• Aventria Health Group

Influence Specialty Drug Coverage for Rare Diseases With a Targeted Employer Engagement Strategy

Pharmaceutical market access vice presidents, executive directors, market access marketing, and brand leads:

A rare disease is defined as any disease, disorder, illness, or condition that affects fewer than 200,000 people. They are serious, progressively disabling, and can be life limiting and life threatening. The good news is that advances in drug therapy have helped patients with rare diseases improve their quality of life and potentially live longer. The bad news is the costs associated with these advancements. It is estimated that specialty medications account for 50% of the total US drug spend, even though only 1% to 2% of Americans take them.

Rare Diseases and Specialty Drug Costs—Top Priority for Employers

A recent Pharmacy Benefit Management Institute (PBMI) survey indicated that managing specialty drug cost trend is the number one goal for employers, followed by reducing inappropriate utilization. Most employers are using traditional benefit plan utilization management techniques. Common strategies include strict prior authorizations (PAs) to label, greater documentation to support authorization, cost sharing, and formulary exclusions. Untoward consequences can lead to high drug abandonment rates impacting employee productivity through increased absenteeism, disability, and medical costs.

Employers realize that new forward-looking solutions are needed to effectively manage costs and patient outcomes. A new value proposition is necessary when designing specialty drug benefits. This includes new financial risk models, health management strategies, and employee support resources specific to their condition. Opportunities exist for pharmaceutical companies to gain a seat at the table and participate in meaningful dialogue with progressive employers influencing benefit design and coverage.

Employer Influence Ecosystem—Prioritizing Employer Targets

Not all employer segments are created equal. Employer segments, influencers, and potential engagement targets have varying levels of influence. The following ecosystem provides a mapping depicting size, influence, and potential impact.

Presenting Aventria Health Group’s Business Planning Framework

Our proprietary PASS (Product Assessment Success Strategy) process provides a business planning framework based upon a “where to play/how to win” assessment. Aventria can help you gain a seat at the table with influential employers to engage in credible rare disease drug dialogue by:

  • Identifying employer engagement and influencer targets through an assessment of the ecosystem

  • Developing disease and specialty drug value proposition, credible communications, and promotional assets to support employer-enabled access for the commercial portfolio and future pipeline therapies

  • Building internal stakeholder understanding and support to enable employer engagement success

To learn more about Aventria’s PASS business planning framework and how we can help you influence specialty drug coverage with a targeted employer strategy, please reach out to:

Dave Dierk, Co-President, 30-year sales and marketing thought leader in pharmaceutical diagnostics, biomedical, long-term care, managed care, employer, and pharmacy communications, at dave.dierk@aventriahealth.com.

Paul G. Pochtar, RPh, 25+ years of experience in leading the successful commercialization of both primary care and specialty pharmaceuticals throughout their life cycle, including several landmark oncology products and other specialty therapeutics, at ppochtar@pinnaclehc.com.

Making a difference in patient care by helping patients, providers, and payers collaborate on shared priorities