U.S. Managed Markets

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Pharmaceutical companies’ U.S. market access teams must prove their products’ value each payer.  These teams communicate objectives to stakeholders and build allies across the pharmaceutical organization. This report provides best practices and benchmarks that enable pharmaceutical managed markets teams to walk into payer meetings confident and prepared, knowing they have the optimal answers to each payer’s questions. Earn payer trust by fostering ongoing dialogues and incorporating payer concerns into product plans.

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Report Details

Publication Date: March 2012
Pages: 114
Chapters: 3
Metrics: 500+
Charts/Graphics: 90+

Top Reasons to Buy this U.S. Managed Markets Report

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 Optimal Market Access Strategies: Drug approval is just one stop on the road to commercial success. Integrate U.S. 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: A product’s market access ultimately rests on the team. Use budget benchmarks, staffing metrics and structure breakdowns to strengthen the managed markets group — and understand how US market groups fit into the larger global market access organization as they overcome the most common operational challenges.

You may also be interested in our market access library as well as our individual market access research reports.

Excerpt from US Managed Markets

The market access function in the United States has been around for many years. Since the development of Medicare/Medicaid and the health insurance industry, biopharmaceutical and device companies have been communicating with payers on a regular basis. At most companies, this responsibility — payer relationship management — falls under the purview of market access. While the role has always been an important aspect of commercialization, global trends are pushing managed markets into a pivotal position in the US market.

Ever-growing drug prices, combined with limited funds, leave payers skeptical, at best, of the latest and greatest therapies up for reimbursement. Facing the same economic challenges as payers in Europe, US private and public payers are now looking to their European counterparts for guidance. Catchphrases such as comparative effectiveness research and value-based pricing have floated across the pond to payers in the US. What used to be simple meetings, ensuring that all of the requirements had been met for the product to be reimbursed, have evolved into highly technical discussions on health economic value. Payers haggle over the price of every new product, leaving US market access teams responsible for proving value in the payer’s language.

Table of Contents

9             Executive Summary

12           Study Methodology

13           Profiled Companies

14           US Managed Markets: Five Recommendations for Success

21           US Managed Markets Structure and Resources

22           Team Structures

29           Staffing and Compensation

39           Funding Metrics

65           Strategies and Processes

66           Managed Markets Strategy

79           Processes for Approaching Payers

91           Managed Markets Challenges and Trends

103         Impact of Market-Specific Trends

Charts and Graphics

Executive Summary

15           Figure E.1: Average Difficulty Ratings of Specific Operational Challenges Facing US Managed Markets Teams

US Managed Markets Structure and Resources

22           Figure 1.1: Department that Directly Manages Payer Relationships, Overall

Team Structures

23           Figure 1.2: Department that Directly Manages Payer Relationships, by Company Type

24           Figure 1.3: Level of Executive that Heads the US Managed Markets Function

25           Figure 1.4: Percentage of US Managed Markets Teams that Report into Larger Global Function, Overall

26           Figure 1.5: Percentage of US Managed Markets Teams that Report into Larger Global Function, by Company Type

Staffing and Compensation

29           Figure 1.6: Average Number of FTEs Staffed to the US Managed Markets Team, by Company Type

30           Figure 1.7: Number of FTEs Staffed to the US Managed Markets Function at Top 20 Companies

30           Figure 1.8: Number of FTEs Staffed to the US Managed Markets Function at Top 50 Companies

31           Figure 1.9: Number of FTEs Staffed to the US Managed Markets Function at Small Companies

31           Figure 1.10: Number of FTEs Staffed to the US Managed Markets Function at Device Companies

32           Figure 1.11: Percentage of Total Staffing Dedicated to Each Managed Markets Role, Overall

33           Figure 1.12: Percentage of Total Staffing Dedicated to Each Managed Markets Role, by Company Type

35           Figure 1.13: Average Minimum and Maximum Compensation Levels of Senior Management of US Managed Markets Teams, by Company

35           Figure 1.14: Average Minimum and Maximum Compensation Levels of Line Management of US Managed Markets Teams, by Company

36           Figure 1.15: Average Minimum and Maximum Compensation Levels of Line Workers/Analysts of US  Managed Markets Teams, by Company

