Professional Documents
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Group 1L - Merck Medcos
Group 1L - Merck Medcos
Made By:
Group 1L
Harsh Sharma Snehal Lokare
Pankaj Ranjan Vaishali Mathpal
Vikas Goyal
2 Agenda
Case Background
Industry Background
What is PBM ?
Sources of Income
Our Insights & Analysis
2 channels of distribution:
Wholesaler Retailer (Wholesaler made 5-8% Gross Margin)
Mail Service Pharmacy (No wholesalers)
Industry was also classified according to therapeutic category
Traditional Success – Development of patented brand name ethical drugs
Traditional boosted initial sales, but on expiry of patent sales declined rapidly
So originally therapeutic efficacy was key element for success, over time
manufacturer’s reputation and sales & marketing effectiveness also important
5 Industry Background
3 phases of FDA approval. Successful approval in all phases needed
Manufacturers applied for patents at time of compound discovery, Patents only
for 17 years, hence only 5 years in market as patent drug
To supplement new product flow, firms formed joint ventures with other firms
In early 1990s, due to growing healthcare expenditure, pharma companies
were accused of hyper inflation
Also market went from being physician controlled to managed care
organizations which led to transfer of purchasing power from manufacturer
In mail distribution channel, cost containment was achieved by reducing co-
payment costs for customer. Led to dispensing process being more efficient
6 Pharmacy Benefit Management
Initially, manufacturers supplied products to wholesalers, chain and
independent pharmacy retailers and mail service retailers
PBMs negotiated lower reimbursement rates in comparison to traditional insurers
They got networks of retailers which increased competition between them
thereby reducing dispensing prices
This network created by PBMs also helped them reimburse the pharmacies
based on a previously agreed discount price based on AWP index
PBMs customer base: 1/3rd self insured employers, 1/3rd HMOs, 1/3rd PPOs
PBM focussed on claims processing, discount negotiation, formula development
& mgmt. and rebates from manufacturers
Also they had to take care of the mail order division.
7 Functions of a PBM
Developing and maintaining a network of providers
Claims processing
Benefit program design input
Drug use control through formularies which were of 3 types:
Open
Incentive based
Closed
Drug use control through Drug Utilization Reviews: improve quality of pharma
care& generate savings
Retrospective
Concurrent
Drug use control through Health Management: helped reducing costs of
chronic disease treatment
8 Sources of Income, Effect on Customer
Manufacturer rebates: from manufacturer
Administrative fees: from plan sponsor
On Discounts from retailers on prescription drugs
As a central repository & distributor of information
Effect on Customer
Customers who used formulary drugs had more benefit from PBMs
Customers who were not on regular drugs ended up paying more than before for the
same drug in case the drug wasn’t covered in the formulary. This happens especially
when physician prescribes a specific brand name which is not on the formulary of PBM
Vertical Integration
Comments from Roy Vagelos, former Merck CEO
“In classic terms of competition, we could see that the power of the
buyers was growing…PBMs were…bringing together the person who
chooses the drug and the person who pays for the drug.”
“Having salespeople visit doctors’ offices does not allow us to reach
PBMs, HMOs, or plan sponsors -- the major players in the emerging
market.”
Merck bought Medco as a response to managed care
Strategic attempt to capture market power
Follow-up on patients with chronic illness who may stop taking
prescribed meds
Position Merck drugs favorably on formulary
e.g. lower patient copay, or lower cost to plan sponsor
10 Motivation
Project Paradigm, studied the changing industry environment
Redefine their role, not just as purveyors but as providers of healthcare solutions
Views on the effectiveness of drug therapy. team drawn to an alliance with or
the acquisition of a PBM
With R&D expenses that running at 8% of sales, any process that lessened
development risk, impact on profits
By 1993, Project Paradigm considering the advantages of acquiring a PBM
Merck’s move to become part of Medco’s formulary was important, willingness
to enter the Pharmacy benefit environment
11 Industry Reactions
Reacted strongly against Merck’s association with Medco
Independent pharmacies shrunk from 33000 to 25000 lost business to PBM’s and
HMO’s
Despite the vehement response from druggists, many discounted a potential
threat to Merck-Medco
Shortly after acquisition, two of Merck’s key competitors, Eli Lilly and SmithKline
also purchased PBM’s
No single company has a sufficient broad product line to fulfil customers’ needs
Despite the difficulties Merck remained pleased with Medco
12 Merck-Medco Evolves
Increased covered lives by 6%, 40% in drug spending
Merck’s share Medco’s $9 billion drug spend has risen to 15 %, up from approximately
10% prior to the merger
Merck’s corporate growth target of 15% to 20%
Merck-Medco’s health management programs targeted a potential patient
population of about 50 million patients
Health management is where Merck-Medco can add real value and where the
margin opportunities exist
Merck-Medco invested heavily in Information systems, spent in excess of 50$ million
on its customer service and 120$ in IT
Name reflects the change-used to be Medco “Containment Services,” now Merck-
Medco “managed Care.”
