U.S. Managed Markets (PH164)

Driving Commercial Success through Outcomes-Based Reimbursement

  • Win US Reimbursement and Build Payer Relationships

    Global trends have pushed managed markets teams into a pivotal position in the US market, where reimbursement has never been more difficult. With concepts such as comparative effectiveness research and value-based pricing floating across the Atlantic, payers dissect new products from every angle. US managed markets teams must prove value in language unique to each payer.  

    To accomplish this task, they anticipate payer needs and unite internal teams behind the most critical goal: earning favorable reimbursement. They communicate objectives to stakeholders and build allies across the organization — from strategic reimbursement, HEOR and pricing to clinical development, marketing and medical affairs.

    This report provides best practices and benchmarks that enable managed markets teams to walk into payer meetings confident and prepared, knowing they have the right answers to each payer’s questions.

    Nurture Payer Relationships

    Earn payer trust by fostering ongoing dialogues and incorporating payer concerns into product plans. The best teams anticipate payer needs and answer questions before they’re even asked.


    Execute Market Access Strategies

    Drug approval is just one stop on the road to commercial success. Integrate market access needs into product development to generate critical data for payers, and plan beyond reimbursement to defend and improve formulary positioning.


    Master Team Operations

    Market access ultimately rests on the managed markets team. Use budget benchmarks, staffing metrics and structure breakdowns to strengthen this group — and understand how US groups fit into global market access as they overcome the most common operational challenges.

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  • Companies Included in US Managed Markets Research

    • Accuray
    • Advanced Vein Therapy
    • Amgen
    • Bayer
    • Becton, Dickinson and Company
    • Cephalon
    • CSL Behring
    • Fianchetto Specialty Products
    • Genentech
    • Genzyme
    • Gilead
    • Grunenthal
    • Ipsen
    • NuPathe
    • Pfizer
    • Smith & Nephew
    • Swedish Orphum Biovitrum
    • Teva
    • ...plus more


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  • US Managed Markets Metrics


    Chapter 1: US Managed Markets Structure and Resources

    Chapter Benefits

    • Explore US team structures within global market access organizations.
    • Track staffing data for whole teams and specific roles.
    • Coordinate marketing and managed markets to develop cohesive messaging and avoid duplicate work.
    • Track managed markets budgets and allocations for key costs.
    • Break down compensation metrics for 7 roles, including national and regional account managers.


    Key Metrics
    52 charts focused on these topics:


    • Department that manages payer relationships (broken down by company type)
    • Percentage of US teams that report into global groups
    • Leadership of the managed market function

    Team Staffing and Compensation

    • Staffing for managed markets teams (by company type and size)
    • Staffing breakdown (%) for managed markets roles (by company type)
    • Senior management compensation metrics
    • Line management compensation metrics
    • Analyst compensation metrics
    • Account management directors compensation metrics
    • Account line management compensation metrics
    • National and regional account management compensation metrics

    Team Funding

    • Managed markets budgets (by company type and size)
    • Internal sources of managed markets funding (by company type and size)
    • Division and allocation of budgets (by company type and size)
    • Operating budgets, total team compensation and travel expenses (by company type and size)
    • Operating budget allocated to specific roles (by company type and size)


    Chapter 2: Managed Markets Strategies and Processes

    Chapter Benefits

    • Build a high-level strategic gameplan for managed markets.
    • Start reimbursement planning as early as possible to give all stakeholders time to contribute evidence needed by payers
    • Coordinate departments and teams behind an overarching access strategy
    • Communicate goals across the company.
    • Build a full product story, including benefits, differentiation from competitors, and compelling reasons for reimbursement.
    • Maintain clear lines of communication among internal stakeholders.
    • Attune the company to payer needs and establish early dialogue with payers.
    • Incorporate payer feedback into product development and reimbursement strategy.
    • Turn account manager into go-to source of information for payer.
    • Look beyond reimbursement to continually defend and improve formulary positioning.


    Key Metrics
    21 charts focused on these topics:

    • Percentage of companies that target specific payer organizations (by company type and size)
    • Ratings of specific payer organizations (by company type and size)
    • Earliest point at which payer communication begins
    • Latest point of contact with payers
    • Ideal timelines for payer communications across different company types


    Chapter 3: Managed Markets Challenges and Trends

    Chapter Benefits

    • Overcome 9 key operational challenges to improve team results.
    • Address 10 critical market factors that create common reimbursement challenges.
    • Gather intelligence via Medicare, one of the least opaque payer organizations:
    • Collect information via quarterly meetings.
    • Listen to decision makers sharing their needs.
    • Leverage Medicare’s status as starting point/benchmark for other payers.
    • Create a culture that makes reimbursement everyone’s responsibility and focuses on gaining the highest possible reimbursement.
    • Gain from European experience to prepare US teams.
    • Understand how US payers look to Europe.
    • Prepare for evolving pressures such as comparative effectiveness and reference pricing.
    • Understand how European groups approach different barriers to market access.
    • Build bonds with European counterparts to gather feedback and advice.


    Key Metrics
    21 charts focused on these topics:

    Ratings of specific operational challenges

    • Anticipating and meeting payers’ demands
    • Gaining an audience with payers
    • Coordinating national and regional account managers
    • Communicating among managed markets teams
    • Working with clinical teams during development
    • Incorporating HEOR data into HTAs
    • Finding high quality, affordable information
    • Managing vendors
    • Impact of trends



    Impact ratings of specific market challenges

    • US economic turmoil
    • US health reform
    • Comparative effectiveness research
    • Medicare Part D
    • EU economic turmoil
    • AMNOG in Germany
    • Reference pricing
    • Value-based pricing
    • Increased use of generics
    • New biosimilar pathways





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  • US Managed Markets Report Excerpt


    The following excerpt is a key finding from the full report’s Executive Summary.

    Involve Commercial Teams in Managed Markets Decisions

    For better or worse, the managed markets team is an arm of the commercial side of the business. Yet many companies do their best to keep managed markets separate from marketing and the brand teams. “Compliance is afraid of how it might look,” said one interviewed executive. But companies that do not allow these teams to work together miss out on a key benefit: unification of message. The executive said he feels that his team spends significant time communicating a specific value proposition to a payer, only to have the marketing team go in a completely different direction. While the messages were true, using both only served to confuse their payer audience.

    Company D chose to make the integration of marketing and managed markets a priority, so the company promoted a managed markets executive to the position of director of marketing for a specific disease state. Her role involves looking at the marketing resources across the board and determining how the company can best position each product via marketing messages and managed markets activities. In the past, managed markets would have to forcefully argue for each resource it received; now, the director of marketing can prioritize funding toward specific products that might need a higher concentration on managed markets.

    Similarly, Company E’s reimbursement team works closely with marketing. With payers becoming more important initially than physicians and patients, the reimbursement team partners with marketing to create payer-centric marketing pushes. Together, they develop materials for the account managers to present to the payer representatives during their meetings. Typically included in the materials are overall value statements and reimbursement justifications along specific disease lines. By collaborating, marketing and managed markets serve to better meet the needs of both teams and use fewer resources — which frees up resources to explore new projects or even expand.

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