Medicare Advantage Plans: Contracting Landscape and Manufacturer Competitive Assessment

Medicare Advantage Plans: Contracting Landscape and Manufacturer Competitive Assessment

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Medicare Advantage (MA) executives identify numerous areas for partnership and collaboration as the segment grows and CMS regulations/restrictions remain stringent. HIRC's report, Medicare Advantage Plans: Contracting Landscape and Manufacturer Competitive Assessment, reviews Medicare Advantage pharmacy and medical directors' evaluation of manufacturers, and focuses on trends in contracting. The report addresses the following questions:

  • Which manufacturers lead in Medicare Advantage executives' evaluation of willingness to contract?
  • Which manufacturers lead in Medicare Advantage executives' evaluation of quality of programs and/or resources? What is the level of customer-facing access?
  • Which contract types are most commonly offered for traditional, specialty, and oncology medications? Which are the most preferred?
  • Which manufacturers are most often nominated as plans' overall "Partner of Choice"?
  • What are the central advantages and challenges of risk/outcomes-based contracts?

Key Finding: Flat access rebates tied to preferred position is the most frequently available contract type offered to Medicare Advantage plans across traditional, specialty, and oncology products.

Novo Nordisk, GlaxoSmithKline, and Lilly Rate Highest in Willingness to Contract. Respondents were asked to consider and rate 41 very large, large, and mid-size pharmaceutical firms on their overall willingness to contract. Medicare Advantage panelists report that Novo Nordisk is the most willing to contract, followed by GlaxoSmithKline and Lilly. Top firms are noted for aggressive discounts or rebates, their product portfolio, and overall ease of the contracting process.

The complete listing of companies is provided in the full report, along with year-over-year ratings and customer comments.

Interest in Risk/Outcomes-based Contracts Focuses on Specialty and Traditional Therapeutic Areas. Respondents were asked to rate their level of interest in risk/outcomes-based contracts with pharmaceutical manufacturers across twelve traditional, specialty, and oncology therapeutic areas. On average, Medicare Advantage executives report the highest interest in risk/outcomes-based arrangements for PSCK9 inhibitors, followed by non-insulin diabetes, and rheumatoid arthritis.

In addition to the complete listing of risk/outcome interest by therapeutic area, the full report includes an in-depth competitive assessment across 41 pharmaceutical manufacturers, Medicare Advantage executives' needs and interest in programs/resource offerings, and detailed profiles for 10 industry-leading pharmaceutical manufacturers.

Research Methodology and Report Availability. In July 2017, HIRC surveyed 48 Medicare Advantage pharmacy and medical directors from national, regional, and BCBS plans. Online surveys and follow-up telephone interviews were used to gather information. The complete report, Medicare Advantage Plans: Contracting Landscape and Manufacturer Competitive Assessment, is available now to HIRC’s Managed Markets subscribers at www.hirc.com.

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