When a physician writes a prescription, the patient’s ability to fill it is uncertain as access is never a guarantee. For example, even in categories where there is virtually no clinical differentiation between brands, formulary coverage differences can cut access by 50% (e.g., GLP-1 agonists for diabetes).
Consider mental health — payers have imposed access restrictions, such as prior authorization and step therapy, to decrease the use of non-preferred drugs by 50%, as was shown in a recent study.
As brands progress through their lifecycles, payers have influence at various stops along the way; for instance, when a product receives a new indication, or a competitor enters the market. This white paper is a roadmap to understanding how payers can impact a brand’s commercial journey.
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