Market Access and Reimbursement

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This comprehensive report examines market access strategy, objectives and trends with data from 70+ pharma and device companies across a range of different markets. Metrics from these organizations detail market access staffing, spending, timelines and activities. Deeper findings discuss how teams build a case for — and communicate — product value to relevant payers (including the development of convincing product value dossiers). Analyze timelines and best practices for integrating input from market access teams into product development decision making.

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Report Details

Publication Date: August 2013
Pages: 250
Chapters: 5
Metrics: 500+
Charts/Graphics: 183

Top Reasons to Buy This Market Access And Reimbursement Report

Market Access Budgets Increased from 2011 to 2013:  Though some companies’ market access budgets dipped slightly in 2012, the general trend of increasing budgets continued through 2013.  Allocate budgets more effectively to key market access subfunctions throughout product development.  Track market access budget trends and projections from 2011 to 2014.

Involve HEOR, Government Affairs, and Pricing Early in Product Development: The timing and level of involvement of health economics and outcomes teams, as well as the government affairs function, can be the key to securing reimbursement for pharmaceutical products.  Coordinate various market access groups’ involvement at the most opportune times during product development — and ensure a smooth launch.  Know when and how often to assess your market access strategy — and establish a schedule to do so.

Prioritize Market Access through High-Level Leadership:  Whether companies have dedicated market access teams or address the function on an ad hoc basis, market access teams are most often led by directors or higher positions.  Discover how companies with and without dedicated market access teams meet reimbursement requirements and support diverse portfolios.  Build market access teams to grow alongside developing products to ensure efficiency and adequate resources throughout development and launch.

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

Excerpt from Market Access and Reimbursement

With such a wide variety of needs, many market access executives have difficulty finding employees who hold any combination of the skills and talents required for the job. Companies should work to attract the talent necessary for a complete team to help market access make the largest possible impact upon company strategy. A highly skilled, efficient market access group allows clinical trials to meet the endpoints that payers want to see, as well as makes sure account managers can best negotiate a better price with the payers. These payers are mainly government entities and insurance companies, but also include hospital systems with their own formularies. The role of market access teams ranges this widely because, even if public and private insurance plans agree to reimburse the product, hospitals need to have it on their own fomulary in order for the product to be accessible.

However, securing adequate resources to build a well-rounded team is a necessity for the success of market access groups. On the whole, market access budgets are steadily increasing, giving the teams more of the flexibility they need to achieve reimbursement for products. Market access budgets are also being allocated efficiently according to current trends in regulations and payer requirements. Health economics and outcomes research (HEOR), for example, has begun to receive a higher portion of the budget than before. This increase in resources follows the trend of government payers beginning to consider and implement requirements for HEOR data upon product launch.

