Whether analyzing market implications for product licensing/acquisition, preparing for a drug launch, or managing a drug through maturity, DKP understands the information and strategic action needed to support your decisions. We inform, design, and execute strategies for what you know you need. However, more importantly, we identify what you “don’t know that you don’t know” and ensure you are prepared along that drug’s commercialization evolution.
Gain perspective on local delivery of healthcare
We get at healthcare access implications for patients. Our deep relationships with providers and payers generate qualitative market research perspectives on market dynamics that will inform your strategies. These perspectives, in concert with data analysis, build actionable reimbursement and access initiatives.
Understand the landscape in which your product is or will be managed
When preparing for market commercialization, you need to understand and anticipate how payers will respond to your clinical data and pricing structure. A detailed landscape analysis will inform those market readiness plans and ultimately support product uptake expectations. By capturing payer coverage, coding, utilization management methodologies, and patient points of access for comparator or competitive agents, DKP paints the picture of the market into which you will enter. From this information, you can prioritize your targets to ensure efficient utilization of time and effort during the launch process.
Gain perspectives on clinical, economic, and resource needs from important healthcare stakeholders
DKP has built a strong panel of advisors to serve as a valuable gauge of market change and distinct clinical and economic needs. The advisor panel includes employers, payers (medical and pharmacy decision makers), and providers (encompassing roles such as physicians, pharmacists, practice administrators, and financial counselors). DKP’s access to these decision makers through DKP SnapShot Surveys®, one-on-one blinded qualitative interviews, and live advisory board forums can build your market knowledge of what to expect for a new product launch and through ongoing product commercialization. Tailor the process to meet your corporate objectives, including focus on a variety of topics such as:
- Initial drug coverage and access decisions from both provider and payer at launch
- Integration and management of diagnostics with targeted therapies
- Patient support program needs and design testing
- Impact of market changes on an oncology practice business model and patient treatment decisions
- Employer evolution in oncology oversight and management
Determine clinical considerations to support your product at launch and beyond
Do you understand the role that clinical compendia play in payer drug coverage decisions? Can you anticipate how your drug will be integrated in oncology pathways, whether generated by pathway vendors, payers, or providers? DKP documents the answers to these questions and more specific to the interpretation and application of your product’s clinical data. Collaborating with your Medical Affairs staff, DKP excels at creating the vital messages to support both compendia and pathway clinical review of your product’s data.
Create launch strategies that work
Designing the right market entry strategies is only one part of the important steps that DKP executes. We also collaborate through the launch phase, helping implement actions directly with payers and providers to increase your efficiencies in achieving your goals and objectives. Learn more about our turnkey launch processes for both oral and physician-administered drugs and biologics, with specific specialization in oncology and rare diseases.
Thus, the DKP Lifecycle Solutions™ team is ready to inform and engage, with the mantra of “the right expertise and actions, no matter what the drug phase.”
Product Development Services
Will reimbursement affect a patient’s ability to access your product?
The reimbursement environment continues to change across payer types and treatment settings. DKP analyses are specific to your market, your products, and your technologies. We provide an analysis of coverage, coding, payment, and how patients would access therapy – from the payer and the provider perspective. Starting with an in-depth market benchmark landscape assessment, you can then measure change in the market. Periodic additional analyses lend perspective on new challenges and opportunities related to product positioning and patient access.
Although the clinical profile for an in-licensing candidate looks promising, do you understand the current reimbursement “space” in which the product will be marketed?
A new in-licensing opportunity may have clear clinical merits, but understanding the reimbursement environment is another key to a successful product. The DKP Lifecycle Solutions™ team approaches your candidate with a full-on analysis of the various factors affecting coverage, coding, and payment within the new product’s target market(s). This provides you a real-world perspective at the point of patient connection rather than just a view from 30,000 feet above the market. This information can then inform your decision on a “go” or “no-go” decision as to how the product will truly affect your organization.
Clinical Compendia Assessments
Do you need to understand how clinical drug compendia affect payer decision making for drugs and biologicals? Do you have a strategy in place to ensure that the compendia acknowledge your product and subsequently support payer coverage and access decisions?
Our clinical compendia services are derived from internal expertise having worked at and with each clinical compendium organization. DKP can provide information on the major compendia used by CMS and commercial payers, including review processes, preferred data sources, and contacts to help you decide whether to submit a request for review of clinical data for your product. Prior to building a compendia strategy, DKP prepares a perspective on competitors or comparators in one or more disease states/tumor types/conditions to identify how your data may be reviewed by any one of the clinical compendia and whether additional data analysis is warranted to support effective compendia positioning.
