Global Market Access Strategies (PH223)

Building Payer Relationships Through Comprehensive Value Stories
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Published 2016
155 Pages
500+ Metrics
200+ Charts and Diagrams

Market Access Teams: Nurture Payer Relationships for Successful Global Product Launches

In today’s pharmaceutical landscape, payer relationship management is crucial for market access teams to maximize revenue throughout the product lifecycle.  Teams that maintain ongoing engagement with payers and have strong knowledge of competitor activities are a hallmark of world-class organizations.

Cutting Edge Information’s umbrella market access benchmarking study, Global Market Access Strategies, provides a comprehensive look at market access strategy, roles and responsibilities.  It is designed to help market access teams structure and allocate resources to their core and secondary operations.  Key charts showcase market access subfunction involvement in developing and delivering health economics data; team budget and outsourcing benchmarks; and staffing breakdowns of prototypical teams to right-size market access groups.  The report also explores the benefits of internal communication and training on market access functions across an organization.

This study provides executives with best practices and timelines for payer relationship management.  It examines the importance of third-party perspectives in building these relationships and how payer engagement impacts product pricing and launch sequences.  Benchmarks compare year-over-year payer relationship management budgets and product pricing activities.

Data were compiled from global, US and country-level teams at Top 10, Top 50 and small pharmaceutical companies.  Altogether, the report’s metrics and best practices recommend the following to help improve your company’s market access strategy:

  • Nurture payer relationships before, during and after launch to ensure and retain market access.
  • Dedicate unique market access strategies to each product to bring key advantages to the launch.
  • Look to health economics experts to overcome internal clients’ lack of HEOR knowledge.
  • Start core market access activities approximately 18 months before product launch.
  • Be aware of the growth and importance of population health management.

 

Key Questions That This Study Answers About Global Market Access Teams 

  1. How early in development should your company’s different market access teams be involved to best position a product for commercial success?
  2. What strategies can your market access teams employ to develop and maintain payer relationships throughout the product lifecycle?
  3. How much money should your team allocate to specific market access activities, such as HEOR or CER?
  4. What are key strategies for using outsourcing to boost your market access capabilities?  How can third-party perspectives strengthen payer relationships and uphold pricing strategies?
  5. How can unique product launch sequences, as opposed to standard templates, capitalize on product value?
  6. How can your company increase market access teams’ impact by educating other internal functions about the groups’ roles and responsibilities?
  7. How can your company leverage other internal teams’ expertise — such as MSLs and regulatory affairs — to develop and communicate product value stories?
  8. What methods might your company use to monitor competitors’ product milestones, and why is this important to market access teams?
  9. What is Population Health Management, and why is this a growing trend within market access?

 

Top Reasons to Read This Report

Strengthen payer relationship management: Payer relationship management remains the centerpiece of most pharmaceutical market access teams. Drug companies must support these relationships with valuable health economics and pricing research. This study includes insights and data on how market access teams develop and deliver relevant and useful data to enhance payer relationships.

Demonstrate product value at a local level: Pharmaceutical companies must demonstrate the value of products in each individual market by combining market access expertise with health economics, patient-reported outcomes and regulatory affairs. This study provides market access teams with a successful strategy for cross-functional coordination that allows them to develop, distribute and support product value stories.

Develop a launch plan at least 24 months before launch: A successful product launch requires a well-established launch sequencing strategy and the expertise of many in-house functions. However, market access teams often provide a foundation for launch sequencing preparations by connecting with local regulatory authorities, payers and physicians, well ahead of product launch. The data in this study provide launch decision details, timelines and other metrics to help market access teams implement and plan successful launches and launch sequences.

Health Economics for Medical Devices Metrics

Chapter 1: Market Access Team's Structure and Staffing

Chapter Benefits

  • Start market access involvement early — at least 12 months before product launch for most activities — to position the product for commercial success.
  • Utilize senior director/VP management to enable payer engagement to shape product development.

 

Chapter Data

31 charts detailing market access teams’ structure, staffing, activities and oversight.  Throughout the chapter, data are broken down by company size (Top 10, Top 50, and small pharma) and by team region (global, US, EU/Canada and emerging markets).

  • Market access teams’ involvement, by subfunction (company type and team region)
    • Market access/administration
    • Product pricing
    • Launch sequencing
    • Payer relationships (managed markets account management)
    • Health economics and outcomes research
    • Comparative effectiveness research
    • Patient-reported outcomes
  • Current and ideal start times for market access subfunctions (listed above) relative to launch
  • Function responsible for market access activities
    • Market access
    • Managed markets
    • Marketing
    • Corporate affairs
    • Other
  • Final oversight of market access activities
  • Level of executive leading market access group (by company type and by team region)
  • Level of executive with final oversight over market access function (by company type and region)
  • Prototypical market access team structure and FTE allocation (by company size and team region)
  • Average total number of market access FTEs (by company size and team region)
  • Average number of FTEs for market access subfunctions

 

Chapter 2: Calibrate Spending and Outsourcing to Meet Market Needs

Chapter Benefits

  • Use benchmarks and market access team priorities to set budgets.
  • At large companies, market access strategy and payer relationships dominate typical budget allocation.
  • Top 50 and small company market access teams instead focus their spending on increased HEOR and product pricing.
  • Use outsourcing to fill key gaps in internal capabilities, such as payer outreach and outcomes data development.

