Continued Consolidation of Power Could Impede Access by Pharma Reps, According to HealthLeaders-InterStudy

June 19, 2012—Nashville, Tenn. —HealthLeaders-InterStudy, the leading provider of managed care market intelligence, finds that managed care organizations around the country are introducing new plans that strike a balance between patient care and cost control. This consolidation of power could emphasize generics and hinder pharmaceutical company sales representatives’ access to prescribing decision makers, according to research from HealthLeaders-InterStudy.

In California, Blue Shield of California is engaging in a statewide re-contracting initiative for the first time in 10 years. The company is looking for a balance between the affordability of narrow networks while minimizing an enrollee’s need to change physicians and possibly disrupting care.

Boston’s Pilgrim Health Care introduced its Focus Network MA earlier this year, a narrow network of 50 hospitals and 16,500 doctors that offers 10 percent savings by excluding Partners HealthCare System and other high-priced providers.

Humana has signed its narrow-network provider groups in Wisconsin to a three-year deal. It offers this narrow network alongside its open-access network to give companies a choice and to keep from losing membership due to the exclusion of health systems in the narrow network.

“As provider networks become narrower, the care of patients will become more concentrated among a smaller pool of physicians,” said HealthLeaders-InterStudy Analyst Laura Beerman. “This will likely decrease the number of prescribing contacts a pharma rep can call on.”