COVID-19 led to the cancellation of in-person meetings and conferences where pharmaceutical manufacturers connect with payers. Precision’s Andrew Cournoyer discusses our research results on the effects of the shift to virtual negotiations between pharma and payers, and the challenges they face going forward.
Virtual Pharma-Payer Negotiations May Require More Persistence in COVID-19 Era
As the COVID-19 pandemic took hold, pharmaceutical manufacturers seeking market access were faced with the cancellation of multiple in-person meetings where they typically can connect with payers. This has led to a widespread shift to web meetings and phone negotiations, both of which may pose some challenges for pharma manufacturers, particularly those that aren’t well-connected to payers already.
“For the bigger manufacturers, there’s really not going to be a difference,” says Michael Schneider, a principal at Avalere who works with life sciences companies to help them develop and implement market access strategies. He notes that he’s had conversations with three large manufacturers within the last month, and all said negotiations are progressing much as they did pre-pandemic, although they have moved to Zoom, WebEx or phone. “I heard the same exact thing from the PBM side too. It’s kind of business as usual — it’s just that we’re not traveling or meeting face-to-face.”
But for medium and smaller manufacturers that are bringing new products to market, the challenges may be somewhat more complex, Schneider says: “It’s easier to get in front of somebody when you can go somewhere and meet them in person.”
Andrew Cournoyer, R.Ph., vice president and director, access experience team, PRECISIONvalue, has looked into how contacts and meetings are being conducted during the pandemic.
“Based on our initial research, which consisted of payer interviews and an app-based survey, all payer-to-pharma negotiations and engagements are happening through a virtual format,” he says. “Traditional webinar-based formats are most common and often utilize well-known virtual platforms such as Zoom, Skype and Microsoft Teams. Direct emails and telephone calls are preferred methods for outreach — these are typically utilized to establish initial contact and set agendas and dates of actual web-based meetings.”
Cournoyer adds: “Many payers appear to be well-equipped in adopting a fully virtual platform for engaging with pharma.”
Overall, the current process of virtual negotiation is working reasonably well, says Mesfin Tegenu, R.Ph., president of PBM PerformRx. “In the age of COVID-19, negotiations as well as conducting a variety of business discussions with pharmaceutical companies has continued virtually via Zoom and conference calls,” he says, adding, “the technology effectively supports clinical and financial data exchange flows to conduct negotiations.”
Still, both sides — particularly the pharma side — need to adapt to changes in the process, insiders say.
Before the pandemic, initial meetups between pharma and payer representatives commonly occurred at big conferences, such as industry gatherings held by the Pharmaceutical Care Management Association (PCMA). Since higher-level staff members from both pharma and PBMs attend those conferences, “sometimes it’s easier to grab a face-to-face meeting with one of the PBM trade negotiators at a meeting like that. And those meetings just have not happened,” Schneider says.
Medium and smaller manufacturers don’t necessarily have well-established relationships with larger national payers, and that makes it more difficult for them to get access when they can’t arrange a brief sit-down at one of these conferences, he says.
Ultimately, “I think you’re going to have a bifurcation: The big manufacturers are probably not going to have a lot of issues getting in front of the payers and continuing on with their negotiations. I think who potentially could have some issues is smaller to mid-sized manufacturers who don’t have a relationship already.”
Cournoyer agrees. “Stay-at-home orders and quarantine measures resulting from COVID-19 started just as pharmaceutical manufacturers and payers were to enter into conference season.” That included major meetings such as the sPCMA Business Forum 2020, which had been slated for mid-March in Orlando, Fla.; the Academy of Managed Care Pharmacy’s annual meeting, which had been planned for late April in Houston; and the Asembia Specialty Pharmacy Summit, which had been scheduled for early May in Las Vegas.
“These conferences are critical for networking and having face-to-face meetings between pharma and payers,” says Cournoyer. “In the absence of these important meetings, pharmaceutical manufacturers had to scramble to get meetings on the books with their payer clients,” which in turn created scheduling bottlenecks and impacted the ability to have follow-up conversations, he says. “Challenges vary, but one common theme is scheduling.”
Another challenge that was raised in PRECISIONvalue’s research on this topic involved “inconsistencies among manufacturers initiating proactive outreach to disseminate drug information,” Cournoyer says. “Payer respondents in our research noted that they had interest in recent drug updates and, specifically, updates regarding pharma actions resulting from the pandemic. A key takeaway that we clearly identified was a strong need for pharmaceutical manufacturers to continue proactive outreach through multiple communication channels, even if they ran into roadblocks with scheduling. Payers were and are seeking information.”