 

Chapter Data

29 charts detailing market access teams’ budgets, spending and outsourcing. Throughout the chapter, data are broken down by company size (Top 10, Top 50, small pharma) and by team region (global, US, EU/Canada and emerging markets).

  • Average annual market access spending (by company size and team region)
  • Percentage of annual spending dedicated to overhead/salaries (by company)
  • Annual spending dedicated to overhead/salaries (by company)
  • Percentages of budget and FTE allocation for market access subfunctions
    • Market access strategy/administration
    • Payer relationship management
    • HEOR
    • Other
    • Launch sequencing
    • Product pricing
    • CER
    • Patient-reported outcomes
  • Budget allocation for market access subfunctions (listed above) as a percentage of spending, by company type
  • Actual average budget allocations for market access subfunctions (Top 10, Top 50 and small pharma companies)
  • Average budget allocations for market access subfunctions as a percentage of spending (by team region)
  • Actual average budget allocations for market access subfunctions (by team region)
  • Changes in budgets for market access subfunctions from 2015 to 2016 — increase, stay the same or decrease; and percentage change in budget
    • Strategy/administration
    • Payer relationships
    • HEOR
    • Product pricing
    • Launch sequencing
  • Changes in budgets for market access subfunctions from 2015 to 2016 — increase, stay the same or decrease
  • Outsourcing of market access activities, by subfunction
  • Percentage of activity and spending outsourced for the following subfunctions:
    • Market access admin/strategy activity
    • Product pricing
    • Health economics
    • Comparative effectiveness research
    • Launch sequencing

 

Chapter 3: Build Payer Relationships Early to Facilitate Customized Pricing and Launch Sequencing Strategies

Chapter Benefits

  • Forge strong payer relationships by incorporating third-party perspectives.
  • Leverage a mixture of government and pharmacy account managers to fulfill payer relationship objectives.
  • Maintain constant contact with third-party stakeholders to develop and uphold pricing strategies.
  • Develop unique launch sequence strategies to capitalize on product value.
  • Align annual payer relationship budgets with scope of anticipated activities.
  • Begin pricing planning during late-stage clinical development to maximize activity impact.

 

Chapter Data 

36 charts detailing payer relationship management and launch sequencing activities.  Throughout the chapter, data are broken down by company size (Top 10, Top 50, small pharma) and by team region (global, US, EU/Canada and emerging markets).

Payer Relationship Management

  • Percentage of market access groups involved in payer relationship activities (by company size and team region)
  • Number of months before or after product launch for start of payer relationship activities (by company size)
  • 2015 budget for payer relationship activities
  • Changes in payer relationship budget between 2015 and 2016
  • Percentage of companies employing managed market account managers (by account manager type and team region)
  • Number of and total annual cost for:
    • National- and state-level account managers
    • Government account managers
    • Pharmacy account managers

Product Pricing

  • Percentage of market access groups involved in product pricing (by company size and team region)
  • Number of months before or after launch for start of product pricing activities (by company size)
  • 2015 budget for product pricing activities (by company size)
  • Changes in product pricing budget between 2015 and 2016

Launch Sequencing

  • Percentage of market access groups involved in launch sequencing (by company size and team region)
  • Number of months before or after launch for start of launch sequencing activities (by company size)
  • 2015 budget for launch sequencing activities
  • Changes in launch sequencing budget between 2015 and 2016
  • Management of launch sequencing activities and responsibilities
  • Design of product launch sequences (by company size)
  • Management of population health management activities (by company size)
  • Group with oversight for population health management activities

 

Chapter 4: Combining Market Access Expertise with Health Economics, Patient-Reported Outcomes and Regulatory Affairs 

Chapter Benefits

  • Leverage market access teams’ expertise and relationships to support health economics efforts.
  • Pursue comparative effectiveness research at the global level to build a stronger value proposition against competitors.
  • Look to internal experts as well as account managers and medical science liaisons to develop and share health economics data.

 

Chapter Data

28 charts detailing health economics (HE) data development, presentation and support.  Throughout the chapter, data are broken down by company size (Top 10, Top 50, small pharma) and by team region (global, US, EU/Canada and emerging markets).

