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What does Market Access actually do?

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anonymous

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I feel like every quarter coverage gets worse. I’m not even excited to get commercial scripts anymore because they’ll probably require a PA and get denied or cost an arm and a leg. I get Medicare and Medicaid are always going to be tough but this drug has been out long enough that commercial scripts should be a lock.
 


anonymous said:
I feel like every quarter coverage gets worse. I’m not even excited to get commercial scripts anymore because they’ll probably require a PA and get denied or cost an arm and a leg. I get Medicare and Medicaid are always going to be tough but this drug has been out long enough that commercial scripts should be a lock.
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That’s the thing. Commercial should be a lock, but it’s not. Nothing is a sure thing here. Uncertainties have devastated morale and continue to result in people leaving this dumpster fire.
 


















anonymous said:
BCBS is terrible now. Other commercial plans require PAs now when they didn’t used to. High copays even after the copay card is applied.
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Senior management doesn’t want to discount the drug to payers. They rather get more from less so to speak. But that isn’t going to help you in the long run. Very few areas are in a good situation. Everyone else will be sunk in the mud with no other options.
 


anonymous said:
Senior management doesn’t want to discount the drug to payers. They rather get more from less so to speak. But that isn’t going to help you in the long run. Very few areas are in a good situation. Everyone else will be sunk in the mud with no other options.
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Then that takes the conversation back to the original question. What does Market Access actually do?
 


In general, Market Access figures out how much to bribe and kickback ("rebates") payers for preference or avoiding PAs or steps, without overpaying, or, if in the medical benefit space, causing an ASP death spiral.

The problem is, most payers can't afford to disrupt existing cash flow to switch or sub, even for a quarter, and would still rather deny, delay, and defend.
anonymous said:
Then that takes the conversation back to the original question. What does Market Access actually do?
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anonymous said:
In general, Market Access figures out how much to bribe and kickback ("rebates") payers for preference or avoiding PAs or steps, without overpaying, or, if in the medical benefit space, causing an ASP death spiral.

The problem is, most payers can't afford to disrupt existing cash flow to switch or sub, even for a quarter, and would still rather deny, delay, and defend.
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"deny, delay, and defend." Sounds like Paratek corporate leadership.
 








anonymous said:
If senior leadership dosent want to discount and the payers don’t want to cover it. Then why do we need a Market Access Team?
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Rocco quit after a year with us. He did a lot of insurance plan research by going online and finding out PA requirements. The workbook for my part of the country is 96% red/ 4% yellow.
He had great previous experience so maybe he figured he would go wherever he is needed more since there is nothing to see here.
 


anonymous said:
Rocco quit after a year with us. He did a lot of insurance plan research by going online and finding out PA requirements. The workbook for my part of the country is 96% red/ 4% yellow.
He had great previous experience so maybe he figured he would go wherever he is needed more since there is nothing to see here.
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The colors in the workbook don’t matter. Even if it’s green they still require PAs and don’t go through most of the time.
 


Rocco l
anonymous said:
Rocco quit after a year with us. He did a lot of insurance plan research by going online and finding out PA requirements. The workbook for my part of the country is 96% red/ 4% yellow.
He had great previous experience so maybe he figured he would go wherever he is needed more since there is nothing to see here.
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Rocco left? He was in my class. Really liked him
 



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