Integrated Research Methodology Integrating Primary, Formulary, and Utilization Data to Assess Stakeholder Influence Dmitry Goldenberg, JD Global Consulting Services, Decision Resources Group Why Read This Poster? Key Trends Impacting Prescribing Decisions Key Questions Requiring Integrated Data Analysis Provider Trends Acquisition and consolidation of providers groups Standardization of product utilization and use of clinical treatment pathways Decreasing payer reimbursement Payer Trends Shift from fee for service to fee for value Increasing management of high- cost categories which have direct product competition Increasing emphasis on quality care for patient populations Stakeholder Influence Re-Evaluation: The transformation and consolidation of the US healthcare system is causing traditional prescribing dynamics to change and biopharmaceutical companies to re-evaluate their stakeholder engagement strategies and tactics. Evolution of Research Methodologies: Traditional primary market research methodologies are no longer sufficient to evaluate the full ramifications of market trends on product sales. New research methodologies using payer formulary data and provider utilization should be used to obtain a 360 degree assessment of the factors that may influence product utilization and market share. Matching Reported and Historical Actions: The use of formulary and provider utilization data is essential to ensure that the reported behavior of stakeholders through qualitative and quantitative market research, matches their actual market behavior and biopharmaceutical engagement efforts translate to a positive return on investment (ROI). Does payer access that a biopharmaceutical company obtains through payer rebates translate to increased product utilization? What influence does payer management have on product utilization at an individual physician and provider group level? How can payers be segmented based on their ability to influence provider utilization of products? How can providers be segmented based on their ability to counteract payer management actions? Payers Prescribing Decision Market Trends Providers Patients Patient Trends Shift of costs to patients through increased out-of-pocket co-pays and co-insurances Consumerization of healthcare and patient empowerment to evaluate potential product choices Increased direct-to-consumer advertising which may dictate product choice Key Data Sets for Integrated Data Analysis Environmental Trends Vertical and horizontal consolidation of stakeholders Expansion of non-traditional prescribing stakeholders influence Increased emphasis on healthcare costs, including drug pricing Environment Payer formulary data Product utilization and claims data Provider and provider-group affiliation/roll-up data Regional MSA relationship and market share maps of payers and providers 3 Analyze Provider Utilization 4 Examine Management vs. Utilization 1 Set Up Analysis Architecture 2 Analyze Payer Management Identify product category and key products for the analysis A basket of products should be used with comparable clinical data, used along the same line of therapy, and being actively managed by US managed care organizations Identify regions across the United States for analysis based on business relevance (e.g., top states by product revenue, regions with the most covered lives, or other factors) Analyze payer and provider linear relationships within identified regions to identify target providers and payers for analysis Analyze payer management of target payers to create management archetypes based on common utilization management levers Segment payers based on the level of differential management exhibited by payers Analyze provider utilization and identify preferred products across individual physicians and provider groups Roll-up individual provider utilization to provider groups and institutions Match provider utilization to key regional payers to enable linear analysis of payer management and actual utilization patterns Overlay the utilization management of payers with provider product utilization Assess whether payer product preference through utilization management policies translates to higher utilization of preferred products by providers Conduct primary research to evaluate factors that may impact provider treatment decisions Analyze return on investment of payer access rebates for preferred access vs. actual product utilization Archetypes Management Detail 1 Preference of 2 products through double step therapy 2 Preference of 2 products through single step therapy and differential co-pay 3 No product preference and parity access Integrated Research Methodology Individual Provider TRx/NRx Rolled-Up Provider Group TRx/NRx Mapping Provider Utilization to Regional Payers Actual Product Provider Utilization vs. Product Payer Preference Group 1 High 70% market share for Brand X Payer 1 Good ROI on payer access rebates; translates to higher provider product utilization Relationship Analysis 50% of HCP 1 patients are from payer 1, and 50% from payer 2 100% of HCP 2 patients are from payer 2 High Adherence to Group Preference High Adherence to Payer UM Actual Product Provider Utilization HCP 3 HCP 1 HCP 2 Payer 2 Payer 1 Group 2 30% market share for Brand X 50% market share for Brand Y Payer 1 No Product Preference Low Adherence to Payer UM Bad ROI on payer access rebates; does not translate to higher product utilization High Payer 2 1 2 Low Level of Management Low High Payer Preference Through Utilization Management (UM) 3 4 Low 0M 5M 10M+ # of Covered Lives