Payers’ operations have changed a year after Covid-19
Covid-19 changed the landscape of healthcare. Pharma companies had to ramp up their digital outreach to continue uninterrupted business. Patients faced other challenges, primarily of losing in-person access to doctors and treatments that were administered at hospitals, physician offices or medical centers. The Managed Care Organization (MCO) or payers are an important intermediary between pharma companies and patients. They manage and implement insurance and medical benefits. Pharma companies present their products to payers, who determine how it is placed in the market, the right price and access for it, and consequently, its affordability to patients.
Unlike the European Union, which has single payer systems, the US has a hybrid multi-player model, including Medicare (government benefit for the elderly), Medicaid (government benefit for low-income groups) and commercial insurance (employer-sponsored health plans). Additionally, there are Accountable Care Organizations (ACOs), Health Maintenance Organizations (HMOs), Integrated Delivery Networks (IDNs) and pharmacy benefit for outpatient drugs, managed by Pharmacy Benefit Managers (PBMs) or companies like Blue Cross Blue Shield.
Given the critical role payers play in access to drugs for patients, this study sought to understand the impact of Covid-19 on their business, how it affected their interactions with manufacturers, how they were adapting to the virtual world, what delays they encountered in new drug releases and what they saw as the way forward.
The survey was conducted in the April to June 2021 quarter by Medical Marketing Economics (MME), an Indegene company, with respondents from its panel of payers. In the US, MME’s panel includes over 100 payers, covering Medicare, Medicaid and Commercial. The study identifies disruptions to the business, impact on care delivery and impact on payer-manufacturer relations. It also offers future expectations in these areas from a payer perspective.
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