The Market Access function in pharmaceutical companies has reached a stage of maturity, and professionals now want to take a step back, explore best practices and identify the best approach to innovation.
There are four dimensions within Market Access that can secure commercial success; Technology, Stakeholders, Environment, and Management. Each dimension plays a crucial role for organisations when innovating, and the interdependencies between each should clearly be understood.
The Technological dimension of innovation in Market Access is comprised of two segments: digital and big data. Digital focuses on communication solutions, either internally or externally. Internally, the deployment of collaborative platforms between several departments should specifically be designed to ensure it meets the needs for Market Access. For example, the solution can be structured in a way that matches the outline of Health Technology Assessment (HTA) dossiers. Externally, digital communication aims to develop innovative media to improve interactions with payers. For example, the development of tablet applications can facilitate negotiations with hospital procurement groups by showcasing savings made thanks to the introduction of a new medicine.
Big data is the second segment of Technology in Market Access; it encompasses a wide number of solutions which enable more robust outputs and predictive analysis of possible competitive moves which can be triggered by the launch of a new product. These innovative analytical approaches are particularly effective in defining winning pricing and access strategies.
The Stakeholders dimension explores how companies should align with other groups. Payer viewpoints have evolved in the past few years, mainly due to the uncertainty around the efficacy of new products, which were tested in a “theoretical” or “perfect” clinical trial environment, and may not deliver on promises when used in “real life” conditions after launch. Companies must now more and more systematically develop real world data collection plans, in particular for innovative medicines. This needs to be planned a long time prior to launch and companies should consider offering pay for performance models, whereby the healthcare system will not be required to pay for treatments of patients who don’t respond to therapies. This transforms the relationship between companies and payers into a long term, continuous partnership.
Patients’ influence on HTA decisions also have dramatically increased in the past few years, as patient representatives sit with appraisal committees in a growing number of countries. This paves the way to further consideration of their expectations by payers who are traditionally less sensitive than physicians to endpoints such as Patient Reported Outcomes (PROs). Implications for companies are numerous, ranging from clinical trial design to patient advocacy strategies.
The Environment dimension looks at the wider stakeholder group - beyond the sole price and access decision makers - and calls for a more prospective vision. The regulator (EMA or FDA), who until recently was the almost exclusive target of R&D teams, now also enters the Market Access arena via early consultations offered to companies, set up jointly with one or a few HTA agencies (NICE in the UK, HAS in France, G-BA in Germany, etc). Furthermore, discussions are being held by HTA agencies and regulatory agencies to enable some convergence in their expectations in terms of clinical trial design: traditionally the company needs to conduct a trial versus placebo to assess the risk benefit ratio as requested by the regulator, whilst the HTA agency would rather expect an active comparator and might further demand a cost-effectiveness analysis. Companies need to take part in these discussions to refine their approach to trial design and align the communication of results.
Other stakeholders, such as private insurers or the Department of Health also call for innovative approaches and companies are increasingly considering that Market Access strategies should tackle any form of pooled funding, including those under a private scheme, and develop a 360-degree vision spanning all possible models: public coverage, complementary insurance, and out of pocket payment. The Department of Health is also regularly consulted when companies propose a radical innovation, such as a population based capitated payment with risk transfer from the national health insurance to either the company or its dedicated insurance captive.
Finally, the Managerial dimension, which aims to structure Innovation in Market Access in terms of teams’ organisation, remains understated. Even the best pricing strategies might only deliver on their full potential if they are supported by teams whose structure, procedures, systems and performance indicators are well designed and effective. Lacking such foundations, many companies today are willing to perform operational reviews, enquire about best practices in similar groups, and identify relevant metrics to help monitor the performance of their Market Access activities.
The Market Access of tomorrow will be multidimensional; companies willing to achieve excellence in its practice will need to develop multi-faceted strategies, using a much more holistic approach than the sole combination of product positioning and pricing strategy.