How to Survive in Pharma's Payer-Empowered World

Posted by Ed Schoonveld on Fri, Feb 15, 2019

This blog post was originally published on ZS's pricing and access blog, The Price of Global Health.

Until recently, commercial success for a prescription drug mainly involved getting the drug on payer formulary and creating pull-through with sales force efforts toward physicians. Success was defined as securing full, unrestricted access and building significant share through share of voice. The rapidly rising cost of healthcare, new emerging pharmaceutical technologies with breakthrough potential, public concerns over drug pricing, and a gradual shift from fee-for-service to value-based payment models are transforming the pharmaceutical market. Today’s market is much more complicated, as public and private payer management is more restrictive, medical communities are more willing to engage in value vs. cost trade-offs, and providers are taking a more holistic and integrated healthcare delivery focus.


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IDNs are Gaining Control Over Doctors' Prescription Pads and Pharma Should Take Note

Posted by Joe Stevens on Mon, Sep 10, 2018

Paul Darling co-authored this blog post with Joe Stevens.

Integrated delivery networks represent a growing percentage of pharmaceutical companies’ customer bases and, while they’re a heterogeneous target audience, their goals are relatively homogenous. My colleague Paul Darling and I covered this point in our previous post, but in a nutshell, our research has found that there are four common goals that can serve as conduits for manufacturers and suppliers to align effectively with their IDN partners: providing high-quality care and improving patient outcomes, reducing the cost of care delivery, boosting revenue, and improving the patient experience and satisfaction. IDNs also are interested in a common approach to achieving those goals: standardizing systems and processes across their various sites of care.


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Transitioning Pharma to Value-Based Payments Will Require More Than Corporate Collaboration

Posted by Paul Darling on Tue, Mar 01, 2016

Healthcare reimbursement in the U.S. is undergoing a fundamental transformation. The Center for Medicare & Medicaid Services has led this transformation, announcing that 50% of all Medicare payments will shift from fee-for-service to alternative payment models by 2018. Pharmaceuticals have been entirely omitted from these plans, as Medicare is legislatively prevented from negotiating drug prices. Hence, manufacturers and private payers are expected to play a dominant role in determining payment models that reimburse pharmaceutical manufactures for value in the form of patient outcomes, rather than the pills, themselves.


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