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Reimbursement vs. Managed Care

Discussion in 'Managed Care Specialists - General Discussion' started by Anonymous, Dec 7, 2008 at 8:12 PM.

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  1. Anonymous

    Anonymous Guest

    Any opinion out there? Some companies combine these two, but as separate areas, which will end up being more valuable come the future....
     

  2. Anonymous

    Anonymous Guest

    In my experience, Reimbursement pertains more so to the medical benefit and can vary greatly across managed care whereas managed care is more so formulary wins and pertain to the pharmacy benefit (eg. tier placement, rebates, etc.). Reimbursement is more challenging and more exciting. Keep in mind we already have numerous consuting companies that specialize in managed care and reimbursement. Heck, i was working for one.
     
  3. Anonymous

    Anonymous Guest

    Hello,

    Does anyone know if there are laws/regulations overseeing reimbursement account rep.positions in the biotech/pharma industry?For example, can a reimbursement position also sell?..or Is it ok for a reimbursement account rep position to have access to sales data?
     
  4. Anonymous

    Anonymous Guest

    There are some companies that allow the reimbursement people to be part of the sales process, but the IGs in most states hate that. Most other companies with medical benefit products (BMS, Biogen, Janssen, Genzyme, Amgen, etc.) have separate reimbursement groups that report through managed markets or market access divisions.
     
  5. Anonymous

    Anonymous Guest

    nice to see some life on this board.

    Anyone know good websites or trade pubs on managed markets? (I'm new and am looking for information resources).
     
  6. Anonymous

    Anonymous Guest

    Anyone know of any managed care marketing job openings?
     
  7. Anonymous

    Anonymous Guest

    For the most part they are toast with the drug rep world.
     
  8. Anonymous

    Anonymous Guest

    Just what is the "new drug rep world?" Drug reps are dinosaurs.
     
  9. Anonymous

    Anonymous Guest

    I will help you

    Manufacturers are NOT rebating like they used to the Regional and National Payer community. The only contracting that really exists is for high volume primary care drugs and drugs that fall heavily into Part-D

    There are so few Regional Payers left that manage their own contracting and formulary anymore. Most are run by a national payer affiliate or a national payer that owns the regional. SO in essence there is NO need for a RAM anymore accept for maybe in unique areas.

    National Account Managers is all that will be needed, but not many of them as well.

    Bio similar products are about to blow up the market.....Reimbursement is getting tougher

    Provider staff are hired and they are as dumb as a stone......manufacturers will need Reimbursement experts to support the market

    Oh also the field sales teams are horrible at delivering a pull through market access message, another reason you need Payer Solutions in the field.

    The old days of going to see the pharmacy director and negotiating for your tier 2 placement.......that ship has sailed as a whole....it is still there but not enough to support head count like in the past!
     
  10. Anonymous

    Anonymous Guest

    I agree with the last poster, the market now needs field level reimbursement people who can maneuver through the reimbursement landscape and find the ways to get product paid.
     
  11. Anonymous

    Anonymous Guest

    What exactly does navigating through the reimbursement landscape mean in the field? (I'm not a rep but am interested in how the field-level rep does this)
     
  12. Anonymous

    Anonymous Guest

    Know your payer landscape. ( your drugs coverage at tgexmanaged care payers)

    Then develop a plan on how you are going to help your provider customers get their patients your drugs accepted and paid for by the payers

    Prior auth, distribution, contracting (rare anymore), advocacy , policy development, prescriber request
     
  13. Anonymous

    Anonymous Guest


    Thank you!
     
  14. Anonymous

    Anonymous Guest

    know there are tools on here that are trying to present themselves elsewhere as "consultants" and experts on Competitive business inteligence research. They don't know jack... so they panic to find the meaning of the basic industry terms their clients use. con artists
     
  15. Anonymous

    Anonymous Guest

    I agree with this statement, but I also disagree with the whole concept in the Primary Care Market.

    Look at the number of certified Part D providers in any given state. Then add the number of commercial provider in a state.

    Now multiply that by the number of different brand name products in a therapeutic class =

    A bunch of hot air blow to a Dr. that can barely keep up with his pat schedule. It's impossible to keep up with it all. So they node and start thinking about what they need to do next.
     
  16. Anonymous

    Anonymous Guest

    Reimbursement is important, no doubt, but having come from both and directing a group in managed markets in oncology I would argue that managed markets isn't simply contracting formulary positioning, but more so negotiating with GPO around pathways and protocol...which in specialty spaces is the name of the game...if they don't even have your product in their sequencing pathway, like in oncology, Reimbursment doesn't matter. Neither is going anywhere.