  • Role of the following subfunctions in developing and disseminating health economics data:
    • Managed markets account managers
    • Medical science liaisons
    • Health outcomes liaisons
    • Health economists
    • Key account managers

Health Economics and Outcomes Research

  • Number of FTEs supporting account managers in HEOR work
  • Percentage of market access groups involved in health economics (by company size and team region)
  • Number of months before or after product launch for start of health economics activities (by company size)
  • 2015 budget for health economics activities
  • Changes in health economics budget between 2015 and 2016
  • Percentage of:
    •  HEOR studies containing retrospective or prospective elements, by company
    •  HEOR studies conducted in-house or outsourced to vendor, by company

Comparative Effectiveness Research (CER)

  • Market access groups involved in comparative effectiveness research, by company size and team region
  • Number of months before or after product launch for start of comparative effectiveness activities, by company size
  • 2015 budget for comparative effectiveness research activities
  • Changes in comparative effectiveness budget between 2015 and 2016

Patient-Reported Outcomes (PROs)

  • Percentage of market access groups involved in patient-reported outcomes (by company size and team region)
  • Number of months before or after product launch for start of patient-reported outcomes activities, by company size
  • 2015 budget for patient-reported outcomes activities

Medical Science Liaisons (MSLs) and Regulatory Affairs

  • MSL role in supporting market access activities (by company size)
  • Regulatory affairs role in supporting market access activities (by company size)

 

Chapter 5: Market Access Team Strategy and Success 

Chapter Benefits

  • Monitor competitor product milestones to ensure that product strategies remain relevant and comprehensive
  • Find ways to demonstrate internal impact through training courses or other cross-functional activities.
  • Overall market shifts and uncertainty have a greater impact on pharmaceutical pricing activities than specific individual regulatory changes.

 

Chapter Data

11 charts detailing market access teams’ strategies, challenges and trends.  Throughout the chapter, data are broken down by company size (Top 10, Top 50, small pharma) and by team region (global, US, EU/Canada and emerging markets).

  • Approach to developing market access strategy (by company type)
  • Functional involvement in developing market access strategy (by company type and team region)
  • Market changes prompting market access strategy reassessment (by company type and team region)
  • Percentage of companies evaluating market access success, by metric (e.g., financial ROI, project goals met, number/proportion of reimbursement success)
  • Challenges facing marketing access teams
  • Trends facing marketing access teams

Global Market Access Strategies Excerpt

The following excerpt is from Chapter 2: Calibrate Spending and Outsourcing to Meet Market Needs

Companies consider a number of key variables when setting budgets for market access functions. Health economic team reporting structures can have a significant impact on market access budgets. HEOR teams at many companies now report into — and are funded by — medical affairs teams. On one hand, this structure can reduce the direct budgetary burden on market access teams when it comes to funding these activities. On the other hand, it can also limit their scope of influence in how research is being guided.

Another major budget factor is the expected reach of payer engagement teams. Payer engagement teams at companies with highly specialized products may have fewer external stakeholders they can talk to than teams with blockbuster products. Specialty products also require managed markets account managers be able to communicate complex economic and pharmacological concepts to payers. Typically, field forces with these specialized skills come at a premium in terms of salary and benefits.

Total Market Access Budgets Increasing for Most Companies 

For surveyed Top 10 company teams, overall market access spending averages around $9 million per year (Figure 2.1). These large teams are typically supporting much larger product portfolios. As a result, large portfolios require proportionally larger investments in outcomes research and payer engagement.

Figure 2.1 (figure not shown) shows that there is a much smaller difference between Top 50 and small pharmaceutical company teams. Overall, surveyed Top 50 teams averaged $1.9 million in spending in 2015. By comparison, surveyed small companies reported $2.1 million in market access spending that year. These findings demonstrate the significant drop in spending that occurs as product portfolios decrease in size.

Health Economics for Medical Devices Sample Findings

The following is a key finding from the report’s Executive Summary:

Consider Product Type When Determining HEOR Study Complexity

Individual types of medical devices require specific HEOR studies to best demonstrate their value in the marketplace. As such, many different types of studies exist that can be used to prove value to payers. When choosing a plan for a given product’s HEOR activity, companies must consider many factors, including:

  • Cost and duration of each type of study
  • The company’s past HEOR experience
  • Payer demands
  • Government regulations
  • Attributes of the product studied

According to one interviewed executive, whether the device is a line extension or an innovative product affects which HEOR studies — and even how many studies — the company performs. A line extension of a previously approved device, for example, will not usually require as much work to determine the price that the company should ask for. This is especially true when the change is minimal and the device maker can request a level of reimbursement around that of the original product. Any increase in price, however, needs to be justified through detailed HEOR data analysis.

Another consideration is whether there are competitors on the market for the developed product. Even if the medical device company does not have its own product to reference, it can use similar products to compare and determine what the market is likely to pay for its new device.

Similarly, a company may create an innovative product that vastly improves upon the current standard of care. In that case, it can more easily negotiate a higher price for its new product by using HEOR data to prove higher value over the current standard. An innovative device with no competitor or without a previous reimbursement set, however, requires the company to perform more extensive research earlier in the development process to determine the device’s market value relative to its outcomes.