A mid-size biotechnology company was preparing to launch its first infused hematology product into a competitive disease state; one in which treatment typically included both drug and non-drug treatment options. Although the new product demonstrated clinical efficacy, the manufacturer realized that, being an infused product, it would face a complex reimbursement environment. They turned to Xcenda for a comprehensive reimbursement and launch strategy.
The Xcenda Solution
Apply Market Insights to Drive Patient Access.
Xcenda recognized that insights from the following studies would be critical to a successful launch:
- Reimbursement Landscape Analysis
- Patient Assistance Program Benchmarking and Exposure Analysis
- Payer and Provider Market Research
Xcenda conducted a reimbursement landscape assessment to do the following:
- Identify key payers
- Highlight appropriate coding options
- Understand Medicare coverage, payment, and coding
- Present a reimbursement framework for their product and 2 key competitors
- Present recommendations to minimize reimbursement barriers and maximize patient access
Xcenda's Certified Professional Coders recognized the importance that coding strategy plays within a successful product launch and provided guidance on coding types and timing.
As Medicare was the key payer, Xcenda conducted a proxy assessment for MAC coverage of key competitors. This helped the client more accurately forecast uptake at launch. We also researched private payers to determine what coverage restrictions (prior authorizations, step edits, etc) the product would likely face.
Design Strategies to Improve Positioning.
After conducting the reimbursement assessment, Xcenda concluded that the new infused hematology product would have steep competition from a lower-priced competitor. Therefore, Xcenda recommended the following strategies:
- A value diagnostic to develop and refine key messages that would drive payer preference
- Market research to test the new value messages and ensure they resonated with both payers and providers prior to implementing the payer communications program
- A predictive payer mix assessment to evaluate future payer changes as a result of healthcare reform, which would inform the manufacturer's hotline services and overall reimbursement strategy
Test Pricing and Positioning Messages.
The Value Diagnostic uncovered key aspects of the product's efficacy and side effect tolerance compared to competing products. Xcenda's Payer Strategy team used this evidence to develop new product value messages to support the niche positioning. Next, Xcenda conducted an advisory board that included payer decision makers from the Managed Care Network, our proprietary panel composed of nearly 100 pharmacy and medical directors. Findings informed the pricing strategy and confirmed that a product value story based on safety and efficacy would be effective.
For physician insights, Xcenda leveraged our proprietary Challenging Cases® series, a market research platform that brings approximately 100 providers together to forecast treatment patterns. Physicians answer questions using an automated response system, which allows fellow participants to see how their peers have answered each question. This method allows our clients to understand current treatment patterns and how their product is viewed in light of currently available data. Both the payer and provider research informed the pricing strategy.
Create Best-in-Class Patient Services.
Xcenda recommended our client carefully consider how the right mix of patient and provider services could impact patient access. So in parallel with developing the payer strategy, Xcenda worked closely with a fellow AmerisourceBergen company that is considered the leader in the design, development, and implementation of unique patient and provider support programs.
We started by conducting a patient assistance program (PAP) benchmarking and exposure analysis, the results of which set the parameters for the manufacturer's reimbursement services.
Our Analysis Provided Key Insights Regarding:
- Program structure and design
- Recommendations for web-based tools
- Drug replacement parameters
- Key premium services that would distinguish the client from the competition
The combined capabilities and expertise of both organizations within AmerisourceBergen Consulting Services created a more efficient partnership that delivered greater value to the client during the critical pre-launch phase. By developing a robust suite of patient and provider services, along with patient-, payer-, and provider-facing resources, the manufacturer was optimally positioned for a smooth launch absent of reimbursement or access hurdles.