Market Access Management (PH160)

Market Access Management Report Sample

The following excerpt is taken from Chapter 1, “Structuring and Funding Market Access Teams.” It discusses the benefits and potential drawbacks of having market access operate as a separate, autonomous group. The full chapter explores several structures and reporting relationships for the market access team, including alignment by therapeutic area or region and reporting lines to commercial groups or research and development.

Functioning as an Autonomous Group

Figure 1.4 [data shown in full report] shows that at 25% of surveyed companies, market access did not fall under the umbrella of any larger group. In these cases, the head of market access has the ear of the most senior management in the company.

Having a market access group that operates independently of other functions is a positive sign, as these groups have their own budget and design strategy independent of other groups. The senior market access executive can present strategies directly to C-level executives, where they are more likely to be incorporated into a company’s global strategy.

Autonomous groups can also enter the process as early as they would like, which is often earlier than they are invited into the process by other groups. At one company with an autonomous group, the market access group is involved in the stage-gating process, helping to determine if the product will pass to the next phase of development. At this company, this level of participation was not present when the market access group reported to the clinical division. After gaining autonomy, the market access group embarked on a campaign to educate project and business leaders on the dangers of development products that are not reimbursed. As a result, the market access group gained a seat at the table during the stage-gating process.

Although autonomous groups are more likely to influence the most senior-level executives, they also run the risk of being siloed, with less influence on the teams that are implementing market access strategies. Independent groups need to ensure that commercial and clinical divisions are familiar with their market access goals and are willing to implement them.

One executive, whose products are used primarily in hospitals, feels that his organization will eventually shift to this structure. In the past, physician preference had been a large driver of product revenues. But as hospitals consolidate vendors and create preferred vendor lists, the importance of market access groups will increase. As a result, they will become key drivers of product strategy, warranting autonomous teams.

The following is excerpted from Chapter 2, “Market Access Activity-Level Spending and Processes.” It analyzes budget allocation for comparative effectiveness research. The full chapter presents detailed spending, staffing and outsourcing data for seven market access activities/subfunctions: pricing, health economics/outcomes research, comparative effectiveness research, managed markets (reimbursement and account management) and government affairs.

Comparative Effectiveness Research Team Spending

Market access budgets dedicated to CER differ by region (Figure 2.28, data shown in full report). Companies in the US have larger budgets than companies in emerging markets due largely to the current and upcoming patent expires – companies are doing everything they can to extend existing drugs or establish new ones. Company 6, a Top 50 company, has a budget of $340,000, which is significantly larger budget than other, smaller companies in the US (which have less than $50,000). This indicates company size correlates with budget size: the more money a company has in the US, the more it is able to dedicate to CER.

However, though US companies surveyed may have larger budgets, companies in emerging markets allocate a larger percentage of their overall market access budget to CER than companies do in the US or Canada (Figure 2.29, data shown in full report). Oftentimes, countries in emerging markets do not have the financial resources to approve multiple drugs for the same indication, so companies must make solid cases for why their products are also needed. This is where CER comes in. Running head-to-head trials can provide countries with the data necessary to support adding additional drugs to their formularies. Also impacting the percentage of market access budget dedicated to CER (Figure 2.30, not shown) is company size. Top 10 companies, which face the current patent cliff most directly and must rush to prove product effectiveness to payers, dedicate the largest percentage of their budgets to CER in an effort to maximize revenue from their existing and upcoming drugs.

The following is excerpted from Chapter 3, “Market Access Strategy and Challenges.” This excerpt discusses one of the key challenges for market access teams: establishing effective communication with payers. The full chapter examines market access teams’ strategic initiatives, placing a high focus on best practices and case studies. Key sections include involvement by market access subteams in different lifecycle stages, methodology behind strategy evaluations and challenges related to operational concerns and to marketing events.

Talk to Payers Early

In any aspect of a company, the most important consideration for a team is its audience, or customers. The major external customer the market access team aims to please is the payer. Unfortunately, too many companies neglect to take advantage of the number one driver of payer satisfaction: the payer itself. The clinical group solicits input from regulatory agencies to ensure it tracks the right endpoints, and the marketing team runs focus groups consisting of patients and physicians to determine whether the marketing strategy works. Market access teams need to ensure that they have addressed every concern of their payer audience. If they can handle these concerns pre-launch, the brand stands to garner significantly higher revenues than if a company waits until its product launch to open communications with payers.

One interviewed market access consultant focused on the European market related that her company conducted market research among European payers and influencers. She discovered that almost universally, payers want to be educated about the product before companies solicit reimbursement. According to the interviewed executive, “Even a quick overview just to give them an idea of what’s coming down the pipeline would suffice, but many pharmaceutical companies just don’t communicate that to them.”

If nothing else, talking to payers early helps prepare them for the product’s launch. As one interviewed executive said, “Communications at an early stage — before products are released to the market — give policy makers and budget holders a chance to predict and plan for the impact of that product.” If they have time to plan and prepare, a high price tag may not be as alarming as it would be if they were made aware of it at launch. Pharmaceutical companies do not want to be associated with added stress; gaining attractive reimbursement is difficult enough already. Instead, they should take the time to ensure a smooth transition for the payer. As the executive concluded, “[Payers] don’t like surprises.” Some companies worry about conflict of interest, but talking to payers pre-registration does not give a team preferential treatment.