DKP PayerScope® Market Monitoring

DKP PayerScope® market monitoring provides high-touch, in-depth custom-designed monitoring services and reports based on each client’s specific needs, providing not only the “in the weeds” details of payer coverage and access for their product to support field reimbursement awareness, but also top-line analytics to support upward reporting to senior leadership.

Our PayerScope team is the “eyes and ears” of the reimbursement environment, constantly tracking and reporting on this ever-changing market. We monitor across different payer types including local Medicare MACs (Medicare Administrative Contractors), Medicare Advantage and Prescription Drug Plans (PDPs), fee-for-service Medicaid, managed Medicaid, and commercial payers, and across the medical and pharmacy benefits to understand the implications for new and current product assets. Our services focus on identifying and communicating coverage and access updates which often uncover issues that provide our clients with opportunities to engage directly with payers.

  • New Drug Uptake Tracker
    • When preparing for market commercialization, having insight into the payer uptake of a comparator product can provide an up-to-date picture of payer new drug uptake timing and coverage processes. Whether oral or IV formulation, DKP PayerScope® services will track and measure a targeted new product entering the market and provide you with the evolving access perspective over a set time period. Findings can include such variables as early drug access options, time to formal coverage, parity to prior authorization criteria, and linkage to product label as just a few of the possibilities. This information can help inform market access strategies, support forecasting needs, and better prepare you for your own product’s pending launch process.

      Reporting is set at your preferred frequency, and report formats that can include graphic map analysis, PowerPoint presentations, and/or Excel reports with detailed findings.

      Uptake tracking can occur with any or all of the following payers, based on the target markets you look to be influenced by:

    • Medicare
      • Fee-for-service Medicare Administrative Contractors
        • LCDs, drug coverage requirements
      • Medicare Advantage and Part D plans
        • Coverage policies
        • Drug and service coding
        • Utilization management criteria
    • Medicaid
      • Fee-for-service agencies
        • Coverage, coding, payment and access
        • Preferred drug lists, injectable drug lists
        • Formularies
      • Managed Medicaid plans
        • Coverage, coding and access
        • Formularies and utilization management criteria
    • Managed Care
      • Commercial plans
        • Medical and pharmacy coverage, coding and utilization management criteria
  • Market Benchmark Perspective
    • DKP PayerScope® services can build a “snapshot in time” of what the payer coverage environment looks like for one or more products to help inform your market commercialization strategy. Selecting specific market examples of comparator IV or oral formulation drugs/biologicals, DKP PayerScope sets out to capture information on formal coverage policies, formulary positioning, prior authorization criteria, quantity limits, specialty pharmacy programs, and more. With this information, you gain insights into different benefit designs, and the market similarities and differences you may face upon FDA approval for the following payer types:

    • Medicare
      • Fee-for-service Medicare Administrative Contractors
        • LCDs, drug coverage requirements
      • Medicare Advantage and Part D plans
        • Coverage policies
        • Drug and service coding
        • Utilization management criteria
    • Medicaid
      • Fee-for-service agencies
        • Coverage, coding, payment and access
        • Preferred drug lists, injectable drug lists
        • Formularies
      • Managed Medicaid plans
        • Coverage, coding and access
        • Formularies and utilization management criteria
    • Managed Care
      • Commercial plans
        • Medical and pharmacy coverage, coding and utilization management criteria
  • Policy Perspectives Tracker
    • DKP PayerScope® services keep you connected to the evolution in regulatory and policy changes. Whether looking at CMS regulatory communications (proposed and final rules, key initiatives, important transmittals, and trends in drug and biological management) or Government Accounting Office (GAO) and Office of Inspector General (OIG) reports, we keep you abreast of changes in a timely manner. Additionally, DKP PayerScope provides ongoing tracking of healthcare reform implementation and evolution, including Medicaid expansion benefit changes, Qualified Health Plan insights under the Affordable Care Act, and much more.

      Time sensitive information is sent to you via DKP e-Alert® communications, with subsequent summary reports built in a format and timing that works for you.

    • Managed Care
      • GAO and OIG reviews/reports
      • CMS regulatory communications
      • Healthcare reform tracking
  • Launch Monitor
    • Out of the gate upon FDA approval, you want to know when payers incrementally make decisions about your new drug/biological, related to coverage, coding, utilization management, and access. The DKP PayerScope® team, through our Launch Monitor™ capabilities, applies high touch monitoring of payers during the launch period, checking payer websites consistently to capture your drug’s access prior to and after full review, prior authorization criteria in relation to label, utilization management such as quantity limits (whether oral or IV), and many other key factors. Tracking P&T meetings and ongoing payer communications on your drug specifically, any competitor, and the drug class in general, will keep you in touch with market access impact.

