This workshop is designed to illustrate key concepts and demonstrate strategies addressing increasing payer pressures to reduce pharma company net sales. Attendees will be active participants in a negotiation role play representing a unique case study. The role play will focus on the payer dynamics after a competitive product with comparable efficacy enters the marketplace. Two teams representing the incumbent and new company negotiate with the PBM team to determine the rebate rate, access (exclusive, second tier, parity, third tier, or excluded), prior authorization and a step edit. Financial implications related to impact of alternative proposals on gross-to-net sales at the PBM/payer level will be assessed.
- Developing key assumptions to estimate gross sales
- Illustration of the GTN funnel
- Commercial payers
- Key factors impacting rebates
- Utilization restrictions – Prior authorization, step edits, tiers & formulary exclusions
- Payer cost controls – Using leverage to extract higher rebates & price protection
- Impact of prior authorization, step edits and patient abandonment on gross sales
- Impact of co-pay cards and co-pay accumulators
- Payer contracting formulary options and related rebates
- Contracting scenarios – Measuring ROI
- Understanding market access dynamics
- Negotiating with PBMs/payers for mutual gains – concepts, tips & techniques
- Hands-on payer negotiation exercise (incumbent, new entrant and payer)
- Accessing key terms to be negotiated and financial implications
- Developing SWOT analysis for the incumbent company, new entrant & PBM
- Evaluating financial implications of tradeoffs between access & higher rebates
- Assessing the impact of negotiation on patients’ access and affordability
- Debrief on negotiation outcomes
- Summary of key learnings