This document discusses market access concepts for healthcare brand management. It defines access as the degree to which a product can be prescribed, reimbursed, promoted and supplied within a market segment. Planning access requires correctly positioning the product, identifying target channels and customers, and developing contracting and marketing strategies. Maintaining and expanding access also requires pull-through initiatives to reinforce contracts, connectivity of information between stakeholders, and selectivity based on clinical value and available resources.

1. Healthcare Brand Management
Market Access Concepts
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2. Healthcare Brand Management
Market Access Concepts

3. What is Access?
• The degree to which a healthcare product is:
– Easily prescribed/used by providers
– Reimbursed by health plans
– Effectively promoted/sold in a market segment
– Available through a variety of contractual arrangements
and supply chain sources

4. Access And Reimbursement
• If payers do not reimburse for the product, it is less likely
caregivers and patients can use it
• Marketing and sales initiatives of manufacturers will be
much less effective
• The product will not be able to generate enough revenue
to be commercially viable
• Competitors will gain an advantage through their market
access initiatives

5. Planning Access
• The product must be correctly positioned with primary prescribers
and provide clear clinical value in patient treatment
• Identify channel(s) your product will be used most, where it
realizes greatest revenue potential
– Target the predominant prescribers and payers in the channel
– Develop and implement a contracting strategy for each
channel, include customers and leading payers
– Fortify the product’s position with physicians through clinical
marketing strategy and accelerate growth with sales tactics,
ongoing promotion and pull-through
– KOL support establishes a conduit of influence into clinical
decision makers and their peers

6. Planning Access
• A direct customer contract can be undermined if product is
available at a lower price through a GPO contract
• Distributors, wholesalers and other reseller contracts
need channel alignment to protect agreements and maintain
profit continuity in other market segments
• Discounts, rebates and other financial features need to be
accounted for throughout agreements to assure margin and
true profit is realized before transactions are underway
• Commercial contract pricing needs to be reconciled against
government contracts requiring “best price”

7. Planning Access
• Sole awards and preferred product positions provide
premium access but require the steepest discounts and
garner the most competitive attention
• Rebates based on volume contracts need clear definition
and dedicated resources to maximize access and accurately
manage rebates through sales tracings, chargeback data
• It is necessary for pharmaceutical companies to balance
direct contracting strategies with healthcare clients versus
GPOs; healthcare entities engage in both arrangements
depending on their procurement preferences

8. Planning Access
• Customer supply chains featuring distributors, wholesalers
and other sources vary, contracts needs to account for these
• Maintaining/expanding access requires a budget to open
new initiatives and provide marketing/sales resources to
propel them
• Access requires selectivity, fortifying/expanding access
should be based on customer need, reimbursement
potential, available resources and long term ROI
• The product must be correctly positioned with primary
prescribers and provide high clinical utility

9. Pull-Through Reinforces Access
• Establishing a leading contractual arrangement and/or preferred
status is just the beginning…
– Physicians and patients need to know they have access to the
product, be familiar with the product’s attributes and establish
the processes to procure it through
– Sales uptake and ongoing momentum is driven by a well-
supported sales force and strong marketing initiatives to fortify
and expand share/revenue
– New competitors will launch pull-through initiatives to penetrate
the market, established competitors will widen share and
prevent newcomers from getting traction
– Physicians and payers need to be continually engaged and
cognizant of the product and its manufacturer’s value

10. Connectivity Coordinates Access
• Access is driven by connectivity and throughput of information:
– Social Media propels clinical and promotional messaging to
healthcare professionals, patients and consumers
– Healthcare plans make data-driven decisions based on care/cost
outcomes, claims processing reporting and member utilization
– Pharmaceutical companies rely on blended data to effectively
contract, maintain compliance, determine share, assess
marketing/sales ROI
– CMS/Federal and state sponsored plans are data dependent to fund
programs such as Medicare, Medicaid, 340B, reimburse providers and
pharmaceutical companies, as well as maintain patient eligibility files
– ACOs are hugely dependent on electronic information flow to manage
their protocols and assess performance

