Services:  Managed Markets Challenges

Challenges and opportunities can vary greatly by product.

Some of the common examples that Profero Group has worked on with clients include the following categories:

Access Misperceptions

As any brand manager involved in a launch knows, payer access decisions can take time. Payer negotiations, category updates, and P&T committee schedules all become factors. Competitive messaging can also further confuse actual access for your product.

The downside of this mix is that prescribers can form negative access perceptions based on early experiences that are very difficult to overcome, especially for lower-volume products.

The Profero Group can help bring these incorrect perceptions back in line with the current reality, enabling healthcare providers to make more informed prescribing decisions. Our techniques involve a series of messaging and design options, coupled together for maximum visual impact in a minimum amount of time.

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Prior Authorization and Step Edits

In certain categories, prior authorization and step edit requirements are universally expected and followed, while in others they may represent a serious barrier to access.

In either case, clearly presenting key requirements and information required by a prescribing office, and doing so in a compliant manner, can be a great service to prescribers and patients.

The Profero Group has substantial experience clearly communicating a wide array of access restrictions and requirements. Ultimately, the goal of these communications is to avoid complicated processes that may deter providers from considering an appropriate product for appropriate patients.

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PBM Carveouts

Multiple payers and benefit designs can be confusing in their own right to both healthcare providers and sales representatives. When a payer also carves out pharmacy benefits for management by a PBM or employer group, things become even more complicated.

The Profero Group can help with both your internal and external communications regarding prescription benefit carveouts. We simplify this issue and related best practices for healthcare professionals, while also creating resources to train representatives to confidently and competently respond to common questions that may arise.

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Medical Benefit Information

The industry is seeing a growing percentage of injectable and infusible products entering the market. These drugs may be covered under either a pharmacy or medical benefit, or in some cases both, and benefit type can also vary payer to payer.

On the medical benefit side, effectively communicating proper coding and reimbursement processes has become an important role for manufacturers. Through the creation of process flows, sample forms, and other techniques, Profero Group can help clearly and concisely communicate medical benefit information to prescribers.

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Medicare Part D and LIS

Since 2004, Medicare Part D has been a highly visible and important benefit for seniors, who are the population segment with the highest proportion of prescription utilization. The Medicare Low-Income Subsidy (LIS) benefit is also extremely important, as it can make products more affordable for seniors lacking sufficient assets or income. Despite the obvious value of Medicare Part D, the administration of prescription benefits through a network of commercial payers and the complicated rules around LIS full- and partial-subsidy qualifications can confuse physicians, let alone their patients.

The Profero Group has spent over 10 years crafting communications regarding these plans and regulations by converting this information into easy-to-understand graphics and visual aids. We help clients share and demystify coverage for their key Medicare prescribers, who, in turn, can better assist their patients.

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Managed Medicaid

With more states transitioning from fee-for-service to a managed Medicaid model, many states no longer have a “standard” Medicaid patient. Reimbursement benefits can vary plan to plan, resulting in confusion among prescribers when trying to select covered medications.

The Profero Group can help identify different types of Medicaid patients in a given state, and communicate key differences along with an overall coverage profile, making physicians more comfortable understanding Medicaid reimbursement for your product.

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Pull-Through Standardization

Large and mid-size pharma companies typically segment their organization by brand, increasing efficiencies and leveraging marketplace knowledge. However, this can make it difficult to standardize pull-through processes and best practices across the organization, which results in different types and levels of compliance policies.

The Profero Group can work with a single brand or across brands to implement and standardize best practices. We also work in partnership with the agency of record to make sure that each brand style and identity is sustained in our pull-through materials, while maintaining compliance with company and plan standards.

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iPad/Web Reimbursement Data

Presenting reimbursement selling aids and customer resources on digital Web and iPad platforms is now a common practice among healthcare companies. However, many companies struggle with how best to share digital managed markets information in a cost-effective manner, while combining datasets and maintaining updates and business rules.

The Profero Group can leverage our digital design and management capabilities, along with our partnerships with leading managed markets technology and data vendors, to develop the best solution for your brand and budget.

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Back Office Support

Coordinating even a simple managed markets flashcard from concept through approval and production involves a variety of personnel, often in very different roles and departments. Communication disconnects can often lead to bottlenecks and additional legwork for Brand/Managed Markets Managers and Directors.

The Profero Group can manage these activities, customizing our role to fit your organization's structure. We are often involved in initial concept discussions with account management, as well as administrative activities such as preparing distribution rosters and submissions for legal/medical/regulatory review. Our directive for each project is to coordinate all steps required in bringing a resource to market, while accomplishing this as quickly and efficiently as possible.

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