emerging importance of the managed care liaison

© 2013 All rights reserved.

The statements and opinions expressed herein

are those of the speaker and Jencen Field Medical

Consulting LLC, and not necessarily those of any

past employer.

No financial interests to disclose.

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MCL = Managed Care Liaison, or “liaison”

Competencies & current value proposition

Changing landscapes as opportunity for

the MCL ◦ Healthcare reform

◦ Biopharmaceutical industry

◦ Customer segments

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“Medical science liaisons…partner the business

side of the equation (managed care) with the

corporate clinical expertise in order to achieve a

true value proposition offering.”1

“MSL contributing to reimbursement discussions

and formulary committee presentations has

increased from less than 10% ….in 2010 to 42% in

2012.”2

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1 “Role of the Pharmaceutical Company in Managed Care”, in Managed Care Pharmacy Practice, R. Navarro (ed), p 348, (2009).

2 “Harnessing KOL Relationships for Optimal Clinical Support”, Cutting Edge Information, (2012).


Maintains working account knowledge

◦ Clinical decision-makers’ product thought processes

◦ Formulary review and approval process

◦ Various clinical / pharmacy touch points within account

Integrates clinical value proposition with overall

account plan ◦ Meets payer’s medical need

◦ Meets internal account objectives

◦ Executive presence at the podium

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Operates independently across multiple networks ◦ Maximizes opportunities for customer interaction

Locally (identification of influential account customers)

Regionally (healthcare business coalitions, AMCP chapters)

Nationally (AMCP, ASHP, PCMA)

Recognizes evolving contacts within account ◦ Quality department

◦ Case mgmt

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Account managers ◦ Effective relationship is a key to MCL success

◦ Build collaborative, strategic partnership

Business updates ◦ Regional ML teams, as group and individually

Communicate insights in both directions ◦ Brings account’s early thinking back into Company

◦ Tests Company’s insights with the account

◦ Facilitates advisory boards (PCMA)

Easily incorporate HEOR responsibilities

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Budget

◦ Dedicated or ‘mixed’ (w/KOL responsibilities)?

◦ Add HEOR responsibilities?

Map MCLs to commercial MC team geographies ◦ Maximum effectiveness when independently accessing

account

A good starting point ◦ Provide continuous medical support for strategic,

national accounts

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Increasing emphasis on value

◦ New(er) unmet needs

◦ Demand for real-world data

◦ Need evidence of value “It is no longer simply about the cost of the drug but total cost of care

to demonstrate a product’s value”3 --Vice-President, WellPoint

Driving quality ◦ Connecting quality to performance to compensation4

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3 “Pharma and Payers—Building Better Relationships”. First Word, Sep 2012. Accessed 5/11/13 at

http://www.reportlinker.com/p01021205-summary/Pharma-and-Payers-Building-Better-Relationships.html

4 T Esse, O Serna, A Chitnis, M Johnson, N Fernandez. “Quality Compensation Programs: Are They Worth All the

Hype? A Comparison of Outcomes Within a Medicare Advantage HF Population”, JMCP, 2013;19(4):317-24.















A Challenge for ACOs

Develop quality measures

acceptable to both plans and providers5

MCL--‘Advisor’ on design of quality metrics ◦ Diabetes (HbA1C, cholesterol)

◦ Pulmonary (appropriate use of antibiotics)

◦ MTM (monitoring of specific drugs)

Coordinate KOL providers with regional ML

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5 “Accountable Care Organizations for PPO Patients”. Integrated Healthcare Association (2011), accessed 4/30/2013 at

http://www.iha.org/ACOWhitePaper_PPO_final.pdf





Scientific / technical → increasing complexity

◦ Large molecules and biologics manufacturing

◦ Genome-based therapies / personalized medicine

◦ Increasing use of technology

Companion diagnostics

◦ MCL—educate clinical decision makers & staff

Economic → decreasing revenue streams ◦ Ongoing generic erosion

◦ Thinner and more expensive pipelines

◦ “New” pharma business model

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Blue ocean6

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6 W. Chan Kim and Renee Mauborgne. Blue Ocean Strategy.: How to Create Uncontested Market Space and Make the Competition Irrelevant.

Harvard Business School Press (2005).


