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Market Access Strategic Execution Consultant

Interpreting Ratios

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Interpreting Ratios

It starts with data and it ends with data. This is why it’s critical for market access professionals to understand biostatistics.

Here’s a cheat sheet of how to interpret ratios in biostatistics using a hypothetical example. It’s one of the few resources from pharmacy school that I still refer to even after a decade.

Morbidity from Prostate Cancer of 400 Men

Measure of Risk

Formula

Radical Prostatectomy (PR)

(n = 200)

Watchful Waiting (WW)

(n = 200)

# men with erectile dysfunction (ED)

 

160

90

Absolute risk reduction (ARR)

Risk in PR – Risk in WW

(160/200) – (90/200) =

0.80 – 0.45 = 0.35 = 35%

Risk of ED was 35% less with WW than with PR.

Relative risk (RR)

AR of PR / AR of WW

(160/200) / (90/200) =

0.80/0.45 = 1.8

Risk of ED with PR was 1.8 times that with WW.

Odds ratio (OR)

Odds of PR / Odds of WW

(160/40) / (90/110) =

4/0.82 = 4.9

The odds of ED with PR are about 5 times those with WW.

Number needed to harm (NNH)

1 / ARR

1 / 0.35 = 3

For every 3 men undergoing radical prostatectomy, 1 will experience ED.

I Get To…

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I Get To...

I have to attend this meeting
I have to turn in this by next week
I have to prepare for this pitch

Vs

I get to attend this meeting
I get to turn in this by next week
I get to prepare for this pitch

How would your world be different if you switched out ‘have’ with ‘get’?

Would your colleagues, employers, and Clients notice the difference?

Would your family notice the difference?

It’s more efficient to pull than to push.

Efficient = less effort, man-power, time, and money for the same outcome.

Formidable

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Formidable

Good strategies supported by bad content are lame.

Good strategies supported by good content are formidable.

It’s time to stop living with crappy content.

Everyday I get a chance to practice my art.

Doctors and lawyers are highly educated professionals, but still use the word “practice” for their professions, indicating they always have something to learn or sharpen. A good practice is specific, focused, and helps me to continue rising.

Bad content ≠ bad writer (rookie mistake!). Bad content can be flipped into good content by the same writer.

Content development is a skill that can be learned.

Questions to Ask at the Kickoff Meeting

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Questions to Ask at the Kickoff Meeting

Professionals ask smart questions. Smart questions set off lightbulbs around the room. They also spare money and headache down the road.

If they haven’t already been answered in the Creative Brief, it might be worth getting them answered by the Client before going off to do the work.

  • What problem is this project trying to solve for?
    • What is it for? When someone hires our service, what are they hiring it to do?
    • Who (or what) are we trying to change by doing this work? From what to what?
    • How will we know if it’s working?
  • How can we build on existing assets and experience?
    • What does it remind us of? Are there parallels, similar projects, things like this that have come before?
    • What assets do we already own that we’ll be able to leverage?
  • Anticipate obstacles.
    • What’s the difficult part?
    • How much of our time and focus are we spending on the difficult part?
    • What part that isn’t under our control has to happen for this to work?
    • How much (time and money) is it going to take to find out if we’ve got a shot at this working out?
    • What do we need to learn?
    • From which people will we need help? Do they have a track record of helping people like us? 
    • What assets do we need to acquire?
  • Belief in this project despite all odds.
    • After the project launches, what new assets will we now own?
    • Why do we believe this project is worth it?

Today is the First Day of Your Product’s Life Cycle

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Today is the First Day of Your Product's Life Cycle

What a phenomenal shape the circle is.

Where does it begin? Now, where does it end.

Is it possible that the circle could’ve started at any another point?

Yesterday ended last night. Today is the first day of the rest of your product’s life.

70% of launches fail. There’s evidence to suggest that the first year sets the trajectory for the rest of the product’s life cycle.

Cycle = circle.

Even if your drug has already launched, do you get another chance to begin?

How you got here is not how you will get there. 

The asset inventory is what it is. It takes months-years to generate new evidence. What will you do in the meantime? Your product already has what it needs to penetrate the market in a way that no other product can–if you allow it.

Take a page from Zig Ziglar’s playbook: If you give them enough of what they want, they will give you everything you want.

Shortcut to Understanding a Therapeutic Area

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Shortcut to Understanding a Therapeutic Area

Fredrick Haugen recently pointed out to me a brilliant observation. Brahe was a famous physicist/astronomer who did countless measurements but didn’t do anything with them. Kepler (whom we might remember from grade school) used the data to figure out the law of planetary motion (planets move in an ellipse instead of a perfect circle).

