ALSCG Maps out Insights of New Health Insurance Marketplace
By Mia Burns (mia.burns@ubm.com)
After the long-awaited launch of healthcare insurance marketplaces and exchanges, the time has arrived to examine the potential effect on the industry and to explore ways to take advantage of new opportunities, according to Alliance Life Sciences Consulting Group. The company recently held a webinar focusing on the current state of the marketplace now that it is open for business.
Joel Owerbach, Pharm.D., VP of Health Policy and Strategy, ALSCG told Med Ad News Daily that he did not find the difficulties that some have experienced in navigating the new marketplace surprising. “The new marketplace requires one of the most complex multi-system, multi-organizational inter-connected information, communication, and validation programs imaginable,” he says. “As anyone who has been through new system development, migration, and deployment, including pharmaceutical company mergers, can appreciate; this is always a more complex and messy process than expected. The new Medicare Part D program implementation back in 2005-2006 was fraught with system and enrollment issues that took months post go-live to work out. For this marketplace - based on the timetable, the complexity, the construction process, and lack of adequate end-to-end testing time documented and reported weeks to months before 10/1; I’m not surprised at all.”
Reports of glitches throughout the process are expected to continue, according to Dr. Owerbach. “We’ll continue to hear about glitches through the process, whether it is a state run program or the federal system long past Nov. 30 and Jan. 1 as all of the pieces begin to come together and a substantial volume of information begins to flow through and between all of the intended systems, organizations and individuals,” he told Med Ad News Daily.
“The new marketplace has new rules, benefits, players and programs that will continue to evolve, change and grow over the next few years,” Dr. Owerbach says. “Benefit designs are treating brand drugs and specialty drugs differently than generics (i.e. a separate brand deductible, or coverage of generics outside of the deductible) and there is likely more out-of-pocket cost liability for individuals for drugs and services before the benefit kicks in compared to current individual and employer group benefit programs. Additionally, there are new formularies, sometime multiple versions, being applied to different marketplace plans and programs.”
Regarding the challenges that the pharmaceutical industry will face, Dr. Owerbach told Med Ad News Daily, “Part of the challenge for pharma is to understand the dynamics, timeline, and geography over which this is likely to unfold relative to the overall marketplace requirements and regulations - short term and long term; optimize access to their products within the new benefits for the marketplace; and assure they are providing the tools and ongoing education/information to the sales and account management teams to best engage with plans and insurers in what hopefully will be a collaborative and win-win process.”
Drug coupons, subsidies, and copay assistance programs will provide opportunities within the new marketplace. “It would appear that drug coupons, subsidies, and copay assistance programs will be allowed within the new marketplace plans,” Dr. Owerbach told Med Ad News Daily. “This presents an opportunity to revisit current programs and to see how they may be best adapted to meet the new benefit and out of pocket cost ‘sticker shock’ realities that members may face. At the end of the day, we would recommend that pharma arm themselves with the right tools, services, and knowledgeable experts to help guide them through all aspects of the business and stakeholder engagement process.”
Previously, ALSCG executives said that these changes would present a new learning curve for the pharma industry. According to Dr. Owerbach, the industry has utilized “a range of watchful waiting to diving in to better understand the potential impact and to incorporate that into strategic planning.”
“There has been a lot of unknowns up until very recently (i.e. who is participating, what will the formularies look like, how many will be enrolling), so in most cases, individuals within the company have been given the assignment to ‘keep up’, learn and provide guidance to others,” Dr. Owerbach told Med Ad News Daily. “I expect the internal focus will expand in 2014 as the marketplace becomes a reality and there is more visible evidence of growth and impact that this will have on business.”
Pharmaceutical Manufacturers Learn State of Health Insurance Marketplace: Alliance Life Sciences Shares New Insights During Free Webinar
After the long-awaited launch of healthcare insurance marketplaces and exchanges, the time has arrived to examine the potential effect on the industry and to explore ways to take advantage of new opportunities, according to Alliance Life Sciences Consulting Group. The company recently held a webinar focusing on the current state of the marketplace now that it is open for business.
Joel Owerbach, Pharm.D., VP of Health Policy and Strategy, ALSCG told Med Ad News Daily that he did not find the difficulties that some have experienced in navigating the new marketplace surprising. “The new marketplace requires one of the most complex multi-system, multi-organizational inter-connected information, communication, and validation programs imaginable,” he says. “As anyone who has been through new system development, migration, and deployment, including pharmaceutical company mergers, can appreciate; this is always a more complex and messy process than expected. The new Medicare Part D program implementation back in 2005-2006 was fraught with system and enrollment issues that took months post go-live to work out. For this marketplace - based on the timetable, the complexity, the construction process, and lack of adequate end-to-end testing time documented and reported weeks to months before 10/1; I’m not surprised at all.”
Reports of glitches throughout the process are expected to continue, according to Dr. Owerbach. “We’ll continue to hear about glitches through the process, whether it is a state run program or the federal system long past Nov. 30 and Jan. 1 as all of the pieces begin to come together and a substantial volume of information begins to flow through and between all of the intended systems, organizations and individuals,” he told Med Ad News Daily.
“The new marketplace has new rules, benefits, players and programs that will continue to evolve, change and grow over the next few years,” Dr. Owerbach says. “Benefit designs are treating brand drugs and specialty drugs differently than generics (i.e. a separate brand deductible, or coverage of generics outside of the deductible) and there is likely more out-of-pocket cost liability for individuals for drugs and services before the benefit kicks in compared to current individual and employer group benefit programs. Additionally, there are new formularies, sometime multiple versions, being applied to different marketplace plans and programs.”
Regarding the challenges that the pharmaceutical industry will face, Dr. Owerbach told Med Ad News Daily, “Part of the challenge for pharma is to understand the dynamics, timeline, and geography over which this is likely to unfold relative to the overall marketplace requirements and regulations - short term and long term; optimize access to their products within the new benefits for the marketplace; and assure they are providing the tools and ongoing education/information to the sales and account management teams to best engage with plans and insurers in what hopefully will be a collaborative and win-win process.”
Drug coupons, subsidies, and copay assistance programs will provide opportunities within the new marketplace. “It would appear that drug coupons, subsidies, and copay assistance programs will be allowed within the new marketplace plans,” Dr. Owerbach told Med Ad News Daily. “This presents an opportunity to revisit current programs and to see how they may be best adapted to meet the new benefit and out of pocket cost ‘sticker shock’ realities that members may face. At the end of the day, we would recommend that pharma arm themselves with the right tools, services, and knowledgeable experts to help guide them through all aspects of the business and stakeholder engagement process.”
Previously, ALSCG executives said that these changes would present a new learning curve for the pharma industry. According to Dr. Owerbach, the industry has utilized “a range of watchful waiting to diving in to better understand the potential impact and to incorporate that into strategic planning.”
“There has been a lot of unknowns up until very recently (i.e. who is participating, what will the formularies look like, how many will be enrolling), so in most cases, individuals within the company have been given the assignment to ‘keep up’, learn and provide guidance to others,” Dr. Owerbach told Med Ad News Daily. “I expect the internal focus will expand in 2014 as the marketplace becomes a reality and there is more visible evidence of growth and impact that this will have on business.”
Pharmaceutical Manufacturers Learn State of Health Insurance Marketplace: Alliance Life Sciences Shares New Insights During Free Webinar
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