Medicare Part D Update - Pharmaceutical Representative
Saturday, Nov 21, 2009
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Medicare Part D Update
Eight ways to penetrate the over -65 market


Pharmaceutical Representative


Diagnosis:
The senior sector is the growth market for pharma and biotech

Prescription:
Find out how and why Medicare Part D influences your territory to boost your company's products

The implementation of the new Medicare Part D prescription-drug benefit in 2006 helped create a "perfect storm" for U.S. pharmaceutical and biotechnology manufacturers. Three key factors combined to deliver this whirlwind market opportunity:

  • The aging of the Baby Boomer demographic group
  • A broad range of chronic – and treatable – diseases and conditions that increase in prevalence among the older population
  • A dramatic increase in prescription-drug coverage for individuals age 65 and older

The Part D benefit is set to enter its third year of operation, and it appears that seniors have adapted to the new system after an often-confusing transition period. Consumer surveys report that as many as 80 percent of Part D enrollees are satisfied with their prescription-drug benefit; significant majorities say that premiums and copays are affordable, and that they spend less on medications than before the benefit took effect. So the drug benefit is here to stay.

As far as drug utilization among seniors under Medicare Part D, consider the following:

  • During 2006, Medicare Part D plan enrollees filled approximately 486 million prescriptions – 15 percent of all retail prescriptions filled for the year
  • Medicare Part D drove utilization across most chronic therapeutic classes (with the greatest induced demand among proton pump inhibitors [PPIs], where switching from over-the-counter alternatives made economic sense for many seniors)
  • Brand share of Part D prescriptions was 36 percent by year-end, slightly higher than the 34 percent brand share recorded for all retail prescriptions.

It's clear that Medicare Part D represents an important market target for branded pharmaceuticals, and it will become even more important as the Baby Boomer bubble continues the transition into old age.

As a pharmaceutical or biotechnology sales professional, you have a very important role to play in helping to meet the healthcare needs of our elderly population. Your products go a long way toward helping to enhance outcomes and improve quality of life while helping to reduce demand for expensive services in areas such as inpatient hospital and emergency-room care.

In addition, your knowledge of pharmacy-related issues in the Medicare sector can go a long way toward enhancing your credibility among providers, sustaining the image of your company, all while supporting increased utilization of your company's products.

With this in mind, below are eight suggestions on ways that you can help your company penetrate the over-65 market.

1 Know how the Part D benefit works One of the key principles of pharmaceutical sales is to focus on the patient. When approaching the Medicare Part D sector, take some time to view matters from the patient's perspective. For this to happen, you need to know how the Part D drug benefit works.

Below are the highlights for the Centers for Medicare and Medicaid Services (CMS) – defined Standard Benefit Plan for 2008. This "Standard Benefit Plan" is the minimum allowable plan to be offered in 2008 for a Part D standalone Prescription Drug Plan (PDP).

Premiums Enrollees must pay a monthly premium to the sponsor of the Part D plan that they select. The estimated actual average premium for 2008 is $25 for basic coverage.

Initial deductible – $275 In the standard plan, an enrollee must pay out-of-pocket for the first $275 in drug costs (up from $265 in 2007).


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