Project Highlights

Specialty Pharmacy: Building a Managed Care Infrastructure

Situation

The company acquired a specialty product that was available for 3 years, but never marketed to commercial or government payers. The product had poor formulary coverage and patients had to pay $2,000 per course of therapy.

Plan of Action

Reimbursement Intelligence created a managed care presentation that educated Managed Care Pharmacy Directors on the condition and treatment options and healthcare cost offsets as a result of product use.

Reimbursement Intelligence also deployed a small Contract sales force with experts in Managed Care Account Management. This Account Management team focused on plans with over 500,000 covered lives where the product was non-formulary.

Results

In a period of 4 months, the RI team gained formulary coverage for more than 7MM covered lives, reducing the patients out of pocket costs from $2,000 to $200.

These results positioned the company for continued growth and access to product for their patient targets.