Schneider urges manufacturers — particularly small to mid-sized ones, who may be operating on smaller budgets — to emphasize proactive contacts with payers, even though it becomes, in his words, “a lot of begging” at times. “Say, ‘Hey, I just need a half-hour of your time to talk about this. Can we have our clinical teams present to your clinical teams?’”
In fact, when Schneider worked at CVS Caremark negotiating on Medicare Part D, he says that “it was always tougher for the smaller to mid-sized manufacturers to get in front of me in my trade director role. But I always tried to go out of my way to make sure I was always hearing what they had to say. But I can’t say that everybody was as open to working with the small to mid-sized manufacturers as I was.”
Task Account Executives With Contacts
Pharmaceutical manufacturers should have account executives conduct direct, personal outreach to their payer contacts, Cournoyer says. “In some instances, there may be multiple contacts at a payer who can meet with pharma.”
If a pharma manufacturer doesn’t already employ account executives with existing payer relationships, the company should hire them, Schneider adds.
“With what’s going on in the industry, even before COVID, there are always account managers out there who have relationships with these bigger payers,” he says. “So it’s probably best for you to go out and grab somebody who has an established relationship with CVS Caremark or OptumRx or Humana or Express Scripts. I think the relationship aspect is going to be more important for the medium- and smaller-size manufacturers, because somebody could always use their relationship to get that meeting with the trade director or to do the negotiation from the financial side or to be able to get in front of the clinical team to present clinical data.”
Still, the COVID-19 pandemic may make it easier in some ways to get ahold of payer representatives, since no organizations are authorizing travel right now, Schneider says. “I always advise people to figure out who the admins are and to go through the admins. They control the calendars. Sometimes that’s the best way to get in front of some people, particularly at the bigger PBMs.”
Take Advantage of Relationships
In fact, “going to anybody you know within the [payer] organization” potentially can help a pharma representative schedule a call or a virtual meeting with the payer, Schneider says. Or “if there’s another account manager you don’t necessarily compete with, sometimes an email from somebody who has a relationship can say, ‘Hey, can you talk to so-and-so at this manufacturer, they’ve been reaching out to you. I know your time is busy, but they’re a good person.’ Sometimes calling in favors like that can work, too.”
Although much of this advice applies in a nonpandemic world, it applies more in the new COVID-19 world, he says.
In addition, what Cournoyer terms “a keen understanding of payer priorities” is necessary. “Understanding the priority can help to ensure a meaningful engagement and avoid extraneous information that may not be of interest at this time.”
Finally, Cournoyer says, it’s critical to have proactive follow-up. “Much of this can happen through email channels, as follow-up web-based meetings may not be feasible due to scheduling obstacles.”
Pharma manufacturers will have different strategies for virtual meetings, depending on whether they’re presenting to the payer’s clinical side or to the financial side, Schneider says. It’s key to know who’s on the call or in the virtual meeting, he notes.
“If it’s the trade team — the financial team — you’re always going to want to talk pretty quickly on contracting strategy and any discounts you’re willing to provide, do you have a contracting strategy, which is the financial piece that makes the trade directors interested,” he says.
In addition, manufacturer representatives should learn the areas of focus for the payer representatives on the call or in the virtual meeting, Schneider says. “Know who you’re talking to. If you’re talking to somebody who’s focused on the commercial side, you’ll want to talk about everything related to commercial. If it’s somebody who’s focused on Medicare Part D, focus on that. If it’s somebody who does both, you’re going to want to focus on the side where your drug might have the most impact.”
Clinical Reps May Have Advantage
In fact, clinical team members may have an advantage in the pandemic since “for all the big payers, the clinical presentations have been done via WebEx or Zoom for years, because clinical people tend to be spread out all over the country to begin with,” he says.
Still, once the manufacturer has scheduled a meeting, the staff members who will be on the call need to answer several questions to prepare, says Cindy DiBiasi, co-founder of 3D Communications, a firm that specializes in helping drugmakers handle different communication issues.
“How do you make sure you’re coming across with clear messages and data points? Who’s answering the questions? How are we going to make sure — if we know we have more people on both sides — that the meeting’s organized?” asks DiBiasi. “I don’t know that this has been all figured out yet, but I think the better companies will be preparing for it.”
According to DiBiasi, “the one potential advantage of virtual is you can get better experts or more people in the room. The company team was normally in the room together.” Of course, the pandemic and virtual work situations of most companies now mean that most everyone is operating remotely, she notes, and that makes it much more difficult to stay in communication privately.
“That element of being on your own and being disembodied from each other, it makes it trickier — it makes it exponentially trickier,” says DiBiasi. Therefore, manufacturers need a robust communications strategy on the back end to enable in-house communication even if team members are dispersed geographically, she says.
