January 20, 2015

From Prescriber to Selector

by Anne Woods, Director; Beverley Herczegh, Director

In the past, when an individual was ill, he or she would go to a doctor who might prescribe a drug treatment that the patient would bring to the pharmacy to have filled. Doctors were trusted experts, and patients did as they were told. They didn’t ask too many questions. Medicine was mysterious.

The health care environment has evolved considerably in recent years, and all stakeholders have been impact- ed. Patients have been empowered by the information age, and medicine is being demystified in spite of the space age modalities of modern pharmacotherapy. Current economic realities juxtaposed with life-saving, innovative treatments have left us with no choice but to engage new models.

The public is now well aware that physicians are no longer the only prescribers. Pharmacists, nurse practitioners, mid- wives, optometrists, and podiatrists can all prescribe now based on defined regulatory limits and personal competence. However, the question of what therapy is ultimately used does not end at prescribing. A multitude of influences determine what therapy is selected — some are health care providers and some are not. We are moving from a prescriber model to a selector model.

Who and what are the selectors?

Ask any market access professional, and they will tell you that their job gets more and more complicated every year. From regulation to reimbursement, the pharmaceutical industry is being asked to provide more (and different types of) data following breakthrough innovation. Fewer and fewer drugs are being approved — even less are publicly reimbursed — and the effect is that some companies may decide not to launch new brands because of this increasingly challenging environment.

For both public and private payers, drug costs continue to be the low hanging fruit against which cost-saving tactics are most easily applied. Payers are directing the course of treatment through adherence to guidelines and stepping of therapy. Increasingly, outcome measurement is directing the course of treatment. Much of this occurs at the pharmacy where messaging on copays, coverage requirements, and payment levels occur, so the alliances formed in this space can and will affect market share for a number of stakeholders.

The interaction between pharmacies, pharmacy benefit managers, and public and private payers has resulted in a wealth of data. Data has always been collected, but, until recently, it was not mined to gather information on payer strategies that meaningfully impact everything from population health to patient choice. Data is now mined with the objective of bridging gaps between stakeholders and capturing everything from real world health outcomes to potential cost savings from choosing one treatment over another.

Technology Is Bridging the Gap

Technology is enabling communication and the collection of data as well as opening the door to personalized medicine. Right now, in the New York Genome Centre trial, thousands of mutations in brain tumours are being scanned with the objective of matching mutations with available cancer therapies. Technology is not replacing the health care practitioner in the pre- scribing process, but it does have the potential to remove some of the trial and error present in the system.

Though pharmacogenomics may seem like the stuff of science fiction, it is not a far leap from the companion diagnostic tests already in use today. From a cost management perspective, personalized medicine makes good fiscal sense, but, from a therapeutic perspective, it allows patient access to medications that are the most likely to produce the best results.

Selectors Will Decide

We would be remiss if we failed to mention that the modern, empowered patient is becoming a key selector. No longer mystified by medicine and with quick access to information, today’s patients, and the patients of the future, are looking to participate. Their employer (payer) wants them to participate. Engaged patients are better informed, cost less, and willing to take part in treatment decisions. Technologies are emerging that will further support patients on this journey, and, in fact, it is possible that the personal health record will outpace the electronic medical record when we compare the uptake of the two in Canada.

The path for the pharmaceutical industry has become a complex one. There are many more touch-points than ever, so understanding how pre- scribers and selectors define the value of a medication is particularly important. Of course, identifying the selector in a given therapeutic area is step one. In the end, a patient-centric position that focuses on the right drug for the right patient at the right time may serve the industry best. The rules are being rewritten. Selectors will decide.

Get in touch with us for more information on this topic.

Originally published in Canadian Pharmaceutical Marketing September/ October 2014. Canadian Pharmaceutical Marketing.