11. Examples of Market Channels
• Dialysis
• Long Term Care
• Mail Order Pharmacy
• Home Infusion
• Hospitals
Each channel
• Infusion Clinics
requires an
• Military Treatment Facilities/MTFs access
• Oncology Clinics strategy…
• Physician Practices
• Retail Pharmacies
• Specialty Pharmacies
• Surgical Centers/Outpatient Surgery,
• Veterans Administration/VA Hospitals & Clinics

12. Leading Pharmacy Entities
Retail Pharmacy PBMs*
– CVSCaremark – ARGUS
– Rite Aid – BioScrip
– Target – Catalyst RX
– Walgreens – CVSCaremark
– Wal-Mart – Medco
– Restat
– SXC Health
In addition to contracting with pharmaceutical manufacturers, PBMs contract with
retail pharmacies to fill prescriptions for pharmacy plan customers
*PBMs: Pharmacy Benefit Managers

13. A Note About PBMs
• PBMs contract with brand and generic manufacturers for better
pharmaceutical pricing and actively manage utilization of prescription
medication by customer plan members
• PBMs feature their own formularies and assertively negotiate for rebates
based on volume/preferred status with pharmaceutical companies
• Some PBMs like Express Scripts, Medco, and SXC operate their own
mail order pharmacies, others like ARGUS, CatalystRx and Restat do not
• PBMs manage prescription plans for employer, government (Medicaid,
Medicare, TRICARE, etc.) and other sponsors
• PBMs offer clinical programs to manage some therapies closely, these
provide access opportunities for manufacturers

14. A Note About Mail Order Pharmacies
• Mail order pharmacies dispense maintenance therapies (cholesterol, diabetes,
contraceptives, hypertension, etc.) in 90-day supplies, it is key for manufacturers
of maintenance therapies to have contracts with mail order pharmacies
• They charge plans/patients less, the concept is patients are getting their
medications “in bulk” 90-day supplies versus 30-day retail increments
• Mail order pharmacies typically operate specialty pharmacy units as well to
dispense injectable products to support advanced patient care
• CVSCaremark, Walgreens, Rite Aid and Wal-Mart operate mail order pharmacies
in addition to their retail pharmacy operations
• Health plans with their own mail-order operations include Cigna (Tel Drug),
Humana (FutureScripts), BCBS (Prime Therapeutics) and United HealthCare
(Prescription Solutions)

15. Leading Payer Plans
Commercial Plans Government Payers
– Aetna – Medicaid (state-based,
– BlueCross BlueShield plans* federally subsidized)
– Cigna – Medicare
– Humana – TRICARE (active/retired
– Kaiser military)
– United Healthcare – 340B Plans
– WellPoint (14 BCBS plans)*
*There are 38 BlueCross BlueShield plans affiliated with the
BlueCross BlueShield Association

16. A Note About 340Bs
• 340B is a Federal drug discount program established in 1992, it requires drug
manufacturers to provide outpatient drugs to eligible health centers, clinics and
hospitals at a discounted/negotiated rate (average 50% below retail)
• The 340B market segment has been growing due to issues with the economy and
larger numbers of uninsured persons but margin is lower as 340B is price driven
• 340B is also known as "PHS pricing" or "602 pricing“, patients discounts are
created by contractual arrangements between the care provider and a pharmacy
• Entities eligible to participate in 340B include:
– Black Lung Clinics
– Disproportionate Share Hospitals (DSHs)
– Family Planning Clinics
– Federally Qualified Health Centers (FQHCs)
– Federally Qualified Health Center look-alikes (FQHCLAs)
– Hemophilia treatment centers
– HIV / Ryan White Clinics
– Sexually transmitted disease and tuberculosis clinics
– State-operated AIDS Drug Assistance Programs
– Urban Indian organizations

