KEY TAKEAWAY: Insurers are having a bigger say in what physicians prescribe to patients and it seems that many are telling patients to check with their insurance companies before writing a new Rx. Pharma marketers need to be aware of this trend and provide information to patients to help them determine if a product will be covered BEFORE they request it.
Yesterday I went to my neurologist to see if there was anything that could be done to help me with the nerve damage I sustained as the result of a bike crash two years ago. She provided me with samples of some medications, but she also warned me “check with your insurer to see if they are covered as some will not cover the cost”. I asked her how often this happened and she replied “a lot more in the last year” and also said that “most patients get upset if I give them a sample that works only to find that it can cost them several hundred dollars out of pocket to fill”. So where is the AMA?
The AMA has been vocal about DTC advertising, but they pretty much have been silent about insurers telling them what they can and can’t prescribe. This is the REAL threat to patients not just high drug prices.
For DTC marketers this shift can have profound effects. Imagine spending millions of dollars on a DTC campaign only to find out that a majority of patients can’t fill the Rx because their insurer said “no”. Some companies, like Biogen, offer to pay higher copays for their products, but too many other companies don’t which in turn leads to less effective DTC marketing.
Before launching a wide, mass market DTC campaign, marketers need to ensure that the product will be covered by popular insurance plans. We don’t want to spend a lot of resources getting patients to ask for the product only to find out their insurer says “sorry no, but try this instead”.