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Market Research: OTCs in Managed Care 2004: Taking the Pulse of MCOs and PBMs

OTCs in Managed Care 2004: Taking the Pulse of MCOs and PBMs


Published July 2004

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This study examines the issues and opportunities for OTC companies that are promoting their brands in managed care settings. It provides objective insights on complex issues surrounding coverage/promotion of OTCs among managed care organizations (MCOs) and pharmacy benefit managers (PBMs), including trends in Rx-to-OTC switches and strategies for successful partnering between OTC companies and MCOs/PBMs. (Y575)

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FULL REPORT [US$ 18 000 (eighteen thousand US Dollars)]

INTRODUCTION [US$ 0]

  • Table 1-1 HEALTH CARE INDUSTRY TERMS USED IN THIS REPORT

OVERVIEW [US$ 550]

  • Table 2-1 PREFERRED PROVIDER ORGANIZATIONS IN THE UNITED STATES BY TYPE OF OWNER, 2002
  • Table 2-3 SUMMARY OF LEADING U.S. PHARMACY BENEFIT MANAGERS
  • Figure 2-1 PERCENTAGE OF PARTICIPANTS BY TYPE OF HEALTH CARE PLAN
  • Figure 2-2 SHARE OF PRESCRIPTION DRUG COVERAGE PAYORS IN 2003
  • Figure 2-3 NUMBER OF PARTICIPANTS BY TYPE OF HEALTH CARE PLAN
  • Figure 2-4 HMO PRESCRIPTIONS AND DRUG COSTS, 2001 AND 2002
  • Table 2-4 POLICY ON USE OF OTC DRUGS IN MEDICAID MANAGED CARE PROGRAMS IN SELECT STATES
  • Table 2-2 ENROLLMENT OF LEADING U.S. MANAGED CARE ORGANIZATIONS, 2000 TO 2002

RX-TO-OTC SWITCHES [US$ 2 000]

  • Table 3 1 MAJOR RX-TO-OTC SWITCHES, 1976 TO 2002
  • Table 3-2 PRE- AND POST-SWITCH SALES OF SELECT RX-TO-OTC SWITCHES
  • Figure 3-1 PERCENTAGE SHARE OF OTC VERSUS PRESCRIPTION MEDICATIONS IN ALLERGY-DRUG-PURCHASING HOUSEHOLDS, 2002 TO 2003
  • Table 3-3 ISSUES AFFECTING RX-TO-OTC SWITCH POSITIONS OF KEY HEALTH CARE SECTORS
  • Table 3-4 LIKELIHOOD OF DRUG CLASSES MAKING THE RX-TO-OTC SWITCH
  • Table 3-5 MCO STRATEGIES TO PROMOTE USE OF PRILOSEC OTC
  • Table 3-6 MCO STRATEGIES TO PROMOTE USE OF CLARITIN/LORATADINE
  • Table 3-7 PBM STRATEGIES TO PROMOTE USE OF PRILOSEC OTC
  • Table 3-8 PBM STRATEGIES TO PROMOTE USE OF CLARITIN/LORATADINE

MCO/PBM POSITIONS ON FORCED SWITCHES [US$ 4 500]

  • Table 4-1 CHRONOLOGY OF EVENTS IN PETITION TO FORCE LORATADINE TO SWITCH TO OTC STATUS
  • Table 4-2 CHRONOLOGY OF EVENTS IN PRILOSEC Rx-TO-OTC SWITCH
  • Table 4-3 ATTRACTIVENESS TO MCOs OF DRUG CLASSES FOR RX-TO-OTC SWITCH
  • Table 4-4 RELATIVE COSTS TO MCOs OF COVERING PRESCRIPTION DRUG CLASSES IN 2002
  • Figure 4-1 PERCENTAGE OF MCO SPENDING BY DRUG CATEGORY, 2002
  • Table 4-7 MCOs LIKELY TO COVER FUTURE SWITCHED DRUGS
  • Table 4-8 PBMs LIKELY TO RECOMMEND COVERAGE OF FUTURE SWITCHED DRUGS
  • Table 4-5 POSITIONS OF TOP MCOs ON FORCED SWITCHES
  • Table 4-6 POSITIONS OF TOP PBMs ON FORCED SWITCHES

COVERAGE OF OTC DRUGS [US$ 4 500]

  • Figure 5-1 TYPE OF FORMULARY DESIGN USED BY HEALTH CARE PLANS, 2003
  • Table 5-2 RETAIL PRICES OF SOME POPULAR OTC PRODUCTS
  • Table 5-3 OTC COVERAGE FOR SELF-INSURED EMPLOYERS, 2002
  • Figure 5-2 PERCENTAGE OF HMOs COVERING OTC DRUGS BY MODEL TYPE, 2000 TO 2002
  • Table 5-5 MCOs THAT SPECIFICALLY EXCLUDE ALL OTCs FROM COVERAGE
  • Table 5-6 PBMs THAT RECOMMEND OTC COVERAGE
  • Table 5-1 PERCENTAGE OF HMO MEMBERS AND PRESCRIPTIONS DISPENSED, BY CO PAY TIER SYSTEM
  • Table 5-4 MCOs THAT COVER OTC DRUGS

PROMOTIONAL AND COUPONING PROGRAMS [US$ 4 500]

  • Table 6-1 COMMON PROGRAMS TO PROMOTE OTC DRUGS
  • Table 6-2 FREESTANDING MCO PROGRAMS TO PROMOTE OTC DRUGS
  • Table 6-3 MCOs THAT DO NOT PROMOTE OTC DRUGS
  • Table 6-4 MCO PROMOTIONAL PROGRAMS FOR OTC DRUGS
  • Table 6-5 PBM PROMOTIONAL PROGRAMS FOR OTC DRUGS
  • Table 6-6 COMMON PROBLEMS IN MCO/PBM COLLABORATIONS WITH OTC DRUG COMPANIES
  • Figure 6-1 WELLPOINT PATIENTS WHO FILLED NONSEDATING ANTIHISTAMINE PRESCRIPTIONS, 2002 AND 2003
  • Table 6-7 RECENT NOTABLE PATENT EXPIRATIONS
  • Table 6-8 TOTAL OTC PRODUCT SALES OF LEADING NONPRESCRIPTION DRUG COMPANIES, 2002 AND 2003
  • Figure 6-2 OTC SALES COMPARED WITH MCO PROGRAM STRENGTH FOR LEADING PHARMACEUTICAL COMPANIES, 2003
  • Table 6-9 LEADING OTC PRODUCTS PROMOTED TO MCOs BY PRODUCT CLASS
  • Table 6-10 LEADING PRODUCTS OF OTC DRUG COMPANIES
  • Table 6-11 OTC PROMOTIONAL CAPABILITIES IN THE NONPRESCRIPTION DRUG INDUSTRY

PARTNERSHIP OPPORTUNITIES FOR MCOs/PBMs AND OTC COMPANIES
[US$ 4 500]

  • Table 7-1 OPPORTUNITIES FOR OTC PROMOTIONAL STRATEGIES WITH MCOs/PBMs
  • Table 7-2 AFFECT OF KEY TRENDS ON OTC COVERAGE AND OTC PROMOTION BY MCOs/PBMs
  • Table 7-3 POTENTIAL HIGH-PROFILE RX-TO-OTC SWITCHES
  • Table 7-4 SIGNIFICANT RECENT AND PENDING PHARMACEUTICAL MERGERS
  • Table 7-5 KEY OPPORTUNITIES FOR OTC PROMOTIONS WITH MCOs/PBMs

FORECASTS AND ASSESSMENTS [US$ 4 500]

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