Disease Management Programs – A Time to Revisit

The Pharma industry landscape has changed dramatically over the last 5+ years. Consider the patent cliff underway; a weak R&D pipeline for blockbuster drugs; spiraling costs on multiple fronts including R&D and managed market rebates; increasing regulatory scrutiny across sales and marketing, and last but not least healthcare reform.

Healthcare reform is the item on this list which potential provides the greatest concern for the industry’s current model of promoting and selling products.  Our healthcare reform act provides for the development of national healthcare data repositories which will capture diagnosis data, medical procedure data, prescription claims data, and lab values.  Additionally, this data will be available for healthcare entities to mine and analyze.  If a healthcare provider is compensated based upon patient outcomes and has a large comprehensive dataset for analysis at its disposal, would the provider prefer to use analysis of the data to development treatment best practices for various patient segments or would the provider prefer to leave the treatment best practices to the decision of the healthcare professional and the influences of sales and marketing?   At least in some instances already, the healthcare providers are already using their own data to drive shared best practices across their network.  Additioally, these two healthcare providers of large networks that have eliminated access by pharma sales reps and all multi-channel marketing to their employee healthcare professionals.

If this approach was adopted widely, traditional sales and marketing to healthcare professionals by pharma would be marginalized.  This is not likely to happen tomorrow but certainly possible if not likely in the future.

Pharma companies have a number of options to make themselves more relevant and an important part of the healthcare ecosystem.

One option would be to develop disease management programs, when implemented with its Branded drug, which would lead to such improved patient outcomes that even after the brand went generic healthcare professionals and payers would continue to prescribe and reimbursement the Brand.

At first pass, this sounds like a rather lofty goal.   Pharma has developed countless disease management programs over the last decade.  However, these programs have not delivered sufficient value as to make them sustainable nor drive brand sales post Brand loss of exclusivity.  There are a multitude of articles reviewing the limited to non-existent financial success of disease management programs.  Just one example of a review is linked below which initiated a host of activity in the disease management industry to substantiate the value of programs.(http://www.cbo.gov/ftpdocs/59xx/doc5909/10-13-DiseaseMngmnt.pdf)

To be clear, this “uber-disease management program”, which I am suggesting, would not be a masked “adherence program” but a comprehensive provider and patient support program.  For the next blog update, we will explore what the “uber-adherence” program might consist of and how various parties within the healthcare ecosystem would need to work together and the benefits for all parties.  Topics to be covered include:

• patient assessment for program inclusion driven by analytics to identify which patients need support, which patient’s behavior can be impacted, and tiered program support aligned with patient need
• required business partnerships between payer, providers, and Pharma as well as the potential value to each party
• data sharing requirements to enable real-time interaction with patients, providers, and plans
• market readiness/requirements to successfully execute, and
• “why” this time could be different for all parties..