36           Figure 1.16: Average Minimum and Maximum Compensation Levels of Sales Account Management Directors of US Managed Markets Teams, by Company

37           Figure 1.17: Average Minimum and Maximum Compensation Levels of Sales Account Line Management of US Managed Markets Teams, by Company

37           Figure 1.18: Average Minimum and Maximum Compensation Levels of National Account Managers of US Managed Markets Teams, by Company

38           Figure 1.19: Average Minimum and Maximum Compensation Levels of Regional Account Managers of US Managed Markets Teams, by Company

39           Figure 1.20: Overall US Managed Markets Budget at Top 20 Companies Managed Markets Funding Metrics

Funding Metrics

40           Figure 1.21: Overall US Managed Markets Budget at Top 50 Companies

41           Figure 1.22: Overall US Managed Markets Budget at Small Companies

42           Figure 1.23: Overall US Managed Markets Budget at Device Companies

44           Figure 1.24: Sources of US Managed Markets Funding at Top 20 Companies

44           Figure 1.25: Sources of US Managed Markets Funding at Top 50 Companies

45           Figure 1.26: Sources of US Managed Markets Funding at Small Companies

45           Figure 1.27: Sources of US Managed Markets Funding at Device Companies

46           Figure 1.28: Percentage Breakdown of US Managed Markets Funding by Source at Top 20 Companies

47           Figure 1.29: Percentage Breakdown of US Managed Markets Funding by Source at Top 50 Companies

47           Figure 1.30: Percentage Breakdown of US Managed Markets Funding by Source at Small Companies

48           Figure 1.31: Percentage Breakdown of US Managed Markets Funding by Source at Device Companies

50           Figure 1.32: Division of Total US Managed Markets Budget by Budget Category for Top 20 Companies, 2011

50           Figure 1.33: Division of Total US Managed Markets Budget by Budget Category for Top 20 Companies, 2012

51           Figure 1.34: Division of Total US Managed Markets Budget by Budget Category for Top 50 Companies, 2011

51           Figure 1.35: Division of Total US Managed Markets Budget by Budget Category for Top 50 Companies, 2012

52           Figure 1.36: Division of Total US Managed Markets Budget by Budget Category for Small Companies, 2011

52           Figure 1.37: Division of Total US Managed Markets Budget by Budget Category for Small Companies, 2012

53           Figure 1.38: Division of Total US Managed Markets Budget by Budget Category for Device Companies, 2011

53           Figure 1.39: Division of Total US Managed Markets Budget by Budget Category for Device Companies, 2012

55           Figure 1.40: Operating Budgets for US Managed Markets at Top 20 Companies, 2011 and 2012

55           Figure 1.41: Operating Budgets for US Managed Markets at Top 50 Companies, 2011 and 2012

56           Figure 1.42: Operating Budget for US Managed Markets at Small Companies, 2011 and 2012

56           Figure 1.43: Operating Budget for US Managed Markets at Device Companies, 2011 and 2012

57           Figure 1.44: Percentage of Operating Budget Allocated to Specific Managed Markets Roles at Top 20 Companies

58           Figure 1.45: Percentage of Operating Budget Allocated to Specific Managed Markets Roles at Top 50 Companies

58           Figure 1.46: Percentage of Operating Budget Allocated to Specific Managed Markets Roles at Small Companies

59           Figure 1.47: Percentage of Operating Budget Allocated to Specific Managed Markets Roles at Device Companies

60           Figure 1.48: Percentage of Operating Budget Allocated to Travel Expenses, by Company

61           Figure 1.49: Total Team Salary Compensation for US Managed Markets Teams at Top 20 Companies, 2011 and 2012

62           Figure 1.50: Total Team Salary Compensation for US Managed Markets Teams at Top 50 Companies, 2011 and 2012

62           Figure 1.51: Total Team Salary Compensation for US Managed Markets Teams at Small Companies, 2011 and 2012

63           Figure 1.52: Total Team Salary Compensation for US Managed Markets Teams at Device Companies, 2011 and 2012

Strategies and Processes

Managed Markets Strategy

71           Figure 2.1: Percentage of Top 20 Companies that Target Specific Payer Organizations

