Market Access Case Study: Optimizing Rebate Investments with PBMs & HMOs

Business Type

Division of Top-10 pharmaceutical manufacturer

Functional Area 

Pricing Policy and Analytics for Managed Care


Historically, Managed Care pricing decisions were made based on highly subjective information and emotion, not “fact based” on historic customer and contract performance. This was due in part to data that was so limited and inaccurate that often the customer was contacted to “see how are we doing.” As a result, members of the Pricing Committee realized that this environment was leading to substantial inefficiencies and marginal rebate investments with its managed care customers. We were brought in to help integrate managed care data and optimize rebate investments.

Business Challenges

  • Due to the fact that there was no rebate system in place, all utilization and market share data had to be pulled and loaded from separate Excel worksheets.
  • Prior administrations had taken a very aggressive pricing stance; any changes would most likely result in push back from the customer.
  • The organization was very silo-based, slowing the decision-making process and buy-in of any new pricing concepts.


We helped the manufacturer analyze approximately two years of data for its dominant brand, comprising more than 12 strategic PBMs and/or HMOs within the managed care market. Our team was supplied with imperfect internal data from the Excel worksheets and manually loaded it into our business tool. Analysis of third-party claims data served as a second validation that there were changes that needed to be made. Once the business parameters were defined, key accounts were then prioritized based on business variables, not emotion.


By implementing our Rational Pricing methodology, the manufacturer was able to identify accounts that were underperforming from a market share and rebate investment perspective. We also developed best practice structures for the manufacturer resulting in a more manageable, efficient contact decision-making process.


Key Takeaways

  • New standard operating procedures for managed care pricing developed and implemented by the Pricing Committee
  • Reduced average discount percentage by just less than 5.0 discount points, over approximately a three-year period, the with marginal to no impact on market share performance
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