In 2021, 3 out of 4 patients who tried to fill a launch brand were unsuccessful due to payer controls. As life science companies continue to launch innovative specialty-lite therapies, adopting a distribution strategy that ensures patients can access the brand as prescribed – efficiently and affordably – can mean the difference between a successful launch and failing to reach their expected value.
As the primary channel for most brands, pharmacy networks play a pivotal role in the distribution, fulfillment, and reimbursement of medications, which means the brand's short- and long-term commercial success ultimately hinges on pharmacy performance. With a rapidly evolving pharmacy landscape, brand teams should need to have a strong understanding of challenges that they face in the retail channel and would be wise to carefully evaluate alternative pharmacy channels that can enable commercial success.
Across industries, consumers increasingly demand convenient experiences beyond the traditional brick-and-mortar retail model. Moreover, patient preferences have evolved to prefer blended care models fueled by the COVID accelerated disruption across healthcare delivery systems. Ongoing labor shortages, inflationary pressure, and declining reimbursement make it difficult for traditional retail pharmacies to meet consumer demands in today’s environment.
For more insights on the impact the pharmacy network can have on your brand’s coverage and access, read this white paper to uncover key trends, opportunities and challenges across the industry.
While the U.S. pharmacy sector has lagged behind others in its adoption of e-commerce, it is quickly following the general retail industry as major pharmacy chains drastically reduce their footprint by permanently closing store locations across the country. Other pharmacy models are also picking up the slack. For example, tech-enabled hub providers are disrupting the status quo with consumer-centric, technology-driven approaches that support patients and healthcare providers across the prescription journey, enabling patients to access their medications conveniently and efficiently.
An ineffective distribution network can diminish patient and provider satisfaction, health outcomes, and gross to net. And strong market access, the ability of a pharmaceutical manufacturer to secure reimbursement and coverage for their products from payers, does not always translate to covered dispenses at the pharmacy level – particularly for specialty and specialty-lite therapies.
That’s why brand teams must understand the following commercialization risks of relying solely on traditional retail networks in an evolving marketplace:
Limited influence – an open channel strategy offers few mechanisms to ensure a product is dispensed as intended at the retail pharmacy level.
Friction in the PA process – Robust payer utilization management requirements, most commonly prior authorization, introduce barriers to patients and healthcare providers that can reduce scripts and PA submission rates.
A fragmented patient experience – An experience that doesn’t align with consumer expectations can reflect negatively on the brand, leading to poor medication adherence and lower refill rates.
Lack of visibility – Limited access to key metrics around benefits verification, PAs, health plan PA behavior, and reimbursement rates inhibit manufacturers’ ability to steer commercialization more effectively.
High distribution costs – The cost of servicing national retail distribution is significant particularly for small and medium sized manufacturers already facing barriers to profitability.
One of the primary contributors to brand success is a market access strategy – and execution – that enables affordable product fulfillment for appropriate patients. Commercialization teams need to understand the makeup and coverage implications of their dispense network so they can take proactive steps to maximize brand uptake and ROI.
What level of prescription coverage do we realize from the pharmacy network? Remember, market access does not necessarily equate to covered dispenses. Considering the influence of payers, PBMs, and network design is essential.
What percentage of health plans have contracts with our dispensing network? You should carefully evaluate if the pharmacy network has the contracts necessary to drive coverage effectively.
What are our pharmacy network’s PA processes and success rates? How efficiently and effectively pharmacies perform PAs can make or break your brand, so having this insight is critical.
How successful is our pharmacy network at driving prescription pull-through? It's crucial to assess the level of patient services program enrollments, brand switching, generic substitutions, and coupon utilization to assess brand pull-through at the pharmacy.
Does my network offer visibility into the prescription journey to inform business rules? In today’s dynamic environment, manufacturers should utilize data to map out friction points in the patient journey that limit access. To do so effectively, brands need timely access to prescription data from the time it's written to point of dispense and beyond.
Phil is an end-to-end pharmaceutical commercialization platform that helps brands conquer traditional retail challenges. By partnering with us, life science companies gain access to a nationwide pharmacy network with 98% plan coverage that allows patients to receive prescribed therapy quickly, conveniently, and affordably. Our digital-first platform helps more patients get started and stick to therapy, automates prior authorizations, and enables manufacturer-driven coupon utilization. Real-time insights give our manufacturer partners strategic visibility into the entire prescription journey.
Read this case study to learn how one of Phil’s life science partners leveraged our nationwide pharmacy network and digital hub to achieve higher rates of prescription coverage, scripts dispensed as written, and refill adherence, significantly increasing net sales.
Our consultants will work with you to analyze your current channel strategy and make recommendations for how to improve patient access and increase the percentage of scripts getting covered by insurance.