Over the past few years, fueled by the promise of advances in health IT, we've had big data dangled in front of us as a treasure trove of information from which we'll be able to glean associations and answers that have been unavailable to us to date.
But while we await big data, we've got some attention-getting numbers available to us on a subject matter equally as complex: the changing model of care in America.
By 2014, assuming the Affordable Care Act remains intact after Inauguration Day 2013, some 32 million more Americans are anticipated to have access to healthcare coverage and resulting care.
By 2015, the US will have 62,000 fewer doctors than needed. Coupled with aging Baby Boomers, the expansion of insurance coverage, and a 15-year freeze on Medicare funding for residency programs, this gap in providers will surpass 100,000 by 2025.
By 2016, seven of the top 10 best-selling drugs in the US will be specialty drugs – products that require high touch and great sensitivity in handling, distribution, and administration – and cost on average $30,000 a year. That compares to three in the top 10 in 2010.
Here are four suggestions for pharmaceutical marketers wondering what these numbers may mean:
Articulating the value of innovation will be increasingly important and routine
For drugs to command premium pricing, marketers will increasingly need to ensure novel therapies meet litmus tests for innovation, as we see countries like the UK and Germany employing to varying degrees. “Me too” drugs will continue to pay a price as drug approval does not necessarily lend itself to coverage and patient access.
Allied healthcare professionals will become even more central to patient care.
As primary care facilities are overloaded, there will be a need to shift routine health and monitoring of chronic disease to other health professionals. With this, demand for physicians' assistants, nurse practitioners, nurses, home health workers, and pharmacists will continue to rise, and patients will have increased interaction with a variety of medical professionals, dependent upon specialization, cost, and availability.
Consumer responsibility for health will be coupled with choice in how to receive it.
As care moves into the realm of its “third place” – care that's powered by transparent information, mobile technologies, and consumer choice – patient preference will influence delivery of care. Watch for bricks and mortar drug retailers to fill the void through an improved ability to provide care and monitoring at the retail level, and to take on more routine tasks like flu shots and injection training. Patients will benefit from experimentation in delivery models and will have more choice of where to go, whom to see, whether they get drugs by mail or at the corner pharmacy, and the times of day and days of the week when care is provided to them.
Costs associated with specialty drugs will change relationship dynamics, especially between pharmacy benefit managers (PBMs) and patients
Given the need for patients to learn to use expensive medications wisely and have support throughout the course of their disease, versus what we'll soon think of as a simple daily pill regimen, the relationship between PBMs and patients will shift from being transactional to ongoing.
Much has been written about the death of the blockbuster, the patent cliff driving “pharmageddon,” and the paucity of drugs in the pipeline. Nonetheless, in 2011 we saw more new drugs approved – 30 – than we had in nearly 10 years.
No doubt the pressure to innovate and provide access through government payers is a large and complex challenge for the pharmaceutical industry, but coverage for 32 million more Americans, more experimentation in the delivery of care, and better access to medical care along a continuum of medical professionals may yet provide a silver lining – and equally impressive numbers in terms of reduced cost and improved outcomes.
Kym White is global practice chair for health at Edelman.
