Managed Care Pull-Through Excellence: From Formulary Access to Increased Market Share

Best Practices, LLC, undertook this research to identify quantitative benchmarks and qualitative insights that will help sales and brand teams understand how to build an effective pull-through program to leverage their managed care contracts and increase market share.

The information in this report will enable account managers, sales leaders and brand executives to identify and close performance gaps in their own pull-through organizations and to improve their processes, programs and activities.

Study Snapshot

Study Overview and Methodology

The report focuses on the following key topics:

· Contracting strategies that support pull-through
· Collaboration across channels and functions
· Effective internal and external communication processes and tools
· Customer segmentation
· Customer communication topics, channels and timing
· Effective activities and programs
· Key Opinion Leader management
· Use of program evaluation metrics
· Trends in pull-through resource levels
· Key challenges faced in accomplishing Managed Care pull-through
· Best practices in achieving pull-through effectiveness

Sample Key Findings & Insights

Programs: Pull-through programs can be highly effective at driving results. In rating four types of pull-through programs, 45% of benchmark participants gave the top rating of high impact to general pull-through support programs (aimed at increasing provider awareness of products), while 24% rated therapeutic intervention programs and 23% rated education support programs high impact. In contrast, only 4% found adherence/persistency programs to have a high impact.

• Targeted Audience: Companies most frequently aim their pull-through efforts at physicians (97%) and physicians’ staff (79%), but patients, health plan members, government agencies and large employers are also common pull-through targets.

• Measurement of pull-through results enables companies to identify ROI and correct ineffective processes, tactics and strategies. Continual measurement helps companies understand the true cost (ROI) of the market share gained with their pull-through initiatives. In addition, regular and consistent measurement and analysis enables pull-through leaders to identify and rapidly change ineffective activities and strategies and improve results.

Executive Summary 5

Introduction 5
Research Focus 5
Research Approach 6
Participating Companies 7
Key Insights 9
Key Findings from Survey 11
Definitions for Terms Used in This Study 15

Building an Effective Pull-Through Operation 16

Programs That Drive Pull-Through 16
Effective Topics for Pull-Through Education 22
Preferred Channels for Customer Education 24
KOL Interaction Impacts Pull-Through Effectiveness 25
Tools, Templates & Processes Boost Pull-Through Success 28
Pull-Through Leadership 31
Changing Resource Levels for Pull-Through 35

Pull-Through in Action 38

Key Steps to Pull-Through Program Excellence 38
1. Manage pull-through complexity by working to a detailed
process model that provides a template for rapid, effective
response to a formulary win. 40
2. Use contract requirements to gain timely plan support for
pull-through activities and programs. 42
3. Foster, recognize and reward cross-company collaboration
—especially between Sales and Marketing. 45
4. Provide field force training on Managed Care basics,
as well as on the specifics of each pull-through initiative. 48
5. Improve physician access with messages that highlight
both the product’s clinical benefits and formulary advantages. 51
6. Coordinate across all the “5 Ps” to engage all external
stakeholders and avoid pull-through disconnects. 53
7. Maintain frequent cross-company communication to
ensure that all internal channels and functions can collaborate
effectively on pull-through. 56
8. Continually measure and analyze results to understand
ROI and to rapidly identify and adjust ineffective strategies and tactics. 58

Key Challenges in Achieving Pull-Through 62

Best Practices for Pull-Through Excellence 65

Appendix 69
Top Three Pull-Through Challenges 70
Top Three Best Practices 71
Survey Instrument 72

List of Charts & Exhibits

Figure 1: Participating Companies.........................................................................................................7
Figure 2: Participant’s Job Titles............................................................................................................8
Figure 3: Job Level and Function/Department of Participants............................................................9
Figure 4: Therapeutic Areas Represented..............................................................................................9
Figure 5: Multiple Programs are Used to Generate Pull-Through...................................................18
Figure 6: Programs Help Companies Capitalize on Formulary Wins...............................................19
Figure 7: Efficacy Benefit Leads Therapeutic Intervention Tactics..................................................20
Figure 8: Top Adherence/Persistency Driver is Patient Education....................................................21
Figure 9: Companies Target Multiple Customer Groups Beyond Providers...................................22
Figure 10: Clinical Data and Practice Guidelines are Best Provider Topics.....................................23
Figure 11: Co-Pay and Adherence are Best Topics for Patient Education........................................24
Figure 12: Preferred Education Topics for Providers and Patients..................................................25
Figure 13: Websites, Special Events Effective for Customer Education............................................26
Figure 14: KOL Interactions Can Have High Pull-Through Impact................................................27
Figure 15: Educators Play Important Pull-Through Role..................................................................28
Figure 16: Most Used Tools and Templates are for Accounts and Education.................................29
Figure 17: Tools and Templates Boost Pull-Through Effectiveness...................................................30
Figure 18: Few Characterize Their Tools and Processes as Excellent...............................................31
Figure 19: Account Managers Most Often Lead Pull-Through Efforts.............................................33
Figure 20: Sales and Account Manager Roles are Distinct but Changing.........................................34
Figure 21: Use District Managers to Maintain Pull-Through Momentum........................................35
Figure 22: Sales is the Primary Home of Pull-Through Employees...................................................36
Figure 23: Majority Expects Recent Resource Increases to Continue...............................................37
Figure 24: Critical Practices for Achieving Pull-Through Excellence...............................................39
Figure 25: Eight Steps to Pull-Through Excellence............................................................................40
Figure 26 : Manage Complexity by Working to a Detailed Process Model.......................................42
Figure 27: Use Contact Requirements to Gain Timely Support from Plan.......................................43
Figure 28: Foster and Develop Cross-Company Collaboration on Pull-Through............................46
Figure 29: Train Sales on Managed Care Basics and Pull-Through Specifics..................................49
Figure 30: Most View Pull-Through Training as Sufficient................................................................50
Figure 31: Performance Boosters..........................................................................................................51
Figure 32: Improve Physician Access with Clinical + Formulary Message.......................................53
Figure 33: Coordinate 5 Ps to Prevent Gaps Between Patient and Product......................................54
Figure 34: Include All External Stakeholders in Formulary Outreach.............................................55
Figure 35: Maintain Frequent Communication to Ensure Internal Alignment................................57
Figure 36: Use Internal Website to Support Pull-Through Teams....................................................58
Figure 37: Continually Measure Results to See ROI and Make Improvements...............................60
Figure 38: 96 Percent of Participants Use Market Share to Measure Effectiveness.........................61
Figure 39: Market Share is the Most Important Success Indicator...................................................62
Figure 40: Top Pull-Through Challenge is Field Coordination/Training..........................................63
Figure 41: Challenges – Field Coordination, Training and Momentum............................................64
Figure 42: Challenges – Limited Physician Access/MD Ambivalence...............................................65
Figure 43: Measuring Return on Pull-Through Investment...............................................................66
Figure 44: Challenges-Resource Limits, Plan Support & Compliance..............................................67
Figure 45: Provider Outreach is Top Area for Pull-Through Best Practices....................................68
Figure 46: Best Practices - Physician/Provider Focus.........................................................................69
Figure 47: Best Practices – Messaging, Collateral and Communication............................................70
Figure 48: Best Practices - Goals, Measurement & Analysis..............................................................71
Figure 49: Best Practices – Internal and External Collaboration......................................................72
Figure 50: Best Practices- Process, People & Programs......................................................................73