13
Questions and Answers
1. What was the rationale for PBMs?
1
Patient Pharmacy
2 3
1 4
Doctor 4
Wholesaler
PBM
1
2
Insurer/HMO 3
Pharmaceutic
2 3 4 al
1 2 Manufacturer
Employer 2 3 4
Disease
Monetary/Transactio 3 DUR/formulary 4 managem
1 Service/prescript on flow 2 n flow management
PROGRAM DESIGN:
Program
Information
Provided to High Risk
physician and Education,
patient Counselling, Case
Patient
Patient Management
identified
completes Referral
through STRATIFY
drug questionnaire
claims
Physician gives
HbA1c Rx Mod/Low Risk
Newsletter, 1-
800 Infoline
2.Strategic fit of Merck-Medco
Needs of Merck
A R&D firm looking for Increased sales of their drugs
Advantages:
Medco Containment services Inc. a firm that specialised in integrated drug
benefit plans and pharmacy services to managed care markets
Marty Wygod, saw an opportunity to revolutionise the distribution system through
centralised mail service distribution that would save the cost associated with
intermediaries margins
Merck found that Medco’s clients base was complementary to chronic care
drugs
Their clients were predominantly Fortune 500 companies, Blue Cross/ Blue Shield
plans, insurance carriers, Federal, State, and local governments, and union
plans which covered their enrolees for life
These clients would be more interested in chronic care therapies which,
although more expensive in the short term, would likely save cost over the life of
patient
3. What does Medco bring to Merck? What
20
are the advantages and disadvantages?
(contd.)
Medco offered “integrated pharmacy services”
Medco’s competitive strength lied in mail service which offered efficient, economic
delivery
Medco offer retail card program, clinically driven programs
Medco again challenged the industry by offering its clients benefit plans with built in
cost savings
Retail card program for prescriptions dispensed from PAID network
Medco delved further into clinically driven programs such as patients profiling and
outcomes research, however, it recognized a need for further clinical expertise
Medco’s strength was in mail service which offered efficient, economical delivery of
long term prescriptions via its 23 pharmacies
Mail Room
Coding of new
Mail Service Pharmacy prescriptions
Delivery “Edits”/Protocols for
incomplete or
Data Entry inconsistent data
Prescription
Filling
Pharmacist
Check
Shipping
4. What does Medco get from the Merck
22 acquisition?
Acquisition would eliminate key information gaps in the drug delivery system
Acquisition of Medco - Step for a new paradigm for pharmaceutical industry
Vision to create the world’s first coordinated pharmaceutical care
Merck - America’s most admired company, 7th straight time in Fortune magazine, a
repeat winner of Best sales Force in the Industry
6/8, Recruiting Top Salespeople, Quality of training, Opening New Accounts,
Holding Accounts, and Reputation Among Customers
No company had better exemplified the drug industry’s resistance to managed
care than Merck
Merck had sales of $9.6 billion, Medco had sales of $ 1.8 billion
Medco growing at 35% a year by riding the very trend that had threatened to
capsize Merck
5.Future of Health management
Health management: Specific planned programs for treatment of chronic
diseases
Programs developed based on existing medical research suggesting better
therapy and low cost treatment
A rarely found marketing strategy of More for less
This is what customers always want
Using this program customer was saving 440$ per year on an average
Future of Health management(Cont.)
Targeted population of 50 million patients
Era of rising medical costs, in 1973 HMO act – to respond to that
Increase in HMO and decrease in Hospital and private care after that