A higher starting point leads to higher reach.

When working with a new disease state, I look to the hard work done by others as my starting point. I’ve found that good continuing education (CE) courses are a shortcut to:

  • understanding the nuances and current issues surrounding the disease state
  • listening-in on happening conversations surrounding the disease state
  • getting a list of recent and reputable references that might be used to cite my work
  • bonus for pharmacists: collecting continuing education credits!

Here are some CE providers that I check out first:

Important note: referencing these CE courses will not fly with medical/legal review. The references that these courses use, however, are fair game.

How do you effectively understand a therapeutic area?

What Does It Look Like?

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What Does It Look Like?

If I want my radical idea to be picked up, it has to look familiar to them.

Build a bridge.

Otherwise, they’re left with two choices: jump across the gorge or go home. What would anyone choose?

In the words of Seth Godin, “It’s far easier to sell someone on a new kind of fruit than it is to get them to eat crickets.”

What precedents have been set? If they did it before, it’s easier for them to do it again.

But First, Questions

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But First, Questions

_______ leads to research.

Research leads to answers.

Answers lead to messages.

Messages lead to content development.

Content development can move customers.

(Fill in the blank)

That first sentence, which is the foundation for everything else to come, is usually overlooked. 

What would happen if builders overlooked the foundation of a skyscraper? Could it even become a skyscraper if the foundation was overlooked?

How Can My Solution Actually Be a Problem?

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How Can My Solution Actually Be a Problem?

In Trevor Noah’s words: ‘It’s a never a good thing when the solution to your problem SOUNDS like a problem.’

We’re the first to point out holes in others’ ideas…but will never—ever—accept the slightest fault in our own.

Wharton professor Adam Grant outlines four distinct thinking styles we use to approach problems

  • Preacher: “When we’re in preacher mode, we’re convinced we’re right,” explains Grant. From the salesman to the clergyman, this is the style you use when you’re trying to persuade others to your way of thinking.
  • Prosecutor: “When we’re in prosecutor mode, we’re trying to prove someone else wrong,” he continues.
  • Politician: It’s no shock that “when we’re in politician mode, we’re trying to win the approval of our audience.”
  • Scientist: When you think like a scientist “you favor humility over pride and curiosity over conviction,” Grant explains. “You look for reasons why you might be wrong, not just reasons why you must be right.”

“I think too many of us spend too much time thinking like preachers, prosecutors, and politicians,” Grant insists.

Grant mentions one Italian study which taught budding business owners to view their plans as hypotheses for testing. Compared to a control group “those entrepreneurs that we taught to think like scientists brought in more than 40 times the revenue of the control group,” he reports (40 times!).

Grant has a point.

The truth works.

All of this is just another way to convey the importance of a learning mindset.

What can I do to be a better scientist? Why is it so hard to be a good scientist?

CMS Final Rule Threatens Existence of Manufacturer Coupons

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CMS Final Rule Threatens Existence of Manufacturer Coupons

Peter Pitts and Jason Zemcik wrote a brilliantly simple article later last week dissecting the CMS Best Price Rule.

Manufacturers offer copay assistance coupons for many drugs in order to offset cost share. Evidence from a Massachusetts Health Policy Commission study suggests that these coupons indeed promote adherence and better outcomes.

Unfortunately, a critical drug pricing rule finalized by CMS towards the end of 2020 could unintentionally jeopardize coupons. The rule requires that manufacturers ensure the benefit of their coupons go solely to the patients. If the coupon’s full value is not realized by the patient, the manufacturer will be required to count it as a discount to the drug’s Medicaid price (manufacturers are required to give Medicaid programs their ‘best price,’ which is the lowest price they offer to any other purchaser of a drug).

How could a coupon possibly benefit anyone else other than a patient? Payers have figured out how to flip coupons on their head in order to remain profitable. Copay accumulators. Under the copay accumulator tactic, the coupon value is not counted against the deductible. Therefore, once the coupon funding is exhausted, beneficiaries are forced to pay their full deductible. When faced with this situation, many patients are forced to decide between paying their rent/mortgage or seeking medical care.

In this accumulator scenario, coupons can be viewed as a price concession to an entity other than a patient since it lowers payers’ cost for the drug. As a result, CMS would require the full coupon value to be factored into Medicaid discounts.

If the best price is brought down further with coupon values, how likely is it for manufacturers continue offering coupons?

If they are forced to thus stop offering coupons, how will this impact patient access to necessary treatment?

Krishna Patel, PharmD
Market Access Strategy and Execution Consultant
info@sojusllc.com
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