Optimizing your hub services program with a gross-to-net lens

Market realities increasingly challenge life science companies’ efforts to unlock the sustainable growth required to continue to offer therapies to patients. Additionally, patient support services have become a necessity to ensure access as payer drug utilization management requirements expand year over year. 

Biopharma manufacturers can not afford to overlook gross-to-net (GTN) when designing and managing their patient support services. A patient centric approach is unsustainable if not balanced by a program design and partners that respond to today’s channel realities. 

What is gross-to-net (GTN)?

GTN represents the difference between the gross revenue from sales at a product’s wholesale acquisition cost (WAC) – or list price – and the actual revenue received by the manufacturer after accounting for various rebates, chargebacks and fees. Essentially, it refers to the shift from the initial list price to actual realized revenue. Consider the follow factors that can influence brand GTN:

According to the Drug Channels Institute, the cumulative total of GTN reductions for branded therapies peaked in 2022 at $250 billion – representing an average brand reduction of 53%. The expanding GTN bubble is a reality that manufacturer teams with a stake in patient access can no longer afford to ignore.

Making the case for taking a GTN lens for Patient Access Programs

The average peak sales forecast for a pipeline drug fell 22% between 2021 and 2022 suggesting.4  Considering this market reality and the downward net sales pressure, it’s clear that GTN should be a factor in access strategies.

Optimizing brand GTN is essential for maintaining profitability and ensuring that treatments remain accessible to a wide range of patients that will benefit. Understanding how GTN management benefits internal stakeholders’ goals can help align teams on a patient-centric and GTN focused approach:

• Marketing: Free up more marketing dollars to grow brand awareness
• Commercial: Enable field team expansion and investment in innovative tools
• Market access:  Create opportunities to maximize coverage at the pharmacy
• Patient access:  Supports investment in financial support programs

5 proven strategies for developing a sustainable patient access program

With siloed channels all too common across the pharmaceutical ecosystem, building effective, GTN incremental hub programs is challenging – but it’s entirely possible with the right approach. These tactics can help brands accomplish that goal:

1. Establish success metrics aligned to brand outcomes

Patient support programs can only deliver value if a high percentage of patients use them to obtain coverage. A poorly utilized program or permanent bottlenecks in the prior authorization process can result in a heavier reliance on manufacturer subsidies, creating a snowball effect that can impact GTN and undermine a brand’s success across the lifecycle. 

2. Evaluate channel partners with a GTN lens

The pharmaceutical channel ecosystem is complex resulting in misaligned incentives. As a result, some entities capture disproportionately more value than they contribute, making it difficult to optimize patient access and GTN. The best way to counteract this problem is to ensure your channel partners (distributors, pharmacies, solution providers) are value-aligned in their approach and pricing.

3. Educate and align field teams

In the era of high drug utilization management (UM) requirements, reliance on the traditional pharma sales model is unlikely to secure levels of adoption and coverage for long term viability. Commercial teams should take an integrated approach with your patient services. They should prioritize patient access and be more responsive to stakeholders, encourage high utilization of preferred channels, and prioritize covered dispenses.

4. Implement effective and sustainable financial assistance programs

In today’s environment, it can be a challenge to ensure these programs are not overutilized. A number of factors can lead to overutilization of these programs including high PA requirements, limited market access, poor controls and a dispense network with significant coverage gaps. Overutilization of your uncovered offering diminishes overall net revenue hampering your overall ability to support patient access. 

5. Take a data-driven approach

Complete visibility across the prescription journey is crucial to brand success. Failure to leverage this information puts your brand at a competitive disadvantage as it adversely impacts patient access. Brands need to use actionable data to make close coverage gaps and make informed decisions on program design.

Ready to position your brand for long-term growth? 

PhilRx is an end-to-end commercialization platform that helps specialty-lite brands unlock patient access to improve GTN. Life sciences companies have access to an integrated, nationwide pharmacy network that helps patients receive prescribed therapy quickly, conveniently, and affordably. Real-time insights give our manufacturer partners strategic visibility across the prescription journey. 

 Learn more by visiting our website at https://phil.us/.