Using coverage and claims data provides pharma a view of payer and prescriber behavior

By Lindsay Lorenzen

VP of Solution Consulting, Norstella

Insufficient return on investment due to an underperforming launch is a thought that makes any pharma manufacturer shudder.

Considering that about half of all products launched over the last 15 years have underperformed pre-launch consensus forecasts by more than 20%, companies must proactively plan their near- and long-term strategies to ensure financial losses remain a thought and not their reality.

And with the average cost of developing a drug nearing $1 billion, it’s more critical than ever not to leave a launch up to chance.

Gaining insight into the payers’ perspective to predict coverage, utilization management, competitors and challenges, especially within the first year post-launch, helps pharma companies avoid losses and make quick, data-driven decisions about their launch.

Why is the payer perspective so important?

Just as manufacturers need to use real-world, patient-level data to inform critical decisions, the same is true for payer data.

Payer data gives pharma manufacturers the visibility they need to develop an informed launch strategy to get their life-saving treatments into the hands of patients and achieve performance goals. By leveraging this data and intelligence, they can anticipate roadblocks and adjust their strategies across the entire drug development life cycle.

At pre-launch, say a molecule has multiple potential applications, and a manufacturer isn’t sure which indication to pursue. Payer data can help them forecast based on historical trends such as sales volumes, peak sales and net product value to predict future uptake. They can also use this data to understand the reimbursement and competitive landscape across the different indications to find the right indication with the fewest restrictions.

Then, once preparing for and at launch, understanding how a payer may manage a drug based on costs, time to coverage, and utilization management tools is invaluable information while building a market access strategy. Knowing what payers are looking for regarding target product profiles and outlining multiple pricing scenarios impacts potential formulary placement or policy restrictiveness.

Post-launch, companies can leverage payer data to track and optimize their strategies to ensure favorable long-term coverage by highlighting potential obstacles from new policies and reports that justify what payers and physicians did.

Real-world use case: Using the payers’ perspective to develop a robust launch plan

One pharma company wanted a more in-depth view of the market access path for their drug two years before launch.

To develop a robust launch plan, they knew they needed a comprehensive view of comparison drugs in similar classes or price points and insights from key payers and IDNs. Then, they could create a solid strategy built upon historical market access data and the “why” behind the trends they found.

They accomplished this by using key analogs and performed a deep dive into market, policy and restrictions data to help predict their launch trajectory.

To gain an even deeper, unique view into their market access path, they conducted 10 double-blinded, 45-minute interviews with key payers. These interviews provided valuable context and explanations regarding the driving forces behind the trends they found.

The combination of the analog analysis and in-depth interviews gave this company the insights and answers they needed to validate and refine their launch plans.

Drug launches bring about a plethora of questions. Gaining an in-depth view of payers’ perspectives provides you with the answer you need to move forward confidently.

Want to learn how? Norstella’s Strategic Launch Report & Evaluate Forecast can help you prepare for launch by identifying critical analogs to accurately predict the uptake of your new brand; prioritize payers that will provide the best outcomes; highlight potential challenges and competition; forecast sales volumes, peak sales and net product value, and more.

At Norstella, we provide answers you can act on. Want to learn how our solutions can help your pharma organization across the entire drug development life cycle? Let’s connect.