consulting, Entrée Health, and Valuate Health Consultancy are sister companies under the Value and Access division of Omnicom Health Group. Learn more about our united organizations here.
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Archbow Consulting helps pharmaceutical and biotech companies in the USA and Europe reach their commercial goals with strategic and tactical approaches to distribution, pharmacy, and patient access. Archbow was founded by industry veterans to meet a need in the marketplace for consulting options that offer diverse real-world experience, are able to leverage deep connections across the industry, and can also provide actionable strategic guidance. We invite you to learn more about our team, services, and clients’ success, and connect with us via email, LinkedIn, Twitter or subscribing to this blog which you can do below.