Our compendia assessments pull clinical data into the overall reimbursement strategy and identify the right approach for your compendia strategy.
Clinical Pathway and Oncology Management System Research
Do you need to understand how clinical pathways have been evolving as one of the primary means by which payers control drug utilization in oncology? Or how they are also used by healthcare providers as a means of documenting evidence-based care?
The DKP team has an ongoing, multiyear project that captures in-depth trending information to understand changing oncology management initiatives with clinical pathway vendors, payers, and providers. The DKP Lifecycle Solutions™ team applies a multi-pronged strategy to understand 1) the role that pathway vendors play in both provider and payer pathway programs and 2) based on what vendors are offering, what do payers buy, what do providers prefer to use, and who is really in the driver’s seat?
DKP also gathers insights on other oncology management models that are unfolding, such as medical homes, episode of care, oncology ACOs, and the use of oncology benefit management services.
- Landscape Assessments
Qualitative Interviews and Advisory Boards
What are payers thinking about your product, or how are they approaching the overall treatment of your product’s target disease? Are they planning to apply utilization management techniques such as prior authorization, increased patient cost share, or even non-coverage parameters?
DKP’s services can link clients with the right mix of influential decision makers to help guide development of clinical trials, market messages, and product positioning within payers. Whether via interactive web conferences or live meetings, we develop the right forum to get clients the needed input.
Quantitative Market Research
Do you need quick answers to pressing strategic questions such as physician dispensing practices, patient assistance program best practices, or use of clinical pathways?
The DKP SnapShot Survey® can get your questions answered within weeks. We have a standing panel of physicians, practice administrators, and payers that respond to short surveys quickly. This means you obtain important insights in a very timely fashion, to inform your ongoing strategies and ensure that your initiatives meet the needs of payers to support patient access to care.
Product SWOT and Value Message Development
Do you understand the internal and external factors that will affect the usage of your product? Do you know how to appropriately position your product from a reimbursement standpoint?
DKP’s team of seasoned consultants helps our clients to take a critical look at a product’s strengths and weaknesses, opportunities and threats. We then parlay that information into fine-tuned value messaging for targeted stakeholders so that reimbursement obstacles are minimized.
Patient Cost Share Analyses
Are you trying to determine a patient’s cost share responsibility versus a competitor? Or do you need to understand forecasting needs for patient assistance or copay program funding?
DKP provides a highly analytical tool for clients seeking to understand the patient cost share exposure across all relevant payer types for a specific disease. Utilizing a highly analytical tool, DKP’s experienced team can:
- Calculate the hypothetical price point against medical and pharmacy benefit structures to identify the patient cost-share for various payer types, and
- Assess the total cost share risk across the estimated payer mix for a disease and the patient cost share based on the hypothetical price point.
For the various payers under which cost share scenarios will be analyzed, DKP will conduct a high level review of published information in order to gain insight into the patient share of cost for a given drug under both the medical and pharmacy benefit.
Strategic Payer Market Monitoring
Are you interested in how payer decisions will affect patient access to care? How Managed Medicaid is evolving across the US? Who is utilizing clinical pathways and how?
DKP PayerScope® monitoring services track coverage, coding, and payment of drugs and biologicals under Medicare, Medicaid, and commercial payers. Besides obtaining policies, formularies, prior authorizations, etc., DKP captures other important information. This includes specialty pharmacy program requirements, payers’ use of oncology benefit management companies, and payer clinical pathway program use. We know which payers are utilizing which clinical pathways so that our clients understand exactly what they are dealing with and plan accordingly.
Health Policy/ACA Monitoring
What are the major health reform initiatives impacting oncology? How are QHPs evolving across the U.S.?
DKP tracks some of the more notable healthcare initiatives to identify how change will affect client products and services. We track oncology Patient Centered Medical Home and Accountable Care Organization evolution so that our clients know what they are facing in the future. We are the eyes and ears for the client so that they can spend more time carrying out their initiatives.
- Qualitative Interviews and Advisory Boards
Drug and Procedure Code Applications
Do you want to make sure that you get the right codes so that your product receives appropriate payment?
The reimbursement process for new pharmaceuticals and technologies entering the market involves three components: coverage, coding, and payment. As one of the components, coding requires a clear plan of action regarding whether a HCPCS, ICD-9, or CPT code is required. Each coding application comes with distinctly different requirements and timelines. We successfully execute the application steps to significantly streamline provider reimbursement for drugs, biologics, devices, and services.
Reimbursement Resource Design
Do you need an expert to make sure that the complexities and nuances of reimbursement are communicated clearly to ensure access to your product or technology?
