By Michelle Vitko,
Senior Research Analyst
When companies first approach payer organizations with information about a new product, it is important that managed markets account managers convey why payers need their product. Account managers must have tangible evidence of the benefits when bringing the product to payers, especially since their first meeting with them could also be their last.
We recently interviewed a market access director at a medical device company who had faced this very situation. Against his advice, a product marketing team he was working with met with a payer group before there was enough clinical information available to justify reimbursement. The team believed that the lower price of the product would outweigh the lack of scientific evidence behind the product and pharmacoeconomic data. Instead, the payer turned them down, and they did not get a second chance to present about the product.
Gaining an audience with key payer stakeholders is quite difficult: they are approached by many companies and are pressed to make tough decisions about approving and rejecting treatments. This makes it all the more important to present data clearly and in an unbiased way, allowing payers to objectively assess the benefits of the product. One market access executive compared payers’ situation to finding the right car: “You don’t want a guy to sell the heck out of you for something that maybe you don’t want.”
Account managers who do not bring convincing outcomes and health economics data risk being thrown on the heap of “nice to have” rather than “have to have” reimbursement rejections. But if the payer can clearly see how a prospective treatment delivers greater value to their clients then managed care account managers are in a much better position to get both formulary approval and favorable reimbursement. For example, they might provide customized health economics data, medical education resources or analysis tools to help payers do their jobs. By offering something of value, account managers are able to build access, credibility and better ongoing relationships with payers.