Payer contracting is a key function for any life sciences organization to ensure their drugs have the desired Market Access against its competition. Across the next 5 years, the gross contracted sales market expects to grow from $ 120B USD to $ 170B USD. This makes it critical for Pharma contracting team to change focus from being reactive, and shift gears on Payer Contracting, defining market access strategies and seek opportunities to make the Payer Contracting decision making accurate and efficient.
Now, the stages across Payer Contracting is long and complex with multiple questions that needs to be answered by Contracting Team, and other stakeholders – to decide if they should contract , or not? Moreover, if they decide to contract- is it going to be financially profitable? ( i.e. desired GTN, positive ROC etc.) Alternatively, is it going to be a strategic contract for the Contracting Team?
By answering, each of the above set of qualitative and quantitative questions- a contracting Team can take a decision, whether to contract, or not to contract with the Payer for the particular brand, in question. The answer to the qualitative questions rests completely on the subject matter expertise of the contracting team, but the answer to each of these analytical questions- can be provided using Reporting, Analytics and AI/ML features and state of the art- decision engine and decision science platforms. Implementation of RPA, BI (Business Intelligence) & AI features across the Payer Contracting Life Cycle can improve the overall efficiency of the team from a decision-making standpoint (optimize rebate payout, improve ROC, impact pull through), but also lead to improved accuracy and speed of the overall process.
In this point of view, we will do a deep dive into the current Payer- Pharma Contracting space, the key intrinsic, and macro challenges pharma organizations have in this space (i.e. Loss of Exclusivity, PBM consolidation). Finally lay down opportunities for Pharma, as to how AI, RPA, and Analytics can change the future of Payer Contracting Strategy for a Pharma organization.
About the Author
Director – Life Sciences Solutions, Incedo Inc.