Pharmaceutical Manufacturer
Industry:
Pharmaceutical Manufacturer
Problem:
A leading brand pharmaceutical manufacturer needed a clear, end-to-end understanding of the prescription journey, from e-prescribing through dispensing and patient pickup. They wanted to identify potential barriers in EHR systems, pharmacy workflows, and payer adjudication systems to enhance patient access, all while gaining practical recommendations to help optimize the product launch and drug utilization.
PHSI Solution:
PHSL created a detailed end-to-end prescription process flow diagram for a new therapy, mapping every stage from prescriber EHR display through hub pharmacy services routing, payer adjudication, pharmacy order entry and dispensing, and patient pickup. PHSL developed realistic mock-ups of the EHR prescribing screens and pharmacy dispensing systems to help illustrate real-world visibility, discussing NDC selection, quantity and refill scenarios, copay card integration, and other potential obstacles. A full PowerPoint deck summarized our findings with mitigation strategies for issues such as formulary positioning, utilization management, product stocking, and prescription abandonment. PHSL delivered a comprehensive process flow overview that was tailored to the client’s product. The project concluded with a 90-minute webinar presentation to help educate internal teams.
Results:
The manufacturer gained actionable insights into how their product would appear to prescribers and pharmacists, understanding potential friction points in the dispensing process and learning practical strategies to improve patient access and reduce abandonment. The visual mock-ups and process flows enabled the teams to better support their field personnel, refine their launch strategy, and strengthen their relationships with prescribers and health systems. The educational session was well received and provided a clear roadmap for addressing real-world barriers in both retail and hub pharmacies.
Industry:
Pharmaceutical Manufacturer
Problem:
A manufacturer of 503(a) products wanted to determine the feasibility of obtaining HCPCS codes specific to their products. They were also concerned that the current HCPCS codes assigned to their products in Medi-Span may be inaccurate and asked PHSL to assist in correcting any inappropriate linkages.
PHSI Solution:
PHSL researched currently available HCPCS codes for the active ingredients present in the manufacturer’s products. PHSL then assessed HCPCS Code options for unfinished drug products and identified relevant sections of the “HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) LEVEL II CODING PROCEDURES” to determine if there was a pathway to obtaining product specific HCPCS codes for the manufacturer. Finally, PHSL reviewed Medi-Span policies for HCPCS code linkages and drafted communications to request a change to the assigned HCPCS codes for the manufacturer’s products.
Results:
PHSL communications with compendia were successful in removing the assigned HCPCS codes from the manufacturer’s NDCs. While research determined that the manufacturer’s products would not be eligible for new HCPCS codes, PHSL was able to educate the manufacturer on the assignment of HCPCS codes and discuss the currently available codes for their products. The manufacturer was then able to determine the best path to reimbursement using available HCPCS codes.
Industry:
Pharmaceutical Manufacturer
Problem:
Regional Medicare administrators were not covering the manufacturer’s product for the latest indication. The manufacturer required expertise with compendia resources to identify product information supporting the Medicare coverage of this new indication.
PHSI Solution:
PHSL researched the product in the specific Medicare-approved compendia, documented findings, and shared the results with the manufacturer. PHSL identified the product status in each compendium and drafted communications to the compendium to request updates where required. PHSL also educated the client about how their product’s new indication was listed in the compendia.
Results:
The Medicare accepted compendia review was successful, enabling the client to support sales growth through documentation and the ability to engage with the Medicare regional administrators. PHSL’s knowledgeable compendia consultants accessed the specific compendia and quickly performed searches and documented results to improve the client’s efficiency.
Industry:
Pharmaceutical Manufacturer
“Individuals used social media to seek advice about medication use… Manufacturers who are aware of these concerns [identified by social listening] can set themselves apart by addressing them.”1
Problem:
A brand pharmaceutical manufacturer wanted to better understand how their newly launched first-in-class product was being described online. Of particular concern to the client was whether the information available on third-party websites aligned with the Prescribing Information (PI).
PHSI Solution:
PHSL conducted this Online Listening activity by identifying target search terms and regularly reviewing a variety of websites, both prescriber/HCP-focused, as well as patient-focused sites. PHSL tracked and presented the weekly findings to the client, uncovering not only any discrepancies with the product’s Prescribing Information, but also reporting upon additional findings related to prescriber and patient product satisfaction and concerns. The rigor that PHSL applies to Online and Social Listening goes beyond generic algorithms, web crawlers, or bots; our pharmacist consultants customize the online and social listening project to our client’s needs, utilizing our industry expertise to analyze the findings for meaningful, more nuanced insights at every step.
Results:
With the information garnered from this social listening project, PHSL identified opportunities to draft communications to correct errors and address omissions where applicable, allowing the manufacturer to mitigate the impact of any inaccurate information. PHSL also created a customized and comprehensive Online Listening Roadmap for the client. This roadmap included:
1 Keller MS, Mosadeghi S, Cohen ER, Kwan J, Spiegel BMR. Reproductive Health and Medication Concerns for Patients With Inflammatory Bowel Disease: Thematic and Quantitative Analysis Using Social Listening. J Med Internet Res 2018;20(6):e206 Available: https://www.jmir.org/2018/6/e206/.
