Sign in

Blog · Data quality and reconciliation · Pharma

Formulary status as a dimension: why call plans count the wrong accounts

How a pharmaceutical commercial team carries formulary and access status on every account so that reach, frequency and share are computed among the accounts where the product can actually be prescribed, the two lists that fall out, calls on blocked accounts and uncalled accounts with open access, and the dated status that makes a quarter's numbers comparable to the last.

The short answerFormulary and payer access status is a dimension on every account, dated, from the market access team's file. Reach, frequency and share are computed among accounts with open or restricted access, not across all accounts, and two lists come out: calls spent on accounts where the product is blocked, and accounts with open access that the plan does not cover. A call plan that ignores access reports reach against a denominator that includes prescribers who cannot prescribe.

A field team's reach is 72 percent of target accounts. Among the accounts where the product is on formulary, it is 61 percent. Among the accounts where it is blocked, it is 84 percent, because those are the accounts where reps have been trying hardest for the least result. Access status on the account record is what separates the two. This guide sets out the dimension, the recomputed measures, and the two lists.

The dimension

Per account, per month:

Status Meaning Counted in
Open On formulary, no restriction Reach, frequency, share
Restricted On formulary with prior authorisation or step Reach, frequency, share, flagged
Blocked Not on formulary Neither; the calls list
Unknown No access data Listed for the access team

The rows you need

  • Account master: account, territory, target tier.
  • Access file: account or payer, status, effective dates.
  • Call activity: account, rep, date.
  • Prescription data: account, product, period, where held.

Account identifiers only. Prescriber names never leave the source.

The measures, recomputed

Reach = accounts called ÷ target accounts with open or restricted access Frequency = calls ÷ accounts called, among the same Share = product prescriptions ÷ category prescriptions, among the same

And the assertion:

target accounts = open + restricted + blocked + unknown

Two lists

Calls on blocked accounts. Per rep: calls in the period on accounts with blocked status on the call date, and the share of the rep's calls that were. A rep at 30 percent is spending a third of their time where the product cannot be written.

Open access, uncalled. Per territory: accounts with open status and no call in the cycle, ranked by category volume. The reach that is actually available.

A worked example

One territory, one quarter.

All targets Open and restricted Blocked
Accounts 210 148 62
Called 151 90 61
Reach 72% 61% 98%
Calls 604 320 284

Nearly half the territory's calls went to sixty-two accounts where the product is blocked. The open-access uncalled list has fifty-eight accounts on it, and the rep's next cycle is that list.

Where it goes wrong

Access not on the account. Reach is computed over everyone. The measure is flattering and wrong.

Status undated. A formulary change restates history.

Blocked accounts removed silently. The calls spent on them disappear with them. Keep them; list the calls.

Mixed payers ignored. An account half open is counted as fully open. Weight or bucket, and state which.

Every cycle, by access status

Mapped once and dated, the access file, the account master and the call activity produce the recomputed measures and both lists every cycle. Covirage builds this from the exports as they are. The pharma page describes the setup, and the reach and frequency guide covers the base measures this dimension corrects.

Questions people ask

Where does access status come from?

The market access or payer team maintains it by plan and by account or geography, usually in a file updated monthly. It is joined to the account master on the account identifier or on the account's dominant payer, and dated.

Why does it need to be dated?

Because a formulary win in month two changes the denominator from month two, and a quarter's reach must be computed against the access that held in each month. Restating history under today's access makes last quarter's reach move.

What about accounts with mixed payers?

Carry the share of the account's patients under open access, from the payer mix on the account. Weight the account by that share in reach and frequency, or bucket it as open, restricted or blocked at stated thresholds. State which.