“When you’re under the gun and you’re the one answering the questions they’re presenting, you can’t also be following your chat box; you can’t be following your texts,” DiBiasi says. Manufacturers need the ability to have back-channel communications during these meetings, just as they need it for FDA advisory committee meetings, she says. “You don’t get a pass on the FDA side on virtual, and you’re not going to get a break on payer negotiation, either.”
On the front-facing side, she says, the team should go in with “very crisp, clear messages and a real game plan of who’s going to speak. It’s got to be really play-booked. You don’t have to do it that way, but if you’re going to do it to maximize that opportunity — which of course you would want to do — that would be the best way to do it.”
Meetings May Have More People Now
Given the newly virtual environment, payers may opt to expand the number of people on a call; previously, they may have limited it to those who were directly on-site at that location, DiBiasi says. “This could be good news or bad news, but it makes it more complicated on some level,” she says. “You’re going to have more voices across the table. But, again, knowing your audience and preparing for that” is key to success.
Of course, Zoom and other virtual calls also don’t allow you to easily pick up on nuanced expressions that people might glean when meeting face-to-face, Schneider says. In addition, “you may be more open in a face-to-face negotiation than on a Zoom call, from either side, just because you never know who’s on a Zoom call or a WebEx and who might be listening in.”
It’s important to consider how to show data in virtual meetings, DiBiasi says. Typically in in-person meetings, manufacturer representatives will show data on an iPad, but that won’t work in a virtual meeting, she says.
In addition, manufacturer presenters need to consider how they will come across on a screen versus how they would come across if they were in the room in person, DiBiasi says. “It’s not just when you go from the ballroom to the living room or going from a stage to a camera. It’s a very different set of circumstances and things you have to do.”
For example, people don’t know where to look so that they come across as looking into the computer’s camera, DiBiasi says. “So often, the angle for the camera is just above the computer screen. Just slightly above your eye line. Most of them are looking down. So what are you seeing? You’re seeing nostrils. You’re seeing double chins,” she says.
Presenters need to be coached to look into the lens of the camera on the computer or into a separate camera, not into the screen, she adds. “If they’re going into meetings that are that important, and they’re trying to convince somebody of something, they need to establish eye contact and person-to-person contact.”
So-called “Zoom fatigue” also is an issue during the pandemic, DiBiasi says. “If we are now taking back-to-back calls and having back-to-back meetings, one after another, after another, and you’re at three o’clock in the afternoon, there’s just so much a human being can take,” she says. “Put yourself in the shoes of the audience and realize what their reality is like — it’s not a perfect world.”
Onus Is on Pharma to Figure This Out
Options may be increasing to get on payers’ calendars, insiders say. For example, “I know that some of the big conferences are setting up virtual rooms for marketing, but you have to know who you want to talk to and hopefully have some kind of a relationship so they’ll accept the call versus bumping into them or making sure you’re present at something you know they’re going to be at and approaching them,” says DiBiasi.
“So it definitely takes the spontaneity out of the moment,” she says. “I think the onus is really going to be on pharma to be more strategic and more sophisticated when it comes to how they’re going to approach this, because it’s a different plan. Now they have to look at this and say, ‘What is our communications plan when we’re going into these meetings?’”
Some manufacturers have considered delaying a new product launch until the pandemic has settled down — and until they can more easily get in front of payer representatives. But Schneider rejects this option out of hand. “I would never recommend that any manufacturer do that. I get a lot of questions about, is there a good time to launch a drug? And I think the best time to launch a drug is when you have FDA approval and you’re ready to go,” he says.
Try to Have Meetings Close to Launch
Schneider says the trade side will “ignore people until a drug is approved or very close to being approved. So if you have a positive FDA advisory board signal, or you can give a potential launch date for your product, that’s going to pique interest, especially for the trade and financial side.” Therefore, he recommends trying to get a virtual meeting as close to launch as possible, so that those trade and financial payer staff members will be interested.
Regardless, Schneider recommends learning to work within the pandemic’s restrictions rather than allowing it to impact launch. “Don’t worry about timing and things like that. Every drug will be reviewed by everybody’s P&T [i.e., pharmacy and therapeutics] committee. So even the mid and small manufacturers that may not have [payer] relationships are still going to have the opportunity to have their drug reviewed by a P&T committee. The question is, are they going to be able to have a chance to present in front of the clinical teams or have a chance to talk to the financial side before that review happens?”
Contact Schneider via Avalere spokesperson Liz Moore at firstname.lastname@example.org, Cournoyer via spokesperson Tess Rollano at email@example.com, Tegenu at firstname.lastname@example.org and DiBiasi via spokesperson Luna Newton at email@example.com.
by Jane Anderson