- Quarterly assessments to monitor site error corrections and updates
- Developing a process to provide consistent site updates beyond the usual drug information destinations like pricing & clinical compendia
- Presenting HCPs with sources reporting accurate information and/or positive impressions from patients and providers
1 Keller MS, Mosadeghi S, Cohen ER, Kwan J, Spiegel BMR. Reproductive Health and Medication Concerns for Patients With Inflammatory Bowel Disease: Thematic and Quantitative Analysis Using Social Listening. J Med Internet Res 2018;20(6):e206 Available: https://www.jmir.org/2018/6/e206/.
Industry:
Pharmaceutical Manufacturer
Problem:
A brand pharmaceutical manufacturer’s drug had a competitor that launched a product with the same active ingredient. Although both products had similar indications, our brand manufacturer client’s product had an additional indication beyond that of their competitor. Our client wanted to ensure that healthcare practitioners were clearly able to differentiate the products for prescribing and wanted payers to be aware of these differences for formulary and coverage purposes.
PHSI Solution:
PHSL performed a review of how both products were listed across the major clinical drug compendia. PHSL identified that the competitor’s product was incorrectly listed as being indicated for our client’s unique indication in one of the leading compendia. It was also discovered that a payer was referencing this compendium listing as a justification for coverage and formulary decisions.
Results:
PHSL was able to work with our client to have their unique indication removed from the competitor product’s clinical compendia listing. The manufacturer was able to use this new compendium change to contact the payer in question and have their own product once again preferred over their competitor’s drug.
Industry:
Pharmaceutical Manufacturer
Problem:
A client offers a product that only needs to be dispensed once per year. Pharmacies dispensing the product were experiencing almost a 90% claim rejection rate from payers. The client wanted to understand the underlying reason PBMs were rejecting claims for their product.
PHSI Solution:
PHSL was able to develop and complete a claims analysis process that sought the root of the issue. In the analysis, reasons for why certain PBMs rejected the claims were identified.
Results:
Through the analysis, PHSL was able to pinpoint the underlying reason for the claim rejections, which revolved around the values that pharmacies were entering on claims for the days’ supply for the product. PHSL’s analysis provided the client with valuable learnings, which they used in their discussions with the affected payers. Once those payers understood the issue and implemented changes to their processing, the client began to realize a reduction in the claim rejection rate for their product that went from 90% to almost 40%.
Industry:
Pharmaceutical Manufacturer
Problem:
A pharmaceutical manufacturer contacted PHSL to evaluate the differences between their copay card and competitors’ cards for competing products. The manufacturer was seeking expertise to validate their copay card marketing message in relation to competitors.
PHSI Solution:
PHSL researched competitors’ prescription drug copay cards to analyze the differences. Using pre-defined prescription coverage scenario descriptions, PHSL compared the copay card offerings. These prescription coverage scenarios ranged from a covered third-party prescription claim to a patient without prescription coverage.
Results:
The manufacturer was provided with clearly defined distinctions between the copay cards across different prescription coverage scenarios. PHSL was able to recommend marketing verbiage that accurately described the manufacturer’s copay card benefits, providing differentiation from multiple competitors and highlighting the varying benefits versus competing products.
Industry:
Pharmaceutical Manufacturer
Problem:
A manufacturer requested assistance reviewing the reimbursement criteria for one of their products and select competitors for each stakeholder in the pharmaceutical supply chain.
PHSI Solution:
PHSL reviewed the brand’s reimbursement rates through Medicaid, Medicare, and commercial insurance. PHSL generated dynamic financial models for both the pharmacy benefit and medical benefit to depict the impact on the different stakeholders. The unique lines of business were blended to examine the products across the spectrum of scenarios.
Results:
PHSL compared the manufacturer’s product to the competitors’ products with the dynamic financial model results across the stakeholders. The manufacturer now had a transparent view into the financial drivers across different products in the therapeutic category and lines of business, and the dynamic model enabled alternative scenario evaluation and testing of the resulting impacts.
Industry:
Pharmaceutical Manufacturer
Problem:
A manufacturer wanted assistance reviewing their draft Prescribing Information (PI) before the drug’s PDUFA date. They were seeking help drafting an order set, or a protocol on how to use the newly launched product, which could be provided to healthcare systems and hospital P&T Committees.
PHSI Solution:
PHSL reviewed the supporting literature and labeling provided by the client and provided a draft order set for the manufacturer’s review and approval. Standard order set sections were drafted to include, but not limited to, the following: concomitant medications, take home medications, nursing orders, pre-medications, laboratory monitoring, drug instructions, and more. PHSL conducted a conference call to review the draft order set with the manufacturer to address question related the order set.
Results:
PHSL provided two draft revisions prior to the final submission. Having a standardized order set available enabled the manufacturer to quickly provide a protocol to hospitals and healthcare systems, helping to mitigate delays in P&T committee evaluation and review. This allowed for faster uptake of their product in hospital systems and helped to ensure the drug was used correctly.
Industry:
Pharmaceutical Manufacturer
Problem:
A brand pharmaceutical manufacturer wanted to evaluate when its pipeline product is approved whether samples of the product should be dispensed at a doctor’s office or if patients should be given a voucher to present at the pharmacy to receive the initial trial of the medication.
PHSI Solution:
PHSL reviewed the pros and cons of each approach which may include cost, ease of use, packaging (bottle vs unit dose), insurance coverage, as well as the benefits the type of packaging affords both prescribers and patients. PHSL also reviewed the qualitative and quantitative benefits of using vouchers, which allow the manufacturer to have more detailed data on the product’s use compared to samples.
Results:
PHSL provided straightforward, sufficiently detailed information to the manufacturer to enable them to make an informed decision as to which approach they should take regarding sample medication.