      Launch Monitor findings can include different reporting opportunities. Whether comparing your product to other treatment options and conducting parity analysis, or demonstrating time to uptake, there are different ways to look at the findings and provide you with valuable information.

      All findings are communicated to you via DKP e-Alert®, with implications of changing position as they occur. Cumulative findings with analytics then can serve to provide broad perspectives on where your product sits at any given time and provide visual uptake progress over time.

      All policy, utilization management, and other findings are captured in our proprietary DKP Compass™ database, to generate real-time and tailored reports on your product’s status, which you access through a customized, password-protected portal.

    • Medicare
      • Fee-for-service Medicare Administrative Contractors
        • LCDs, drug coverage requirements
        • Coding updates
        • Contractor evolution
        • Provider communications
        • Open meetings
      • Medicare Advantage and Part D plans
        • Coverage policies
        • Drug and service coding
        • Utilization management criteria
        • Specialty pharmacy and points of access
        • Regulatory communications
    • Medicaid
      • Fee-for-service agencies
        • Coverage, coding, payment and access
        • Preferred drug lists, injectable drug lists
        • Formularies
        • State regulatory interpretations
      • Managed Medicaid plans
        • Coverage, coding and access
        • Formularies and utilization management criteria
    • Managed Care
      • Commercial plans
        • Medical and pharmacy coverage, coding and utilization management criteria
        • Specialty pharmacy programs
        • Compendia and publication influence
        • Qualified Health Plan benefit structure
  • The Market Monitor™
    • Once your product has been established with payers, it remains integral to stay on top of any movement in coverage, coding, and access changes that may affect patient access and your ongoing strategic planning process.

      DKP PayerScope® services conduct The Market Monitor™ activities to keep track of payer change, provider communications, utilization management updates, etc.

      The Market Monitor findings can include different reporting opportunities. Whether comparing your product to other treatment options and conducting parity analysis, or simply denoting when policies change for your product, there are different ways to look at the findings and provide you with valuable information.

      All findings are communicated to you via DKP e-Alert®, with implications of changing position when appropriate. Cumulative findings with analytics then can serve to provide broad perspectives on where your product sits at any given time and show change over time.

      All policy, utilization management, and other findings are captured in our proprietary DKP Compass™ database, to generate real-time and tailored reports on your product’s status, which you access through a customized, password-protected portal.

    • Medicare
      • Fee-for-service Medicare Administrative Contractors
        • LCDs, drug coverage requirements
        • Coding updates
        • Contractor evolution
        • Provider communications
        • Open meetings
      • Medicare Advantage and Part D plans
        • Coverage policies
        • Drug and service coding
        • Utilization management criteria
        • Specialty pharmacy and points of access
        • Regulatory communications
    • Medicaid
      • Fee-for-service agencies
        • Coverage, coding, payment and access
        • Preferred drug lists, injectable drug lists
        • Formularies
        • State regulatory interpretations
      • Managed Medicaid plans
        • Coverage, coding and access
        • Formularies and utilization management criteria
    • Managed Care
      • Commercial plans
        • Medical and pharmacy coverage, coding and utilization management criteria
        • Specialty pharmacy programs
        • Compendia and publication influence
        • Qualified Health Plan benefit structure
  • Clinical Insights Tracker

    Payers utilize clinical compendia and health technology assessments (HTAs) in their decision making for drugs and biologicals. Therefore, it is valuable for brand management, market access, and medical affairs to understand the changes over time in decisions made by compendia such as Micromedex® DRUGDEX® and NCCN Drugs & Biologics Compendium (NCCN Compendium®) and HTAs such as ECRI Institute and Hayes.

    DKP PayerScope® services track changes and report to you when monographs or reports are updated for your product(s) or product comparators and competitors. Reporting via DKP e-Alert®, we send time-sensitive information to you for action and then follow up with summary reporting. These findings help you develop ongoing clinical communication strategies and identify how payers may apply the information derived from compendia and HTAs.

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"Though DKP has a number of clients, I always feel that if an issue or question arises, I can reach out via email or phone to get the help I need."

Associate Director, Market Access & Reimbursement
Pharmaceutical Company