DKP has demonstrated expertise in creating content and designing formats for educational programs or customized programs such as:
- Inpatient documentation resource
- Billing and coding guides
- Physician office or hospital outpatient sample claim forms
- Sample letter of medical necessity
- Sample prior authorization documentation form
Payer Targeting and Communications
Do you understand all of the factors that may affect the utilization of your drug? Which factors will affect which payers and how they ultimately position your product?
Many factors affect how a payer will approach coverage and ongoing utilization oversight, such as:
- The category/class of the drug, biologic, device or service
- Mode of administration or use
- The payer system itself (commercial, government)
- Geographic exposure (national plan vs. local plan)
- Technology price
- Benefit design objectives
- Regulatory mandates
- Employer interface and expectations
Integrating consideration of these and other factors, we develop tailored strategies to effectively position your product, technology, or service among different payers. This includes a possible national strategy to identify your objectives and goals with payers in a general sense, as well as local implementation strategies and pull-through tactics to address the nuances of local healthcare delivery.
Do you want to enhance uptake of your product by getting the right information to the right people quickly?
Upon FDA approval, an effective launch strategy can include sending clinical and economic information to payers to aid in the development of coverage decisions. We maintain a current database of target payers for mailing and emailing, including Medicare, Medicaid, and key commercial payer organizations.
Do you have an issue, such as an incorrect listing of a code, with a particular payer? Is your product not showing up on the NOC list?
DKP’s reimbursement consultants can help you with both government and commercial payer access to help resolve issues that may be preventing patient access to your drug. DKP often works with CMS, MACs, and Medicaid agencies as well as commercial payers, Medicare Advantage, and Medicare Part D plans as an intermediary to affect change when needed.
Medicare, Medicaid and Commercial Plan Monitoring
Do you need up-to-date information on how payers are handling your product?
Our DKP PayerScope® team monitors targeted payers to quickly identify issues and their impact on our clients’ products. Our team is skilled at identifying emerging issues and recognizing their potential impact on our clients’ products. When we see new opportunities or possible risks, we promptly inform our clients and provide recommended actions via our DKP e-Alerts®.
In addition, our clients often want to understand their competitive environment, whether that includes other treatment interventions or no treatment at all. The experienced DKP staff helps connect the dots on what constitutes your competitive profile. We integrate the reimbursement perspective to track how payers are structured (payer profiles), how they position the competition, and how providers are responding to the reimbursement environment.
Sales/National Account Manager/Executive Reimbursement Training
Are you looking for someone with reimbursement expertise to train your company on the basics of reimbursement or specific issues that affect the reimbursement of your product?
Reimbursment is what we do at DK Pierce. We know it. We can teach it. To keep your company on the cutting edge of the healthcare marketplace, internal education on the changing reimbursement environment is important. We develop training programs for all levels within your company, from field sales staff to National Account Managers to executives. The training sessions build core competencies and demonstrate the importance of appropriate reimbursement for market success.
Coverage and Development Outreach Gap Fill
Do you need additional assistance as your company prepares for a new drug launch or the expansion of current FDA indications? Have new codes been issued to describe your technology or service?
Our expertise in working directly with Medicare, Medicaid, and commercial payers across the U.S. qualifies us to provide services to meet your needs, precluding the need to hire additional field-based personnel. Based on our access to a variety of payers, we can quickly request the change and monitor the payer’s actions to affect change.
Payer Meeting/Agenda Calendars
Would you like to know when important meetings are taking place so that your company can be represented when necessary?
DK Pierce tracks and provides reports for clients on all Medicare meetings such as Medicare draft open meetings, as well as Medicaid open public meetings (Pharmacy and Therapeutics Committee and Drug Utilization Review Meetings). This service is tailored specifically to each client based on the products and drug classes relevant to them. Notifications of relevant meetings are sent to the client via monthly reports or DKP e-Alerts® (for time sensitive information).
- Drug and Procedure Code Applications
Product Trend Analyses
Do you need to better understand how your product is doing versus the competition? Do you have a new indication or product extension on the horizon?
By analyzing comparators, historical trends in payer perspectives on new indications, formulations, etc., we can help our clients better understand the factors that are driving product usage (or lack thereof) and the important clinical data and messages that should be part of an expansion strategy.
Health Policy Research and Analysis
Do you understand the market changes coming down the pipeline that may affect reimbursement of your product?
DKP can help companies understand the implications that health policy may have on your product. Whether bundled payment systems or biosimilar competition, DKP can help you to develop reimbursement strategies to better position your product for the long term.
- Product Trend Analyses
We'd love to help you. Give us a call at (317) 873-0303.
"The services DK Pierce offers are individualized to the needs of their customer."