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.
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.