The Affordable Care Act mandates a wide array of changes for which the pharmaceutical industry must be prepared. Regardless of where you stand on the issue, the Affordable Care Act requires marketers in the industry to rethink how to provide the best patient care possible for the greatest number of people while staying within regulations. There are certainly strategies for accomplishing this, but first we need to know how the law impacts marketing in the industry.
Now that health coverage programs can be purchased through state exchanges and on healthcare.gov, traditional payer groups are less responsible for paying for prescription drug costs. Although the Affordable Care Act plans typically cover generic and lower-cost branded medications, patients are more responsible than ever for paying higher copays and for specialty drugs (that can cost tens of thousands of dollars). Patients usually pay about 29% of the cost of specialty drugs under private healthcare plans, but under bronze and silver Affordable Care Act plans patients pay around 40% of the costs.
The most common generic and low-cost branded drugs are generally covered by the Affordable Care Act, but the range of drugs that it covers is limited in favor of broader health coverage elsewhere. Each state with exchanges chooses its own set of prescription drug coverage, which can differ drastically. This is illustrated well by a recent Avalere Health study, which shows that of the 22 drugs available in the Angiotensin II Receptor Antagonists drug class, all 22 are available in New York exchanges, 20 are available in Colorado exchanges, and 11 are available in Maryland exchanges.
As a professional working for a health care company, you may not be as worried about the implications of the Affordable Care Act on your sales in New York, but what about Maryland? How do you know which drugs health care professionals will prescribe from the more limited options available to them? How do you ensure that your medication reaches the patients that need it the most?
The answer to these questions is simple—medical education. In this day and age, health care professionals must be more prepared than ever to choose the right medications for their patients, and the best way for them to follow regulatory guidelines is simply to be prepared. They must be able to identify health issues quickly and accurately, and know enough about the limited medications that they can choose to prescribe.
Including medical education as part of the marketing mix is becoming increasingly important for more and more organizations. Ensuring that doctors understand their products and are comfortable prescribing them under the right circumstances can be vital to survival since the Affordable Care Act was passed, and it is the most effective means of ensuring top-notch patient care. Direct-to-consumer advertising and sales representative activity will still be important tools for industry marketers, but the information health care professionals really need and are seeking comes from medical education programs.
[1] Gottlieb, . Forbes, “No, You Can’t Keep Your Drugs Either Under Obamacare.” Last modified December 09, 2013. Accessed January 31, 2014. http://www.forbes.com/sites/scottgottlieb/2013/12/09/no-you-cant-keep-your-drugs-either-under-obamacare/.
[2] Pearson, Murphy. Avalere Health, “Drug Coverage in Essential Health Benefits Benchmark Plans: Formulary Analysis.” Last modified January 2012. Accessed January 31, 2014. http://www.avalerehealth.net/pdfs/Avalere_EHB_Formulary_Analysis.pdf.
