SOURCE: Cutting Edge Information

Cutting Edge Information

September 15, 2015 12:32 ET

80% of Surveyed Companies Begin Talking to Payers Prior to Registration and Launch, According to Cutting Edge Information

RESEARCH TRIANGLE PARK, NC--(Marketwired - September 15, 2015) - Life science companies navigating US government payers' guidelines for reimbursement have found these tasks increasingly intricate, especially in light of recent guidelines under the Affordable Care Act. As Medicaid at the state level transitions to managed care on a larger scale, drug companies must react by tailoring their approach to meet those payers' specific needs. A major key to obtaining an optimal formulary position is to begin discussions with government payers early on in product development, according to a market intelligence report by pharmaceutical research firm Cutting Edge Information.

More than 80% of surveyed companies begin talking to payers about new products before registration and launch. Getting internal government reimbursement groups involved this early requires successful coordination with clinical development and R&D groups to ensure that the trials being run, especially crucial Phase 3 trials, are designed to address payers' top concerns. Developing this dialogue and making sure that trial designers understand the importance of addressing payer concerns are key aspects of a well-rounded government payer strategy.

Once companies collect Phase 3 data, managed markets account managers are responsible for keeping their products at the forefront of payers' minds -- via scheduled meetings throughout Phase 3 and Registration -- at the majority (57%) of surveyed companies in "US Government Reimbursement: Winning Key Formulary Positions and Managing Pricing Systems."

"HOL and MSL roles in the reimbursement process vary among companies. At 14% of surveyed organizations, the HOLs or MSLs take the lead in communicating with payers," said Jacob Presson, senior research analyst at Cutting Edge Information. "But even among companies that place the primary responsibility of payer communications onto other groups, there is a strong trend toward relying on health economics or scientific knowledge personnel to support payer relationships."

"US Government Drug Reimbursement" provides a roadmap for better navigating government drug reimbursement amidst the growing influence of the Affordable Care Act. The report, derived from primary resources and direct interviews, focuses exclusively on US government reimbursement strategies and trends, draws on quantitative and qualitative data from top-performing life science executives to provide actionable insights for winning and maintaining formulary position. Additional guidance outlined in the report includes:

  • Anticipating government payer needs and developing strong market access strategies
  • Managing payer relationships before and after product launches to maintain formulary position
  • Understanding compliant government reimbursement practices in the United States' new healthcare environment

To learn more about Cutting Edge Information and its research report offerings, please visit

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