Throughout IQVIA’s webinar series,付款人覆盖范围的变化在COVID-19期间 - 跟踪什么以最大程度地减少对制造商的影响, we provided insights into the scope of possible pandemic-driven patient impacts, as well as considerations for how to track the resulting changes over time.
Additionally, the webinar series underscored the importance of adopting or modifying strategies for managing payer plan switches. Consider the following three scenarios to further understand what types of manufacturer strategies and/or considerations are most appropriate. Keep in mind that individual manufacturers could experience more than one scenario depending on the diversity of their portfolio and the scale of sub-national variations within their markets.
Scenario 1: High rates of switching to a Health Insurance Exchange (HIX)
在许多方面，这是最简单的情况，因为有许多商业保险的患者正在改用覆盖范围，但仍在商业上保险。
尽管付款人组合确实会极大地影响品牌财务状况，但我们预计在这种情况下，回扣利率不会经历巨大的变化。会改变的是患者援助计划。青铜层计划的患者可能会具有可扣除和高成本的福利设计，这些人可能必须在同一日历年中通过第二扣除阶段购买。对于品牌产品，随着计划切换导致患者的销售增加，这将导致Copay偏移支出激增。
此外，许多地点在医疗交流方面没有提供多种消费者选择，因此许多患者可能会转变为与以前相同的付款人/计划。必威手机APP制造商应谨慎对待付款人获得额外的本地市场份额，直到个人计划代表特定市场中的主要配方。实现此类本地市场量的付款人可能会对医师的看法和溢出产生重大影响，并在回扣谈判中以更多的杠杆作用定位付款人。
Scenario 2: High rates of switching to Medicaid
这是受当地监管环境影响最大的情况，因为ACA医疗补助扩张状态更有可能看到高医疗补助转换率。近几个月来，内布拉斯加州，密苏里州和俄克拉荷马州已投票进行医疗补助扩展，因此随着时间的流逝，这种情况可能会变得更加普遍。
The biggest impact on manufacturers resulting from higher Medicaid volume is on net-price management. In this scenario, Mandated Medicaid rebates and Best Price regulations become increasingly important to a brand’s P&L as Medicaid volume increases. Mature brands may be at penny pricing in this channel, completely eroding the profitability of patients with Medicaid insurance.
As more patients become Medicaid enrollees, we also expect to see the340B Drug Discount Programcontinue to expand as more hospitals qualify for the program. Many manufacturers have invested heavily in 340B tracking and rebate auditing capabilities to prevent double-dipping, but these functions will take on even greater importance as Medicaid volume grows.
方案3：转换为现金/折扣护理的高率
对于品牌产品，作为现金填充的患者并不代表主要的毛细管风险，但确实代表了更大的顶级风险。未投保的患者的现金成本填充品牌产品的处方非常高，折扣卡仅抵消了相对较少的共付额。制造商可以选择从放弃高成本脚本的患者中损失销量，或者他们可以通过传统的Copay卡或患者援助计划（PAPS）尝试为这些患者提供帮助。这两种选择都有饮食能力的缺点，因此制造商的前进道路将取决于微妙的平衡支持量增长而不会削弱净价。
The role of discount cards moving forward is something to monitor in this scenario. We have already seen these companies form partnerships with pharmacy benefits managers (PBMs) to enable rebates to be passed through to patients, but it is unclear if this capability will be extended to truly uninsured patients.
无论情况如何，都利用机会
One thing is consistent across all three scenarios: major disruption is occurring and will only expand over time. Manufacturers need to be able to consistently track ongoing market trends in as close to real-time as possible, and to also develop the strategic agility to capitalize on transient opportunities.
With the help of IQVIA’s COVID-19 tracking tool, which uses a patient-based tracker approach, manufacturers can do this with ease and accuracy. To learn more, contactBrian Fallica.
该资源是博客系列的第3部分，该系列专门针对COVID-19期间的付款人覆盖范围更改。读第1部分和第2部分for additional insights on this topic.
