Benchmarking Physician Prescribing Against True ... - IMS Health

Benchmarking Physician Prescribing
Against True Business Potential
BENEFIT DESIGNS REVEAL IMPACT OF PATIENTS COSTS
Pharmaceutical companies routinely turn to insurance plan
formularies to understand performance drivers for their products. But
individual benefit designs under the plan are contracted at the local
level, where premiums, co-pays, and tier status are negotiated by
employer groups. In this environment, the formulary information tied
to a national plan does not provide the level of insight necessary to
uncover real prescriber access — often creating missed opportunities
or inefficient resource allocation.
It is now possible to explore the “why” behind product
performance within plan designs by better understanding the
competitive context — the cost differentials and options available
to the patient and prescribing physician. IMS recently conducted
an analysis of the angiotensin receptor blocker (ARB) market that
reveals how visibility into the co-pay structures that drive patient
behavior can contravene what companies believe they know about
an individual physician’s prescribing potential.
THE STUDY DESIGN
The ARB market is highly commoditized. For this study,
IMS selected the lens of AVAPRO ® , one of many products
in the category. The analysis covered the top 150 prescribers
in the commercial Chicago metro territory, based on ARB
market volume for one quarter in 2010.
Rx BENEFIT DESIGN
CASE STUDY
VISIBILITY INTO VARIABILITY
Employer-based plans impact product access and price and
influence patient behavior. Until now, pharmaceutical companies
have lacked sufficient visibility into local plan designs,
many of which do not follow national published plans.
IMS Rx Benefit Design provides insight into the actual copay
structures — those that are constructed for employers
within each plan, payer, and PBM. Patient choices can be
understood in the context of cost differentials, or what the
patient might have paid through another option.
This solution enables improved contracting, resource
allocation, targeting, segmentation, and messaging.
Rx Benefit Design provides the most granular information
available to evaluate physician prescribing and patient use
for a product. For this analysis, IMS calculated brand shares
within the overall plan as well as in each plan benefit design
for comparison. IMS then calculated an opportunity share for
each prescriber.

BEYOND THE FORMULARY
With IMS Xponent PlanTrak ® , IMS first evaluated subnational
performance by plan. AVAPRO has an above
average share in the Chicago territory and an even higher
share in the top plan in the territory, Blue Cross Blue
Shield (BCBS) of Illinois. (The preferred brands within this
PPO are BENICAR ® and DIOVAN ® . )
The analysis showed that 17 percent of AVAPRO volume for
the BCBS PPO was through a 2-tier structure. This finding
reveals that the assumption that tier status alone reflects
therapeutic options available to patients does not
necessarily hold true. It also refutes the commonly held
belief that 2-tier designs are predominantly closed and thus
provide very little opportunity for non-preferred brands.
Performance of preferred brands also varies across multitiered
benefit designs, as observed by an analysis of co-pay
differentials available through Rx Benefit Design. AVAPRO
and DIOVAN, for instance, mirrored what IMS has seen in
almost every market studied: As co-pay differentials (i.e.,
difference between tier 2 and tier 3 co-pays) decrease, the
transaction shares of those drugs move closer together. (See
Figure 1). For example, the non-preferred drug AVAPRO is
only 2.3 percentage points lower than the preferred market
leader Diovan when the differential is $15, compared to a
FIG. 1: CO-PAY DIFFERENTIALS DRIVE
PATIENT CHOICE
BCBS-IL
TRx Share
35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
28.9%
4.8%
17.6%
7.5%
— Avapro — Diovan
13.7%
11.4%
0.0%
$20-$50 $30-$50 $20-$35
24.1 percentage point gap when the differential is $30. This
finding is significant for a competitor to the dominant
drug in the category.
PHYSICIAN-LEVEL OPPORTUNITIES
Physician performance can also be evaluated within the
context of benefit design. As indicated in physician-level
Xponent PlanTrak data, AVAPRO’s share is significantly
different across the top prescribers in the top local plan,
ranging from 0 percent to 31 percent. The volume for
the top writer with no AVAPRO prescriptions is highly
concentrated in BCBS-IL PPO (60 percent). Despite the
fact that AVAPRO is not a preferred drug, Rx Benefit
Design shows that 31 percent of the benefit design volume
for this physician is advantageous for AVAPRO (18 percent
from the $20/$30 co-pay category in which AVAPRO
does well and 13 percent from the $15 2-tier design).
(See Figure 2).
After identifying such opportunities for growth within a
plan for a product with relatively poor formulary position,
the company can re-evaluate physician targeting, call plans,
frequency, messaging and resource allocation, including
sampling. Providing a doctor with information on patients’
willingness to pay within certain design structures can be a
value-add. Such insight also may be used in goal setting for
the field force.
Benchmarking at the level of granularity provided by Rx
Benefit Design enables the company to compare a given
physician’s prescription volume (11.1 percent in the case
shown in Figure 3) to the shares within each specific design
rather than solely to the overall plan volume (8.3 percent).
AVAPRO performance is strong in the $30_$50 design and
shows potential for growth in the $20_$35 design.
Across the entire territory in the Chicago area, the analysis
uncovered 45 prescribers for whom the prescribing
opportunity had been understated and another 44 for
whom the opportunity had been overstated prior to the
benchmarking done with Rx Benefit Design. This is a
significant change in potential resource allocation for one
territory, which will result in a much higher ROI by
focusing effort on prescribers with true potential.

FIG. 2: CO-PAY STRUCTURES
REPRESENT HIDDEN POTENTIAL
� OTHER (3) 14%
� AETNA IL 5%
� COUNTY HEALTH 5%
� MEDCO 7%
� FEPBLUE 9%
THE ULTIMATE ROI
Such analyses, which increase the accuracy of physician
benchmarking, finally reveal the true impact of managed
care. The data can be leveraged for goal setting, targeting,
segmentation and monitoring sales force performance.
Benefit design details can put the performance of individual
physicians in a new light, revealing that some have greater
FIG. 3: MORE ACCURATE BENCHMARKING BASED ON TRUE POTENTIAL
Plan
Benchmark
Avapro BCBS-IL
Plan Rx Benefit
Design Benchmarks
Avapro BCBS-IL in
each Rx Benefit Design
Physician 13434 TRx by Plan
$30_$50
7.4%
20.7%
Potential for Avapro
31% of the BCBS-IL plan volume for
this Dr is advantageous for Avapro
BCBS-IL
(PPO) 60%
Avapro
8.3%
$40_$60
0.2%
0.0%
BCBS-IL
potential than had been assumed and that others, previously
viewed as under-performers, are indeed prescribing to their
full potential. Whether expectations are realistically reduced
or dramatically raised, the results are the same: optimized
resources and the highest possible return. ●
For more information, call 800.523.5333 or contact
your IMS representative.
$20_$35
11.4%
0.0%
11.1%
25%
20%
15%
10%
5%
0%
BCBS-IL by Benefit Design
21%
$40_$60
18% 16%
$20_$35
$25_$50
Dr 75318
Avapro
Shares
13%
$15
9% 6%
$30_$50
$20_$50
17%
Other
Benefit
Designs (5)

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