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Market Access Strategic Execution Consultant

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?

Lexus Came From Toyota Embracing Conflicting Goals

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Lexus Came From Toyota Embracing Conflicting Goals

If the market demands conflicting outcomes, embrace it (before someone else does).

The market is demanding health care delivery that is affordable + effective—highly conflicting priorities!

Harvard Business Review narrated a successful case of embracing conflicting goals:

‘When designing what became the Lexus line, Ichiro Suzuki, Toyota’s chief engineer, stipulated that the new car needed to be faster, lighter, and more fuel efficient than existing luxury sedans. The order was full of contradictions. Making a car faster usually meant having a bigger, heavier engine; making it lighter without compromising power meant stripping out luxury that was essential for this segment. So, the Lexus team returned to fundamentals and re-evaluated their most basic assumptions about how to build a car. Alongside tens of smaller new ideas, they designed and built a first-of-its-kind aluminum engine that made the car 120 pounds lighter, improving weight and fuel efficiency, thereby delivering on a seemingly impossible demand.’

Right now, all eyes are on payers and PBMs. What are they doing to make health care affordable + effective? Drugs are only effective is they’re used for the right patients at the right time.

I Must Govern the Clock, Not Be Governed by It

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I Must Govern the Clock, Not Be Governed by It

‘I must govern the clock, not be governed by it.’  –Golda Meir

Golda Meir lived for a single goal that was impossible to achieve. All of her efforts were for this particular goal. She achieved it.

In the process, she set an example for what a person in control of her situation is capable of:

  • Valedictorian despite being poor
  • Wife
  • Mother
  • Signer of Israeli Declaration of Independence
  • Prime minister
  • Iron Lady of Israeli politics
  • Personally visited families of soldiers killed in battle

…and yes, she was a woman.

Flying Together

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Flying Together

Once a hunter cast a net over a flock of birds busy pecking at grains. Flustered, the birds scrambled to escape in every direction—but in vain. Until a wise leader amongst them said, ‘We can still escape. Stop trying to fly in all directions. All of you fly in this direction,’ as he pointed up. ‘One, two, three!’ As ordered by their leader, the birds took off together. And they took the net with them.

How many birds needed to move upwards in order for this escape plan to work? ALL. Could any single bird have managed to escape alone? Absolutely not.

There is an important lesson about teamwork in this kids’ story. Think about the laggards in your team. A team is only as strong as the weakest person.

By definition, humans make mistakes (otherwise we wouldn’t be humans, we would be God). We’re in this together.

Even if they don’t have the self-confidence to say, ‘today I’m going to do the best job,’ I don’t believe anyone intentionally comes to work saying, ‘today I’m going to do a terrible job.’

We can all benefit from encouragement and upliftment.

Catch 3 people doing something right everyday (and I don’t mean false praises). Challenge yourself to do this for a month. This is the posture of good-finding. Blaming undoes us, whereas good-finding nourishes us (both the person on the giving as well as receiving end).

Pandurang Shastri Athavale (my friend, philosopher, and guide) puts it very simply: ‘The other is not another, he is my Divine brother.’

How can we all fly upwards TOGETHER (because we NEED to fly together)?

Ensure Preapproval Information Exchange (PIE) Is On Time

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Ensure Preapproval Information Exchange (PIE) Is On Time

AMCP held an insightful webinar on preapproval information exchange (PIE) in June 2020. I encourage you to check it out.

Lisa Cashman (Director of Clinical Account Services, MedImpact Healthcare Systems), Laura Randa (Vice President Market Access, HEOR and Public Policy, Mycovia Pharmaceuticals), and Jay Jackson (Senior Vice President, Consulting, Xcenda) shared generous insights on payers’ perception of preapproval information exchange (PIE).

Payers want information as early as possible because they might make budgeting decisions a year-out—up to 25% of payers initiate this process 18 months from launch (depending on their plan size). The information they want can broadly be categorized into 3 buckets: volume, patient profile, and cost.

Unfortunately, many PIEs occur too late to be useful for this purpose.

The panelists suggested the following timeline:

  • 18-12 months from launch: communicate indication, development plans, preliminary data, epidemiology, and disease information
  • 3-6 months from launch: keep the conversation going by providing updates and pricing information (to the extent that you feel comfortable sharing)
  • Leading up to launch: begin engaging in health care economic information exchange

Respect Time if you want your investment to work for you.

‘If you’re early, you’re on time. If you’re on time, you’re late. If you’re late, [hopefully you’re not dead. Because if you’re still alive, you get a second chance].’

When do you engage with payers in PIE?

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