Question for group.

[anonymous]

Full disclosure - I am not with your company and I am going to be posting this on a couple of other boards. I am trying to get feedback from some experienced reps on a situation and ethical question I have.

I work for a small pharmaceuticals company and sell an expensive specialty product. Because of price, this product has a 0% dispense rate if it is not reimbursed. Here is where it gets tricky, reimbursement is very challenging but improves 3 fold if a specific diagnosis code is used when the HCP prescribes. Because of this, my company incentivizes us on several factors - individual prescription, completeness of the prescription (our proprietary prescription form includes a diagnosis code which we are encouraged to have checked off) and dispense.

The bottom line is, we are bonuses not only on the script, but also paid on the diagnosis. Several of my colleagues and I feel that we have no business as a sales team encouraging a diagnosis, especially since it is drectly related to reimbursement rates. Looking for your thoughts as a group of long term experienced reps. I've been around CP long enough to know I'll get blasted by a some, hoping for a few educated responses. Thanks.

 

[anonymous]

Full disclosure - I am not with your company and I am going to be posting this on a couple of other boards. I am trying to get feedback from some experienced reps on a situation and ethical question I have.

I work for a small pharmaceuticals company and sell an expensive specialty product. Because of price, this product has a 0% dispense rate if it is not reimbursed. Here is where it gets tricky, reimbursement is very challenging but improves 3 fold if a specific diagnosis code is used when the HCP prescribes. Because of this, my company incentivizes us on several factors - individual prescription, completeness of the prescription (our proprietary prescription form includes a diagnosis code which we are encouraged to have checked off) and dispense.

The bottom line is, we are bonuses not only on the script, but also paid on the diagnosis. Several of my colleagues and I feel that we have no business as a sales team encouraging a diagnosis, especially since it is drectly related to reimbursement rates. Looking for your thoughts as a group of long term experienced reps. I've been around CP long enough to know I'll get blasted by a some, hoping for a few educated responses. Thanks.

Encouraging diagnoses is part of what many reps are supposed to do, and according to those that were in the field pre-1998 (the kick off of the Reach & Frequency wars), thats what they did. However, this industry has been dumbed down to the point that outside of catering lunches and given a half-dozen canned marketing messages, we're not allowed to do too much.

 

[anonymous]

Full disclosure - I am not with your company and I am going to be posting this on a couple of other boards. I am trying to get feedback from some experienced reps on a situation and ethical question I have.

I work for a small pharmaceuticals company and sell an expensive specialty product. Because of price, this product has a 0% dispense rate if it is not reimbursed. Here is where it gets tricky, reimbursement is very challenging but improves 3 fold if a specific diagnosis code is used when the HCP prescribes. Because of this, my company incentivizes us on several factors - individual prescription, completeness of the prescription (our proprietary prescription form includes a diagnosis code which we are encouraged to have checked off) and dispense.

The bottom line is, we are bonuses not only on the script, but also paid on the diagnosis. Several of my colleagues and I feel that we have no business as a sales team encouraging a diagnosis, especially since it is drectly related to reimbursement rates. Looking for your thoughts as a group of long term experienced reps. I've been around CP long enough to know I'll get blasted by a some, hoping for a few educated responses. Thanks.

Your company sounds crooked, they probably violate HIPPA laws, and the pbms will lock you out when they get wind.

Get a new job

 

[anonymous]

I disagree with #2, we sell products for diabetes, not tell docs to dx diabetes so it will go through.

 

[anonymous]

all youre doing is helping the doc utilize the correct icd 10 code. if your drug truly shows no benefit over the others then skip it but if it works much better than comp i say why not

 

[anonymous]

if as you have stated, you are in a specialty rare disease space, the correct diagnosis code is simply the point of entry for benefits verification and reimbursement work to begin. I suspect there are also clinical criteria to be met as a requirement for reimbursement along with the correct ICD-10 code. Most specialty, rare disease molecules also have out of label utilization. Th correct Dx code along with accompanying criteria and clinical info is a critical component of a professional and ethical rep/HCP interaction. All three serve to protect the rep from the appearance of off label promotion. Any other utilization is totally up to the HCP, however the company and/ or its agents are prohibited from providing any service, i.e., reimbursement support or benefits verification. The company is at risk if they incentivize for any utilization outsid the label. I am not familiar with any payer that will reimburse outside of the approved use without extensive work from the HCP and life altering or saving clinical evidence.

 

[anonymous]

thank you.

if as you have stated, you are in a specialty rare disease space, the correct diagnosis code is simply the point of entry for benefits verification and reimbursement work to begin. I suspect there are also clinical criteria to be met as a requirement for reimbursement along with the correct ICD-10 code. Most specialty, rare disease molecules also have out of label utilization. Th correct Dx code along with accompanying criteria and clinical info is a critical component of a professional and ethical rep/HCP interaction. All three serve to protect the rep from the appearance of off label promotion. Any other utilization is totally up to the HCP, however the company and/ or its agents are prohibited from providing any service, i.e., reimbursement support or benefits verification. The company is at risk if they incentivize for any utilization outsid the label. I am not familiar with any payer that will reimburse outside of the approved use without extensive work from the HCP and life altering or saving clinical evidence.