"approved and preferred first line for all Obama care and Medicaid patients. No age restrictions no step edits. No prior auth. From age 0-99." Chaching. $$$$$
Not if you don't track your lunches or color code your calendars. Thats whatdrives business. At least thats what KK thinks
Affordable care act or Obama care whatever you want to call it is playing a big part in what's being written right now. You may have coverage on the main plan but the chunk that falls under the ACA is costing patients $80-300 after the voucher and after the 3000 deductible. These patients are not getting the product and are getting genetic low cost medications instead. Rightfully so. Shire is doing doing nothing about those patients. This is the fastest growing market right now. A waste of an opportunity to captitalize on the adult market. Instead of getting the KAMs to secure placement on these plans, shire has gone the other way and laid them off. Ultimately throwing in the towel. Kudos to Floridia and for the other states that don't have to deal with all the small ACA plans and instead had the state just expand Medicaid for mental health patients.
And to think, our esteemed BU leader perry wants nothing to do with Medicaid. He hates paying the rebate and doesn't think bonus should be paid on those scripts either. Let the coverage slip and listen for the huge sucking sound that otherwise will be the demise of Vyvanse. Dumb ass, he is!
If the company gets paid for these scripts so should the rep. If they want to discount the amount paid on these scrips and are ALSO going to decrease the goal expected on high medicaid territories than fine. But to eliminate this from the bonus plan all together would be a huge huge mistake. This would be assuming that once a medicaid patient, always a medicaid patient. If new patients is your goal than cutting this out is a bad strategy.
This is more of reason to offer a voucher program for the ACA high deductible/ high copay plans. If Shire could offer a 6 month free or something to help them until they hit the deductible the insurance plans will pick up the retail price. Giving the patient the opportunity to have success on the product and they would be more to continue on and/or switch their plan the next year. 30 day free is not enough time. By the time they get to the right dose, they are asked to pay $300 for it. Our studies were 12 weeks, the trial cards should last 12 weeks. I know how PS works. He wants to stop reps from being paid bonus on vouchers as well. Rewarding the territories with high commercial use and low voucher redemption.
This is interesting. Whatever happened to "senior leadership" and their plan to target Medicaid? We have been instructed non stop to do it and to move away from commercial plans even though this is against all compliance regulations. I need my job, but..
I'm glad someone finally brought this to light on here. The ACA plans are growing more and more and providers are having a hard time keeping coverage straight. Personally, I sell in a very complex managed care environment and asking a provider to remember 5 or 6 medicaid plans, 5 or 6 commercial plans and THEN the ACA plans is impossible because all the plans cover Vyvanse differently. Kudos to the regions that don't have to deal with this-Id love that as well and you should take advantage of the great coverage. But just remember it is not like that for everyone and we should be goaled accordingly. I know this will get the negative haters saying how it shouldn't matter etc....but the fact of the matter is that it does. And unless you have had to sell in this type of market where you scratch and claw not just for new scripts but also just to keep scripts because it's constantly changing then you don't have a right to hate on people who do.
