Misaligned incentives can be found everywhere across the healthcare ecosystem. Inflated list prices needed to support an arcane discounts/rebates model, intermediaries profiting from every transaction along the supply chain continuum, and legacy infrastructure that rewards volume instead of value are just a few examples that plague our industry. Even the recently passed IRA has embedded incentives that will favor high list priced and highly rebated medicines. All of these tend to favor profits over lower patient costs and better outcomes.
We have a system that uses profits from rebates/discounts to influence formulary and treatment options when lower cost alternatives exist. Reimbursement rates and practice economics have become a significant influencer on medicine selection and divisive marketing practices can further confuse patient and provider decision-making. Our system has evolved where non-clinical personnel and practices have equal, if not more, influence on treatment decisions often exposing patients, health plans and employers to higher costs.
To overcome these perverse incentives, the first step is to understand how, why, and where misaligned incentives exist across the supply chain of your medicine. This provides the ability to develop robust strategies and set tactics to help ensure appropriate patients have access to cost-effective care and outcomes. Such knowledge and action are a priority in the preparation of the launch of a new medicine. Failure to do so often leads to the following:
* Inflated price concessions
* Higher patient out of pocket costs
* Provider economics influencing the selection of higher priced medicines in less optimal sites of care
* Financial incentives outweighing clinical considerations
* Slower medicine adoption
* Suboptimal patient outcomes
While we can’t change this dysfunctional system of “pay to play” incentives in the near term (dramatic policy changes needed), you can mitigate a medicine’s exposure through deliberate upfront market access actions:
– In-depth analysis/mapping of medicine flow and dollars along the value chain while identifying who is benefiting and “losing” along the way
– Clear medicine value proposition with messages that resonate with each customer segment
– Integrated pricing, contracting, and distribution strategies
– KOL strategy to proactively influence intermediaries
– Early payer engagement to discuss and help mitigate any misaligned incentives
– Field teams understand the issues and can push through them
– Patient support to navigate complexity and mitigate excessive out of pocket costs
– Corporate relations/marketing teams being assertive and proactive with dispelling misinformation
Please reach out to us at info@a3access.com for help with your mitigation strategy.