J-codes. ICD-9 codes. CPT codes. UB-04 forms. Medicare reimbursement appeals. Care Management Strategy and Solutions. Formulary access. Business case. Value prop. These are just a few of the vocabulary words from a whole new language I’ve been learning—the language of Payer.
I’ve spent 20+ years in pharmaceutical advertising—long enough that I truly thought there was very little left for me to learn. How wrong I was. When our Payer group expressed the need for more copywriters recently, I answered the call. And the last couple of months have been quite a ride.
Suddenly I was a newbie again. I went from focusing on one or two products with one client to juggling more than half a dozen different brands for three different clients simultaneously. Beyond the multitasking, though, I’m discovering that breaking out of one’s comfort zone is, while scary, the best and fastest way to grow, personally and professionally. And I’m fortunate to have found some very smart—and very patient—teachers along the way.
Payer is the future of our industry. As everyone from the federal government on down turns their focus to managing the cost of healthcare, the days of billion-dollar blockbuster brands (like Claritin—an account I worked on for seven years) are behind us. Budgets are tighter. It’s not enough to convince a doctor to write a prescription when any one of a handful of middle men—pharmacies, pharmacy benefit managers (PBMs), commercial insurers—can step in and switch that branded drug to a generic, charge a hefty copay to discourage patients from paying for it, or just refuse coverage altogether. Efficacy and safety aren’t the most important selling points anymore—they have become the price of entry to a market that is much more cost-sensitive. And patients are more discriminating too—no longer willing to blindly follow a physician’s directives, especially in the current economic environment, they scour the Internet and become educated, sophisticated healthcare consumers in their own right.
We are all going to need to learn this new language—promoting pharmaceuticals in this brave new world requires talking about our brands in a whole new way. The points we use to persuade potential customers are going to have to be more compelling than “Drug X worked better than a placebo.” And I’m excited to have the opportunity to be involved in this emerging area.
My horizons have broadened exponentially in the short time I’ve been involved with Payer—I’ve worked on reimbursement guides, wrote a sales training manual teaching reps how to use a formulary access app, crafted emails announcing formulary status changes, and edited a PowerPoint promoting care management solutions (online resources and programs that encourage patients to participate in improving their health). And I know I’ve only scratched the surface—Payer encompasses a wide range of audiences, not just payers but also HCPs, patients and even caregivers. Future projects could include everything from writing a value prop, to a webinar, to materials for an ad board. I look forward to continuing to learn, and ultimately master, the terminology that sounds like Greek to me today. And maybe, just maybe, I’ll figure out what a business case is, and how to fill out a UB-04 form!
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