17. GPO and Healthcare System Leaders
GPOs Healthcare Systems
– Amerinet – Dept. of Veteran Affairs/VA
– Gerimed – HCA Inc.
– Epic – Community Health Systems
– HealthTrust Purchasing – Trinity Health
Group (HPG)
– Partners Healthcare
– Innovatix
– NYC Health & Hospitals Corp.
– ION (M
– Kaiser Permanente
– MedAssets
– Universal Health Services Inc.
– MHA
– Catholic Healthcare West
– Novation
– Adventist Health System
– PDM
– Tenet Healthcare Corp.
– Premier
GPOs are frequently a part of the Healthcare System access formula

18. A Note About GPOs
• Group Purchasing Organizations (GPOs) contract with manufacturers of
brand or generic pharmaceutical products, medical devices, equipment
and other items used in healthcare settings
• Healthcare entities pay a membership fee to “join” a GPO to get access to
discounted pricing GPOs negotiate with manufacturers, GPOs also collect
1-3% margin from drug products and provide other services to gain
• Some GPOs are business units of distributors/wholesalers but do not
take possession of products, they are price-driven, contracting entities
• HPG, MedAssets, Novation and Premier are larger independent GPOs
• Wholesaler operated GPOs include INN, ION (AmerisourceBergen),
VitalSource (Cardinal Health), Onmark, U.S. Oncology (McKesson)
• An array of customer groups use GPOs including healthcare systems,
hospitals, oncology clinics, home infusion, surgical centers, dialysis
clinics, physician groups and long term care companies

19. Nursing and Assisted Living Facilities
Nursing Facilities Assisted Living
– HCR ManorCare – Emeritus Corp.
– Golden Living – Brookdale Senior Living
– Life Care Centers – Sunrise Senior Living
– Kindred Healthcare – Altria Senior Living
– Genesis Healthcare Corp. – Five Star Quality Care
– Sun Healthcare Corp. – Assisted Living Concepts
– SavaSeniorCare – Merrill Gardens
– Extendicare Health Services – HCR ManorCare
– ELGS – One Eighty-Leisure Care
– Skilled Healthcare Corp. – Life Care Services
Once highly fragmented, consolidation among nursing and assisted living facility
operators continues which will greatly concentrate revenue sources in the future

20. Long Term Care Pharmacy and Home Infusion
LTC Pharmacies Home Infusion Providers
– Guardian Pharmacy – Apria
– Millenium Pharmacy – AxelaCare Home Solutions
– Omnicare – CarePoint Partners
– Partners Pharmacy – Healix
– PharMerica – Home Solutions
– Senior Care Pharmacy – Infuscience
– Lincare
– OptionCare/Walgreens
– Vital Care
The home infusion provider market continues to evolve through consolidation of
existing providers and hospitals expanding their services into home infusion offerings

21. Surgical Centers and Dialysis Clinics
Surgical Centers Dialysis Providers
– Amsurg – American Renal Associates
– HVP – Centers for Dialysis Care
– Meridian Surgical Partners – DaVita
– SCA – Dialysis Clinic Inc.
– Surgical Care Affiliates
– Fresenius
– Symbion
– United Surgical Partners
– Innovative Dialysis
Systems
– Renal Advantage
GPOs are frequently a part of the Surgical – Renal Care Partners
Center access formula
– Satellite Healthcare
– U.S. Renal Care
DaVita and Fresenius control two-thirds of the U.S. dialysis market, consolidation in
the channel is frequent and driven by cost controls to generate revenue under
Medicare patient care performance standards and reimbursement limits

22. Access Summary
• Each market channel requires its own access strategy
• Fully account for primary physicians and payers in each channel to
position, price and promote product successfully
• Contracting may involve direct-to-customer, distributor, GPO, wholesaler,
payer and other arrangements to succeed in the channel
• Competitors are selectively stronger/weaker in different channels, exploit
channels they are weakest in to grow product sales
• Contracts are only part of market access, contract management, pull-
through and connectivity are necessary to maintain/expand sales/share
performance
• Be selective, fortification and expansion of access requires clinical
performance to demonstrate true value and gain acceptable
reimbursement levels --plus suitable resources to sustain initiatives for
acceptable financial returns

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