Eric Jen, PharmD

Payer-focused reporting should not just identify winners and losers, but rather, it should drive a benchmarking process that informs strategy and guides activity. Embracing this maxim means that executive-level reports should answer two questions: 

Which payers are supporting/impeding achievement of a brand’s forecast or objectives?

 What is the plan (goals, objectives, and strategies) guiding efforts to improve payer-level performance for a brand? 

Through each of the seven components numbered in gold below, and clarified in this article, the following reporting construct succinctly answers these two questions.

The account percentage of total brand potential defines the potential that a specific payer may contribute to a brand. It should be expressed as a percentage of a brand’s total potential patients, or more accurately, class prescriptions managed or influenced by the payer.

Understanding this contribution is the first step in ensuring that each payer receives a commensurate level of attention. Moreover, this percentage is a useful input in quantifying the gross-to-net impact of a contract or in translating performance of a payer into actual sales impact.

The following grid reviews three methods to estimate an account’s contribution. Carefully building this estimate using a combination of any of these approaches will yield useful output.

Components #2 and #3: Trended share and impact

By displaying trended share performance and impact side by side, this section directly informs the level of urgency or attention that a specific payer should receive when implementing reparative strategies.

Multiple metrics may be used to express account performance, but limited reporting space requires that one metric that best informs the following question, be chosen: 

To what degree does performance within this payer sufficiently support the brand in its achievement of its gross revenue forecast?

Directly correlate with a brand’s net revenue, and

Be expressed via a timely and accurate trend line for all key payers (and ideally geographies)

Although imperfect, a brand’s market share achieved within a payer may be the best metric to measure performance. as long as market share is translated into revenue impact.

Impact estimates the value in revenue of the difference between the performance of a brand at the account against a forecast. If account-level forecasts are not available, impact could express the revenue value of the difference between brand performance at an account versus the brand’s national benchmark performance for a product called LowPress.

Of the details expressed in this article, this component is the most difficult to summarize so that it both fits into the report and practically defines an achieved reimbursement position.

To explain further, it is easy to assign a general reimbursement label like those listed in the box below. Unfortunately, such labels inadequately convey the complexity of a reimbursement position, especially when compared with the positions assigned to a product’s competitors.

Labels answering the questions posed in the right box below should inform how a customer applies patient cost and/or prescribing obstacles to the product, relative to the costs and obstacles assigned to competitive, or alternative, agents. Applying a range of colored symbols like the two used in our example report above may best reflect a scale between favorable or unfavorable reimbursement.

The components in this section summarize results of a systematic process, led by the account manager, to build a plan to maximize net revenue at each account.Presenting these results, using a GOST (goals, objectives, strategies, and tactics) format yields two outcomes.

Confirms that the requisite planning has been thoughtfully and consistently completed, and

Ensures future accountability to the plan and its objectives.

The purpose of payer-based marketing is to achieve reimbursement positions that maximize net revenue across all accounts. Towards this purpose, two possible goals could be pursued for a brand for each payer:

Payer-level performance reporting can directly influence strategic brand decisions and overall revenue impact.

Executive-level insights into trended share, reimbursement, and planning help identify which payers drive, or hinder, growth.

Structured frameworks like GOST ensure leadership teams hold account strategies accountable and focus on the most impactful opportunities.

Gain/maintain the best possible reimbursement positions, and

Drive sales given the reimbursement positions

The strategies and tactics one would employ to achieve Goal 1 are plainly different than those employed to achieve Goal 2. Given such differences, the first output of the planning process, reflected in this report, is to define how time or resources—focused on an account and on behalf of a brand—should be allocated between these two goals.

Time allocation is dependent on factors such as those displayed in the graphic below. Simply, a goal to gain or improve a formulary position should receive a larger allocation of time/resources (the arrow indicator should shift left) if a formulary decision is imminent, or a smaller allocation (the arrow should shift right) if a decision has just been finalized.

A goal is usually general. An objective is precise and meets five criteria: It is specific, measurable, achievable, relevant and timebound (“SMART”).

Given that performance must be measured for all key accounts, every account should have a measurable performance objective such as attaining a 32% market share for product X by the end of the fiscal year for example.

For those accounts in which a brand is also seeking a reimbursement position, an objective defining the desired position and the related decision date should be reflected in the report as well.

The report should also summarize the strategies that will be followed to achieve the objectives. Broadly, a strategy isan overall plan of action to achieve an objective. The grid below summarizes how a SWOT analysis, which should be prepared for each account and each brand, can transmute into strategies.

The grid displays four types of strategies generated via a SWOT. As shown, a strategy should have an external element (such as an opportunity), as well as an internal element (such as a strength). An S-O strategy, for instance, leverages a “strength” (like positive health economic data) to capitalize on an “opportunity” (such as customer’s expressed interest in such data).

Whereas there may be multiple strategies for an account, this report should reference the most important of these strategies.

A commitment to systematically prepare and deliver this performance-focused report can ensure that executive-level attention is focused on the most impactful payers and that account teams are held accountable to plans to drive performance.

Bill Barr is a principal at at Acuitas Analytics, a consultancy centered on payer-focused data management, reporting, and market access, while Eric Jen, PharmD, and Wendi LeVigne are the director of market access strategy and planning at Sandoz and president of Nexus Global Solutions respectively.

Articles

Payer-focused reporting should facilitate strategic benchmarking rather than merely identifying winners and losers. Executive-level reports must address payer performance and strategic planning to enhance brand objectives. Key components include assessing payer contribution to brand potential, trended share and impact analysis, and reimbursement positioning. Planning involves setting goals, defining objectives, and developing strategies using a GOST framework. A systematic approach ensures accountability and focuses on impactful payers. This methodology aids in maximizing net revenue and achieving optimal reimbursement positions across accounts.

Payer-level reporting should do more than track performance—it must guide strategy, focus resources, and drive measurable brand impact.