by Laura Kholer
You may have heard the term “pull-through,” but why is it getting so much attention?
You are well aware of formulary access, and the challenges healthcare providers (HCPs) and patients can encounter when an HCP prescribes a medication. Typically, when a treatment is nonpreferred, or worse, not covered, the cost to the patient is very high and many times not affordable because the patient bears the full burden of the out-of-pocket costs.
Given the current spend and trend of pharmaceutical products—which is growing and unsustainable—many payers engage in contract negotiations with manufacturers as part of the determination for product placement on their formulary. Where a product is placed on formulary can impact its cost and affordability and, to some extent, may become a barrier to prescribing.
As part of the formulary access contracting process, rebates are negotiated. Rebates are a percentage of overall product sales volume that are prescribed by a payer’s network of physicians to the payer’s member population. The more volume a payer sees in their market, the bigger the rebate to the payer.
For this reason, rebates are considered a revenue stream for payers. If you consider a product like HUMIRA® (adalimumab), which has more than $16 billion in annual sales, and apply an industry average rebate of 10%-20%, you’ll find a significant stream of revenue! On a smaller scale, even if a product only has $100K in sales with a particular payer (and assuming the 20% rebate would apply) that health plan would reap $20,000 in rebates from that product’s manufacturer, if their product is contracted for formulary access. Multiply that by many of products across many contracts and you will start to appreciate the impact of formulary access.
Since the level of formulary coverage is paid for by the manufacturer, the manufacturer must account for these rebates as a revenue deduction (RD), which may impact profitability, both of which can be improved through increased sales volume.
That’s where pull-through and a strong agency partner come in. Pull-through is a marketing strategy that we employ to help educate HCPs on a product’s own formulary access and vs competitors. Pull-through also extends to communicating patient affordability support, such as copay cards or patient assistance and support programs (for eligible patients).
Pull-through can be communicated through personal and nonpersonal channels and typically includes pertinent formulary information, such as a product’s formulary access status by payer at the national, state, or metropolitan statistical area (MSA) level, and can even be as detailed as drug-related, payer-specific coverage policies related to a specific physician’s office. Payer-specific coverage policies include prior authorization (PA) requirements, step edits, and/or quantity limits.
As you can imagine, all of this complex information can be challenging for sales representatives to communicate to HCPs and their office staff, and likewise, for HCPs, their office staff, and patients to understand. Thus, pull-through communications can help overcome these challenges by:
- More effectively communicating formulary access status and payer coverage policies
- Educating HCPs regarding patient affordability options
- Helping to remove prescribing barriers related to access by informing HCPs and office staff of the patient support services availabl
Pull-through communications may include resources delivered by sales representatives, for example:
- Formulary flashcards
- iPad digital platforms, such as our Element Access Tool
Pull-through also can be communicated via nonpersonal channels, such as:
- Direct mail
- Formulary alerts via social platforms (Epocrates or Doximity)
- Electronic health record (EHR) platforms (OptimizeRx, RxNT, Practice Fusion, etc).
Why pull-through? In just one example, in a multichannel pull-through campaign conducted in 2018, we were able to demonstrate excellent results,* including:
- Highly favorable return on investment (ROI): >20:1
- Incremental revenue lift: ~$5M
- TRx lift: ~3% (average)
- HCP engagement: ~140% of goal
Now that you have a better understanding of what pull-through is and the impact it can have on the success of your brand, ask yourself these questions:
1. Does pull-through work?
Yes, based on the unprecedented results outlined above, and other results we’ve seen from other campaigns. Historically, pull-through is a proven investment that can be measured and evolved for optimal engagement and performance.
2. Should I consider pull-through for my brand?
Yes, in most cases, and particularly if your brand has more favorable access than its competitors in large national or regional plans. In cases where formulary access challenges exist, pull-through can help overcome those challenges by reinforcing the patient affordability programs or patient support services that may be available to eligible patients.
3. Should my brand invest in pull-through?
Yes, but it’s important that you invest wisely. You need a comprehensive strategy that includes collaboration with the brand team and media partners—one that is developed in collaboration with an agency partner who has deep expertise in market access messaging. Planning discussions are imperative to optimize your investment in the most appropriate channels with the greatest possible reach without inundating your HCPs with too much information—whether it be clinical, access related, or both.
Have a question or want to discuss how we can help your brand? Reach out to Laura Kohler, SVP, Management Supervisor, Ogilvy Health: firstname.lastname@example.org.
*Results are from a specialty pharmacy biologic product and will vary by therapeutic category and specialty.