Managed Care

Managed healthcare in the U.S. has never been more complex. Cost-shifting to patients, increasing copay-tier levels, rising co-insurance, government reforms, and the influx of generic and the over-the-counter (OTC) competition are just some of the leading drivers to this ever-evolving environment. Likewise, managed care influence on manufacturers’ commercial performance is increasingly significant. More than four out of five U.S. prescriptions are covered by a private or government third party. And, three out of five patients receiving healthcare services get them through third-party payers.

It is essential to understand these managed care market dynamics and influences when developing and refining product strategy. G & S Research helps you stay informed of the evolving landscape and understands the implications on your business. We work with you to identify the drivers and barriers that impact formulary access and to understand optimal product positioning with key managed care decision-makers. This enables you to better realize the commercial potential of your brand or portfolio.

Services

G & S Research’s managed care-related services are applicable to all stages of the product lifecycle: product development, launch, growth, maturity, and pre-patent expiry. Likewise, our market research addresses a full range of research and business objectives, including:

Formulary/ Access Strategy

• Determine the value proposition for your brand that best resonates with key payer groups, including Medicare and Medicaid
• Demonstrate the therapeutic and pharmacoeconomic value of your product
• Uncover drivers of payer sensitivity to better demonstrate brand value
• Test product profiles and pricing strategies to determine contracting strategy and desired tier placement
• Identify product offerings beyond price concessions to help secure preferred formulary status when it makes economic sense
• Where product is not preferred, investigate programs such as patient couponing to reimburse copays
• Develop strategies to optimize access when your brand is restricted (e.g., prior authorizations, step edits)

Market Evaluation

• Assess market demographics, payer mix, and reimbursement of existing products
• Understand how your therapeutic class is perceived by payers, including unmet needs in the class and desired new product attributes
• Assess the impact of impending regulatory and legislative initiatives

Physician Perspectives on Managed Care

• Determine how formulary status and restrictions, such as prior authorization, influence prescribing
• Understand what product messages motivate physicians to write a non-preferred product

Patient Perspectives on Managed Care

• Uncover managed care’s influence on patients, including patients’ ability to pay for prescriptions, motivation to switch to a generic or OTC, and receptivity to coupons
• Assess why patients will pay more out-of-pocket for certain drugs and who and what influences these decisions

Stakeholders

Our research professionals have significant experience and keenly understand the many stakeholder groups in the managed healthcare market space. These include:

• Healthcare Maintenance, Preferred Provider, and Point-of-Service Organizations
• Pharmacy Benefit Managers
• Hospitals and Medical Facilities
• Integrated Health Systems/ Group Purchasing Organizations
• Medicare
• Medicare Advantage
• Medicaid
• Veteran’s Affairs/ Department of Defense
• Pharmacy, Trade, and Wholesalers
• Assisted Living Facilities/ Long-Term Care
• Employers and Employer Coalitions
• Physicians
• Pharmacists
• Patients

Exceptional Research Design and Execution

Of all the constituents in healthcare today, managed care professionals are among the most challenging to reach for market research. G & S Research has a proven track record of successfully recruiting key pharmacy and medical directors from top national and regional health plans, PBMs, Medicare, and Medicaid. We understand what it takes to not only reach these influential stakeholders, but to design research that is targeted towards the unique needs of the payer environment.

And whether the research involves payers directly or addresses the managed care influence on physicians, pharmacists, and patients, G & S Research custom designs each research engagement so it efficiently and effectively addresses your specific business information needs. The combination of exceptional project leadership, 100% custom research, steadfast focus on project outcomes, and in-depth knowledge of the managed markets environment equates to winning outcomes for our clients, time and time again.