Case Studies / Payer Strategy / Reimbursement Planning

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Payer Strategy / Reimbursement Planning
REIMBURSEMENT STRATEGY
A small biotechnology company needed a forward-looking view of reimbursement trends in a niche, CMS-dominated therapeutic area. This information was required for a product formulation decision that would greatly impact stakeholder incentives (and thus projected sales). Aquest organized a mini advisory board of clinical thought leaders as well as reimbursement thought leaders for a series of challenging, forward-looking interviews that were used to calculate expected NPV’s of each formulation choice. In the end, the company ceased development of what had to that point been the lead formulation and replaced it with a more commercially viable alternative.
US LAUNCH PLANNING AND EU GO / NO-GO
A small biotech company with a novel phase 3 asset desired a full slate of market feedback across physicians and payers (in the US) and Health Technology Assessment entities (HTAs; in the EU5) to help guide launch planning. Aquest planned out and executed an aggressive series of 5 inter-related primary market research assessments in a 2 month period, including quantitative US demand studies focused on the impact of payer utilization controls on physician and patient behavior, and how this translates to share uptake. In addition, we conducted a qualitative EU assessment (executed in collaboration with Aquest’s UK affiliate) focused on answering the go/ no-go decision in Europe by benchmarking pricing and coverage expectations (for a set of analogs and the profile of interest) and quantifying how these would translate to a revenue projection. Armed with this data, the client was able to make an informed decision regarding further EU investment as well as prepare for a successful US launch.
MOCK P&T COMMITTEE
A large pharma company with a niche specialty product was facing a launch from a competitor expected to lead with a payer-focused strategy (based on cost-effectiveness). Aquest conducted a series of phone-web interviews with payers (pharmacy and medical directors at various sized plans) to mimic a real-world competitive selling situation. Messaging insights were generated that helped prepare all internal stakeholders for the competitive challenge.
PAYER/ THOUGHT LEADER VALUE PROPOSITION DEVELOPMENT
A small specialty pharmaceutical company commissioned Aquest to interview large payers (pharmacy/medical directors at managed care companies and PBMs), thought leaders, and community physicians on a Phase II product they were considering acquiring. Aquest conducted telephone interviews with representatives from each group and provided the client with a clearly written report that warned of key potential strategic pitfalls, particularly in light of nascent trends within the therapeutic category.
MARKET ACCESS / CLINICAL DEVELOPMENT STRATEGY
A public biotech company commissioned Aquest to help determine how to most efficiently develop a compelling payer case for a phase 2 asset in the context of the remaining clinical trial work. They were considering whether to integrate utilization management and pharmacoeconomic data collection in phase 2b/3 studies or whether to conduct a separate, phase 4 “real world” trial for this purpose. Aquest conducted interviews with internal and external stakeholders and used this guidance to develop a set of decision analysis criteria that balanced time to market, budget constraints, clinical and regulatory risk, and a rapidly changing competitive landscape.
REIMBURSEMENT STRATEGY
A small biotechnology company needed a forward-looking view of reimbursement trends in a niche, CMS-dominated therapeutic area. This information was required for a product formulation decision that would greatly impact stakeholder incentives (and thus projected sales). Aquest organized a mini advisory board of clinical thought leaders as well as reimbursement thought leaders for a series of challenging, forward-looking interviews that were used to calculate expected NPV’s of each formulation choice. In the end, the company ceased development of what had to that point been the lead formulation and replaced it with a more commercially viable alternative.
US LAUNCH PLANNING AND EU GO / NO-GO
A small biotech company with a novel phase 3 asset desired a full slate of market feedback across physicians and payers (in the US) and Health Technology Assessment entities (HTAs; in the EU5) to help guide launch planning. Aquest planned out and executed an aggressive series of 5 inter-related primary market research assessments in a 2 month period, including quantitative US demand studies focused on the impact of payer utilization controls on physician and patient behavior, and how this translates to share uptake. In addition, we conducted a qualitative EU assessment (executed in collaboration with Aquest’s UK affiliate) focused on answering the go/ no-go decision in Europe by benchmarking pricing and coverage expectations (for a set of analogs and the profile of interest) and quantifying how these would translate to a revenue projection. Armed with this data, the client was able to make an informed decision regarding further EU investment as well as prepare for a successful US launch.
MOCK P&T COMMITTEE
A large pharma company with a niche specialty product was facing a launch from a competitor expected to lead with a payer-focused strategy (based on cost-effectiveness). Aquest conducted a series of phone-web interviews with payers (pharmacy and medical directors at various sized plans) to mimic a real-world competitive selling situation. Messaging insights were generated that helped prepare all internal stakeholders for the competitive challenge.
PAYER/ THOUGHT LEADER VALUE PROPOSITION DEVELOPMENT
A small specialty pharmaceutical company commissioned Aquest to interview large payers (pharmacy/medical directors at managed care companies and PBMs), thought leaders, and community physicians on a Phase II product they were considering acquiring. Aquest conducted telephone interviews with representatives from each group and provided the client with a clearly written report that warned of key potential strategic pitfalls, particularly in light of nascent trends within the therapeutic category.
MARKET ACCESS / CLINICAL DEVELOPMENT STRATEGY
A public biotech company commissioned Aquest to help determine how to most efficiently develop a compelling payer case for a phase 2 asset in the context of the remaining clinical trial work. They were considering whether to integrate utilization management and pharmacoeconomic data collection in phase 2b/3 studies or whether to conduct a separate, phase 4 “real world” trial for this purpose. Aquest conducted interviews with internal and external stakeholders and used this guidance to develop a set of decision analysis criteria that balanced time to market, budget constraints, clinical and regulatory risk, and a rapidly changing competitive landscape.