71           Figure 2.2: Percentage of Top 50 Companies that Target Specific Payer Organizations

73           Figure 2.3: Percentage of Small Companies that Target Specific Payer Organizations

73           Figure 2.4: Percentage of Device Companies that Target Specific Payer Organizations

74           Figure 2.5: Percentage of Third-Party Companies that Target Specific Payer Organizations

75           Figure 2.6: Average Importance Ratings of Specific Payer Organizations to Top 20 Company S       trategy

76           Figure 2.7: Average Importance Ratings of Specific Payer Organizations to Top 50 Company Strategy

76           Figure 2.8: Average Importance Ratings of Specific Payer Organizations to Small Company Strategy

77           Figure 2.9: Average Importance Ratings of Specific Payer Organizations to Device Company Strategy

77           Figure 2.10: Average Importance Ratings of Specific Payer Organizations to Third-Party Company Strategy

Processes for Approaching Payers

80           Figure 2.11: Earliest Phase at Which Companies Begin Communications with Payers, Overall

81           Figure 2.12: Earliest Phase at Which Companies Begin Communications with Payers, by Company Type

83           Figure 2.13: Companies’ Preference to Begin Communications with Payers Earlier

83           Figure 2.14: Companies’ Preference to Begin Communications with Payers Earlier: Currently Begin in Phase 3 or Later

84           Figure 2.15: Ideal Phase at Which Companies Would Begin Communications with Payers, Overall

84           Figure 2.16: Ideal Phase at Which Companies Would Begin Communications with Payers, by C     ompany Type

85           Figure 2.17: Time at Which Companies Cease Communications with Payers, Overall

86           Figure 2.18: Time at Which Companies Cease Communications with Payers, by Company Type

87           Figure 2.19: Companies’ Preference to Continue Communications with Payers for a Longer Period of Time

88           Figure 2.20: Ideal Time at Which Companies Would Cease Communications with Payers, Overall

88           Figure 2.21: Ideal Time at Which Companies Would Cease Communications with Payers, by Company Type

Managed Markets Challenges and Trends

92           Figure 3.1: Average Difficulty Ratings of Specific Operational Challenges Facing US Managed Markets Teams

93           Figure 3.2: Quantifying Companies’ Difficulty Anticipating Payers’ Demands

94           Figure 3.3: Quantifying Companies’ Difficulty Gaining an Audience with Payers

95           Figure 3.4: Quantifying Companies’ Difficulty Meeting Payers’ Demands

97           Figure 3.5: Quantifying Companies’ Difficulty Coordinating National and Regional Account Managers

98           Figure 3.6: Quantifying Companies’ Difficulty Communicating Between Managed Markets Teams

99           Figure 3.7: Quantifying Companies’ Difficulty Working with Clinical Teams During Development

100         Figure 3.8: Quantifying Companies’ Difficulty Incorporating HEOR Data into HTAs

101         Figure 3.9: Quantifying Companies’ Difficulty Affording Quality Information

102         Figure 3.10: Quantifying Companies’ Difficulty Managing Vendors

Impact of Market-Specific Trends

103         Figure 3.11: Average Impact Ratings of Specific Market Challenges Facing Current and Future Managed

 Markets Operations

105         Figure 3.12: Quantifying Companies’ Difficulty with US Economic Turmoil

105         Figure 3.13: Quantifying Companies’ Difficulty with US Health Reform

106         Figure 3.14: Quantifying Companies’ Difficulty with Comparative Effectiveness Research

107         Figure 3.15: Quantifying Companies’ Difficulty with Medicare Part D

108         Figure 3.16: Quantifying Companies’ Difficulty with EU Economic Turmoil

109         Figure 3.17: Quantifying Companies’ Difficulty with AMNOG in Germany

111         Figure 3.18: Quantifying Companies’ Difficulty with Reference Pricing

112         Figure 3.19: Quantifying Companies’ Difficulty with Value-Based Pricing

113         Figure 3.20: Quantifying Companies’ Difficulty with the Increased Use of Generics

114         Figure 3.21: Quantifying Companies’ Difficulty with New Biosimilar Pathways