Well, thanks for having me Williams. So as Williams said, my name is Doral
Fredericks. I am the vice president of Medical
Affairs and Global Communications, for Bausch + Lomb.
just to give you a quick background as to why I'm actually okay to talk about this,
since I'm not in sales, or I manage markets anymore.
I did my PharmD., MBA at USC, and then worked at a residency at Kaiser
Permanente in Harbor City, which sort of the port of LA area.
was there, got hired on, and was there for about a year, and decided the
industry was really where I wanted to, to go.
So I started out as an MSL with Aster Pharmaceuticals which became AstraZeneca.
Was there for about two and half years, and then moved over to Novartis for about
nine. And at Novartis I did a variety of
different things. As a medical science liaison, director of
the MSO group, as a director of the managed market, hence why I'm talking
about this. and then, finally left off as the
Regional Medical Head for the Western Uni, or the western part of the, the
States. and then moved over to Ista
Pharmaceuticals as a Vice President of Medical.
Ista was a small, opthalmic company, based in Irvine, which was recently
acquired by Bausch + Lomb. And so I was asked to stay on as the VP
of Medical and Global Communications with, with BNL.
So I've been with them since about last June.
All right. So I've done a variety of things in
industry, and glad to be here, talking to you today.
All right. All right.
So talking about kind of what, what I want you guys to achieve today.
Fairly easy. this'll be a casual lecture.
So please, ask questions as we go along if you have them.
because the more, I know this stuff already.
So it's better for you to ask me the things that you're interested in, and I
can give my insights on things. So what I'd like you to walk away from
this lecture, is to understand managed markets and, and how it's really working
in the new healthcare landscape. Because with the Affordable Care Act,
things are changing very quickly. 'Kay.
I'd also like to give you an idea about the things that you have to think about,
with regard to putting together managed care strategy and a sales strategy.
And those are the two things. So if you get that, you're good.
So I'm going to break this down into kind of three ways.
The first one being sort of an overview of managed markets, the healthcare
landscape, and, you know, what we're really thinking about when we're talking
about managed care right now. 'Kay?
We'll then go into what makes up a good manage care strategy, and how that
relates to a sales strategy. Now have you guys had your marketing
lecture yet? The pieces of like, what goes into
marketing for commercialization product? I'll take that as a no.
[LAUGH] Alright. I'll be touching a little bit upon that,
normally that lecture comes first, but I know it's always changing based on when
the lecture available. So if you have any questions about how
that fits in, let me know. But, managed markets sales and marketing,
all really fit very closely together. So it's really important to understand
and think about aspects of each of them. 'Kay?
When we're thinking about the first thing is who our managed, managed markets
customers. There's two main things to really think
about. First one, they are entities that play a
key role into how drugs are delivered to patients, and the rates that they're
going to be paying for it. Alright?
they do exert a lot of influence now, especially more than ever, over the
choices of drugs that physicians and pharmacists can give to their patients.
and what's interesting is they can become, they can be public or private.
So the, the public is really the government paying.
And the government is becoming a larger and larger piece of this whole puzzle.
15 years ago, Medicare Part D didn't exist.
Medicaid was relatively small, and it was the manage care landscape was dominated
by, by the Signa's, the Aetna's and the United's.
That power is actually shifting, and I'll show you how that impacts pharmaceutical
industry, in just a minute. Okay?
So we when talk about sort of the largest manage care channels, what are we
thinking about? So the first one, are commercial plans.
And these are private entities that are either Manage Care Organizations, or
Pharmacy Benefit Managers. Okay?
What's interesting and something to keep in mind about these, is Manage Care
Organizations probably aren't quite as price sensitive as you might think.
It depends. It, it really depends on if they're an
integrated force, or if they're carved out.
And what I mean by that, is companies that sort of do disease state management
are much more conscious of the overall cost of care, as opposed to just the cost
of medications. So even though a medication may be little
bit more expensive, they may be willing to put it on formulary, because, overall
it may decrease utilization. Alright?
As opposed to, like, the Pharmacy Benefit Managers, or carve outs, in the Managed
Care Organizations that are interested only, well really only in price.
So a couple of things to keep in mind. People have different reasons for making
decisions. Alright?
Now, the commercial plans are really still the principle source of coverage
for a lot of people, specifically those who are employed or retiree coverage.
it covers about 100, 170 million Americans, and this, you know, continues
to grow as the population gets, it gets larger so, it's still a very, very
important piece. And they administer, like I said, either
medical or pharmacy benefits for these patients.
Medicaid is, as you guys are probably aware, a public source.
It's, it's a combination of federal and state funding for low income Americans.
All right? currently about 55 million Americans are
enrolled in the, in the different states. What's interesting is under the
Affordable Care Act, there's discussion that up to about 12.5 plus or minus a
million patients may actually go into the Medicaid system.
So you're going to have more patients in that piece.
And there's a continual struggle, because the Federal government doesn't want to
pay for it necessary. The States don't want to pay for it, so
it's like, we're getting these people in the system, but who's going to pay for
it? So it's always, always a challenge.