Commercial health plan lives represent just over half of the US population, making this channel critical for account managers to understand. Most commercial insurers use pharmaceutical benefit managers (PBMs) to negotiate with drug manufacturers and to determine cost containment measures in drug benefit design such as prior authorizations and step therapy. This means the key decision makers affecting coverage and contracts span beyond the walls of the insurer even within a single channel.
In addition there are moving parts both in and outside the plan. Just take a look at the recent acquisition of Aetna by CVS to see how this supply chain is being disrupted. The deal gives consumers a one-stop shop of integrated benefits management and distribution; however it also gives the organization more leverage at the negotiation table with drug manufacturers.
To understand the decision making tree behind commercial health plan contracts and benefit design, an account manager needs to understand the landscape at the time, all the organizations that touch drug benefit design and contracts, and the key players within an organization that play a role. Consider The Brooks Group’s Commercial Health Plan Primer to support your account strategy in this channel. In this primer you will learn:
- Organizational dynamics within commercial health plans and the key players that directly and indirectly affect prescription utilization
- The key performance indicators utilized by health plans and the key attributes of the largest plans
- How market consolidation impacts health plans, as well as the current and future trends impacting key decision makers within commercial health plans
This resource will help you see through all the moving parts on a shifting landscape. Contact us to learn more and improve your performance with this overview of commercial health plans.