Blue ocean6 → Pink ocean

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Blue ocean6 → Pink ocean → Red ocean

◦ Formerly uncontested market space becomes crowded

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Blue ocean6 → Pink ocean → Red ocean

◦ Formerly uncontested market space gets crowded

Example: Hepatitis C virus ◦ Pursuing “Holy Grail”, i.e., oral, interferon-free, qd therapy

◦ 10 companies conducting 83% of clinical trials7

◦ 14 Phase III trials completing Q1 2014

◦ Likely lacking head-to-head data

◦ Cure rates and safety profiles roughly similar

◦ Above suggests minimal product differentiation

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7 Doro Shin. “The race toward an interferon free world: The current field of HCV treatment research, including recent financial deals “ Citeline (2012)

Accessed May 7, 2013 at http://www.citeline.com/wp-content/uploads/HCV-Competitive-Treatment-Lansdcape.pdf

http://www.citeline.com/wp-content/uploads/HCV-Competitive-Treatment-Lansdcape.pdf











Orphan drug market ◦ 22% of all new drugs in development are for rare diseases8

◦ 70% of above are considered first-in-class

Example: Juxtapid ® and Kynamro ® ◦ Approved within 4 weeks of each other for HoFH

◦ ~300 US patients

◦ Labels nearly identical

◦ Annual cost: $235,000-$295,000 (J); $176,000 (K)

◦ “…payer-decision making will most likely be shaped by

each product’s individual clinical profile.”9

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8 “Orphan Drugs to Create Paradigm Shift in the Pharmaceutical Industry! “ Frost & Sullivan April 6, 2013. Accessed April 15, 2013 at

http://www.prnewswire.com/news-releases-test/frost--sullivan-orphan-drugs-to-create-paradigm-shift-in-the-pharmaceutical-industry-89979267.html 9 J. Pecherer.” Competitive Headwinds: the Beginning of the Kynamro and Juxtapid Story.” Decision Resources. Feb 2103, accessed May 10, 2013 at

http://decisionresources.com/trackback/6c021a04-3f6b-4490-82d3-80b868baf168/Competitive-Headwinds--the-Beginning-of-the-Kynamro-and-Juxtapid-Story.aspx

http://www.prnewswire.com/news-releases-test/frost--sullivan-orphan-drugs-to-create-paradigm-shift-in-the-pharmaceutical-industry-89979267.html


























































Unsustainable pricing models

◦ Zaltrap®--refused by Memorial Sloan-Kettering10

◦ Provenge® --cost, benefit, demand issues prompt re-think11

Result ◦ Lack of product differentiation

◦ Manufacturers competing on price

A solution ◦ MCL: possesses skill set for identifying discreet areas of

clinical / economic / humanistic differentiation

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10. R. Conti and E. Berndt. “Winner and Loser from the Zaltrap Price Discount: Unintended Consequences? “ Health Affairs Blog , Feb 20, 2013,

Accessed May 8, 2013 at http://healthaffairs.org/blog/2013/02/20/winners-and-losers-from-the-zaltrap-price-discount-unintended-consequences/

11. M. Herper. “The Key Question for Dendreon: Is There Demand for Provenge? “ Forbes.com , Jul 23, 2102. Accessed May 9, 2013 at

http://www.forbes.com/sites/matthewherper/2012/07/31/the-key-question-for-dendreon-is-there-demand-for-provenge/

http://healthaffairs.org/blog/2013/02/20/winners-and-losers-from-the-zaltrap-price-discount-unintended-consequences/









































Government

Employers

Integrated Delivery Networks / Integrated

Health Systems

Group Purchasing Organizations

Retail Pharmacy Chains

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Government

Employers

Integrated Delivery Networks / Integrated

Health Systems

Group Purchasing Organizations

Retail Pharmacy Chains

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State health insurance exchanges

◦ Consumers: significant knowledge gap

◦ Plans: changing coverage policies

◦ Industry: need to adapt payer strategies

MCL value-adds ◦ Network to identify clinical decision makers

◦ Interact with policy makers to differentiate products

◦ Enhance broader corporate educational efforts

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68.5 percent of workers in firms with 50 or more

employees were in self-insured plans12

Changing payer dynamic ◦ Plans and servicers taking on more of claims admin role

MCL value-adds ◦ Acct mgmt & networking: identify clinical decision makers

◦ Scientific mastery: educate diverse stakeholder groups

12 P. Fronstin, Ph.D., ”Self-Insured Health Plans: State Variation and Recent Trends by Firm Size”. Employee Benefit Research

Institute, Nov 2012.

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The MCL

◦ Independently delivers value at intersection of medical

science and business

◦ Role anticipated to evolve in response to larger

changes

The new biopharma industry business model

Need for innovative clinical differentiation in

increasingly crowded product markets

Shift in payer demographics

Payers increasing demand for value-adds across the

care continuum

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Life is a learning experience;

only if you learn.

--Yogi Berra

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emerging importance of the managed care liaison

Business

uncontested

blue ocean

competition

rights reserved

renee mauborgne

chan kim

managed care

2013 athttp