New alliances - Pharmaceutical Representative

Major national health plans, smaller regional health plans, pharmacy benefit management companies, retail pharmacy corporations and professional pharmacy organizations are putting their stakes in the ground in preparation for the launch of the Medicare drug benefit beginning in January 2006. Each group is defining its role in this substantial shift in payment for pharmaceutical and biotech products for seniors in the U.S. market.

The Medicare drug benefit presents challenges and opportunities for the pharmaceutical and biotech industry, too, as some of its relationships with these stakeholders grow and change. You, the sales representatives, are the face of the industry to most of its customers who interact regularly with patients. Therefore, Medicare Part D is a chance to reach millions of newly insured senior subscribers and increase your products' visibility through the retail pharmacies they visit regularly.

Importance of the retail pharmacist

The retail pharmacy has been a regular stop in your territory because the retail pharmacist is in a position to talk to the patient and the prescriber daily about your products. For many reasons, the retail pharmacist is becoming an ever-more-important link in the pharmaceutical and biotech distribution chain, and now the Medicare drug benefit is accelerating this increase in the pharmacist's importance.

Pharmacists are important for all the reasons we already know:

* They administer therapeutic switches at the point of sale.
* They advise patients on product usage.
* They communicate with physicians' offices many times a day about product switches.
* Their knowledge includes how products are used, who uses them, the most popular dosages and formulations, competitive information, and managed care organization formularies.

The local pharmacist is a retailer, dispenser, educator, counselor and medical services provider. Under Medicare Part D, the part of Medicare that exclusively provides the drug benefit, these roles are expanded and strengthened, making it even more important to keep your company and its products in front of pharmacists.

Seniors will turn to their local pharmacy outlets and trusted pharmacists for information about the Medicare Part D benefit. Pharmacy groups such as the Alexandria, VA-based National Association of Chain Drug Stores, the Alexandria, VA-based National Community Pharmacists Association and the Washington-based American Pharmacists Association are already building relationships, information channels and alliances to create a strong retail network to provide products, services and information to seniors.

Knowing about these alliances and relationships will help you provide the best service to your customers -- the prescribers, pharmacists and patients -- and leverage these connections to ensure that your products reach those who need them.

Medication therapy management

The Medicare Modernization Act of 2003 requires prescription drug plans and Medicare Advantage -- Prescription Drug plans to provide medication therapy management services to qualified Medicare beneficiaries through pharmacists in the retail setting. It is estimated that about 22 million of the 43 million Medicare beneficiaries will be eligible for medication therapy management services based on these eligibility criteria:

* Will reach at least $4,000 in drug costs in 2006.
* Has more than one chronic disease.
* Is taking multiple medications for chronic diseases.

The APhA and the NACDS Foundation have developed a document that puts forth a "unified vision of core components of MTM" and requires pharmacists to take a more active role in patient care under the Centers for Medicare & Medicaid Services rule. An April 2005 joint report said the CMS expects medication therapy management to:

* Enhance patient understanding of appropriate use.
* Increase compliance with medication therapy.
* Result in collaboration between the pharmacist and the prescriber.
* Improve detection of adverse events.

According to the report, pharmacists will be communicating with physicians and other healthcare providers, "including consultation on selection of medications" [emphasis added]. This CMS directive reinforces the role of pharmacists as partners in the prescribing process as their counseling role is mandated under the MMA.

What do medication therapy management services mean for you? It is more important than ever to keep your products in front of the retail pharmacist, especially if you are promoting products for chronic diseases that are covered under the MTM clause, such as diabetes, depression, hypertension, heart disease and hyperlipidemia.

Health plans target seniors

The Minneapolis-based health plan giant UnitedHealth Group, which recently acquired PacifiCare, is aggressively growing its senior beneficiary base to position itself as a major provider of benefits under the MMA. Its effort includes a $75 million information campaign in cooperation with the Washington-based AARP, part of which involves designing and marketing plans to help seniors sign up for Medicare Part D.

The health plan has established relationships with both a major national drug chain and a major national mass merchandiser to promote the benefit.

As you begin to see more mega-alignments such as the ones between this large health plan and national retail outlets, you will want to know the status of your products in these plans and work closely with your managers to pull your products through in this massive effort when you visit the associated pharmacy outlets.

A plan to help dual eligibles

The dually eligible Medicare/Medicaid beneficiary is a high-volume prescription user. Dual eligibles currently receive their medical care under Medicare and their outpatient prescription drugs under Medicaid, which means their medications are subject to state formularies and preferred drug lists where applicable. However, under the MMA, the 6.4 million dual eligibles will receive their medications under the Medicare drug benefit beginning in January 2006.

Because the shift will cause them to be in different plans with different formularies, the CMS has contracted with several large, influential pharmacy organizations to track the dual eligibles and compare their current Medicaid plans with those they will have under Medicare in order to ensure that patients are guaranteed continuity of therapy.

You can help transition dual eligibles by finding out if you have products in your portfolio that are on the Medicaid formulary -- for example, drugs that treat severe mental illnesses -- and alerting pharmacists with large dual-eligible populations so they can ensure that the patients will continue to have access to your medications during the transition to Medicare.

Value-added materials and programs

In addition to these major efforts, this is a good time to promote your company's own patient assistance program and find out how and when it can provide coverage to those whose needs will not be completely met by the Medicare drug benefit.

Also, continue to offer educational materials to the pharmacist. Arm retail pharmacists with information they can use to help specific patients during counseling, since counseling will become an important and mandated part of their job under Medicare Part D. Pharmacists may also appreciate brochures, coupons and tear-offs for counter display that discuss conditions and offer products for diseases common to seniors.

Pharmacists are already working very hard to meet demand, so anything you can provide to assist them in explaining products and diseases and easing their customers' transition to the Medicare drug benefit will help make their jobs easier.

Maximizing the golden years

Be aware that the Medicare drug benefit offers new opportunities for your products to reach seniors, for the retail pharmacist to act as an essential member of the care team who ensures that pharmaceutical and biotech products are used appropriately, and for sales representatives to play a valuable role in this care team by knowing about the programs and alliances that affect your products.

Leverage these programs and relationships to put your products in the hands of the seniors who will be looking to gain access to them under Medicare Part D. The Medicare drug benefit is a strong, federally backed insurance program that expands access to pharmaceutical and biotech products. Effectively implemented, the MMA will maximize the health, productivity and longevity of those in their golden years.

About the Author

Tony Pinsonault