Table of Contents

10           Executive Summary

14           Study Methodology

15           Study Definitions

16           Market Access Strategies: Five Recommendations for Success

24           Fulfilling Market Access Needs through Structure

25           Drivers of Varied Market Access Structures

46           Pipeline Growth and Market Access Staffing Needs

59           Increasing Budgets Indicate Promising Future for Market Access Teams

60           Upward Trends in Overall Market Access Budgets

77           Impact of Pipeline and Other Factors on Budget Allocation

115         Implementing Market Access Activities to Achieve Strategic Goals

116         Market Access Activities

152         Market Access Strategy

164         Outsourcing of Pharmaceutical Market Access Activities and Budget

174         Overcoming Market Access Challenges to Navigate Complex Global Trends

175         Roadblocks to Gaining Optimal Pharmaceutical Market Access

222         Measuring and Demonstrating Market Access Team Success

226         Current Market Access Trends and a Look Forward

229         Market Access Group Profiles

CHARTS AND GRAPHICS

10           Executive Summary

16           Market Access Strategies: Five Recommendations for Success

16           Figure E.1: Average Market Access Budget from 2011 to 2013

18           Figure E.2: Involvement of Functions with Market Access by Phase

21           Figure E.3: Position Heading Market Access Function

22           Figure E.4: Position Heading Market Access Function by Region

24           Fulfilling Market Access Needs through Structure

25           Drivers of Varied Market Access Structures

26           Figure 1.1: Percentage of Companies with Dedicated Market Access Departments

27           Figure 1.2: Percentage of Companies with Dedicated Market Access Departments, by Company Type

28           Figure 1.3: Structure of Market Access Activities

29           Figure 1.4: Structure of Market Access Activities by Company Size

30           Figure 1.5: Structure of Market Access Activities by Region

31           Figure 1.6: Number of Distinct Market Access Groups

33           Figure 1.7: Percentage of Companies with a Separate Market Access Team for Emerging Markets

34           Figure 1.8: Function that Oversees Market Access Activities at Companies with No Dedicated Department

35           Figure 1.9: Reporting Structure for Dedicated Market Access Departments: All Companies

36           Figure 1.10: Reporting Structure for Dedicated Market Access Departments: Top 10 Companies

37           Figure 1.11: Reporting Structure for Dedicated Market Access Departments: Top 50 Companies

37           Figure 1.12: Reporting Structure for Dedicated Market Access Departments: Small Companies

38           Figure 1.13: Reporting Structure for Dedicated Market Access Departments: Device Companies

39           Figure 1.14: Reporting Structure for Dedicated Market Access Departments by Region

40           Figure 1.15: Position Heading Market Access Function

41           Figure 1.16: Position Heading Market Access Function by Company Type

42           Figure 1.17: Position Heading Market Access Function by Region

43           Figure 1.18: Functions Involved with Market Access Teams: All Companies

43           Figure 1.19: Functions Involved with Market Access Teams: Top 10 Companies

44           Figure 1.20: Functions Involved with Market Access Teams: Top 50 Companies

44           Figure 1.21: Functions Involved with Market Access Teams: Small Companies

45           Figure 1.22: Functions Involved with Market Access Teams: Device Companies

46           Pipeline Growth and Market Access Staffing Needs

47           Figure 1.23: Number of FTEs from Functions Involved with Market Access: All Companies

48           Figure 1.24: Number of FTEs from Functions Involved with Market Access: Top 10 Companies

49           Figure 1.25: Number of FTEs from Functions Involved with Market Access: Top 50 Companies

50           Figure 1.26: Number of FTEs from Functions Involved with Market Access: Small Companies

50           Figure 1.27: Number of FTEs from Functions Involved with Market Access: Device Companies

52           Figure 1.28: Distribution of FTEs from Functions Involved with Market Access: All Companies

52           Figure 1.29: Distribution of FTEs from Functions Involved with Market Access: Top 10 Companies

53           Figure 1.30: Distribution of FTEs from Functions Involved with Market Access: Top 50 Companies

53           Figure 1.31: Distribution of FTEs from Functions Involved with Market Access: Small Companies

54           Figure 1.32: Distribution of FTEs from Functions Involved with Market Access: Device Companies

55           Figure 1.33: Number of Market Access FTEs by Region: All Companies

56           Figure 1.34: Number of Market Access FTEs by Region: Top 10 Companies

56           Figure 1.35: Number of Market Access FTEs by Region: Top 50 Companies

57           Figure 1.36: Number of Market Access FTEs by Region: Small Companies

57           Figure 1.37: Number of Market Access FTEs by Region: Device Companies

59           Increasing Budgets Indicate Promising Future for Market Access Teams

60           Upward Trends in Overall Market Access Budgets

61           Figure 2.1: Average Market Access Budget from 2011 to 2013

62           Figure 2.2: Average Market Access Budget from 2011 to 2013, by Company Type

63           Figure 2.3: Average Market Access Budget Without Salaries and Overhead from 2011 to 2013, by Company Type

64           Figure 2.4: Average Market Access Budget from 2011 to 2013, by Region

65           Figure 2.5: Average Market Access Budget Without Salaries and Overhead from 2011 to 2013, by Region

66           Figure 2.6: Total Market Access Budget for 2013, by Company

67           Figure 2.7: Total Market Access Budget Without Salaries and Overhead for 2013, by Company

68           Figure 2.8: Total Market Access Budget for 2012, by Company

69           Figure 2.9: Total Market Access Budget Without Salaries and Overhead for 2012, by Company

70           Figure 2.10: Total Market Access Budget for 2011, by Company

71           Figure 2.11: Total Market Access Budget Without Salaries and Overhead for 2011, by Company

72           Figure 2.12: Handling of Market Access Salary and Overhead Activities

74           Figure 2.13: Percentage of Market Access Budget Dedicated to Salaries and Overhead from 2011 to 2013, by Company Type

74           Figure 2.14: Market Access Budget Dedicated to Salaries and Overhead from 2011 to 2013, by  Company Type

76           Figure 2.15: Average Regional Allocation of Market Access Budget for 2013

77           Impact of Pipeline and Other Factors on Budget Allocation

78           Figure 2.16: Percentage of Market Access Budget Dedicated to Activities: All Companies

80           Figure 2.17: Percentage of Market Access Budget Dedicated to Activities: Top 10 Companies

82           Figure 2.18: Percentage of Market Access Budget Dedicated to Activities: Top 50 Companies

84           Figure 2.19: Percentage of Market Access Budget Dedicated to Activities: Small Companies

86           Figure 2.20: Percentage of Market Access Budget Dedicated to Activities: Device Companies

88           Figure 2.21: Percentage of Market Access Budget Dedicated to Activities: US

89           Figure 2.22: Percentage of Market Access Budget Dedicated to Activities: EU/Australia/Canada

90           Figure 2.23: Percentage of Market Access Budget Dedicated to Activities: Emerging Markets

92           Figure 2.24: Percentage of Companies Predicting Change in Budget Allocation from 2013 to 2014: All Companies

94           Figure 2.25: Percentage of Companies Predicting Change in Budget Allocation from 2013 to 2014: Top 10 Companies

96           Figure 2.26: Percentage of Companies Predicting Change in Budget Allocation from 2013 to 2014: Top 50 Companies

98           Figure 2.27: Percentage of Companies Predicting Change in Budget Allocation from 2013 to 2014: Small Companies

100         Figure 2.28: Percentage of Companies Predicting Change in Budget Allocation from 2013 to 2014: Device Companies

102         Figure 2.29: Percentage of Companies Predicting Change in Budget Allocation from 2013 to 2014: US

103         Figure 2.30: Percentage of Companies Predicting Change in Budget Allocation from 2013 to 2014: EU/Aus/Can

104         Figure 2.31: Percentage of Companies Predicting Change in Budget Allocation from 2013 to 2014: Emerging Markets

105         Figure 2.32: Percentage of Projected Change in Market Access Budget from 2013 to 2014: General Market Access Activities

106         Figure 2.33: Percentage of Projected Change in Market Access Budget from 2013 to 2014: Comparative Effectiveness Activities

107         Figure 2.34: Percentage of Projected Change in Market Access Budget from 2013 to 2014: Government Affairs Activities

108         Figure 2.35: Percentage of Projected Change in Market Access Budget from 2013 to 2014: HEOR Activities

109         Figure 2.36: Percentage of Projected Change in Market Access Budget from 2013 to 2014: HOL Activities

110         Figure 2.37: Percentage of Projected Change in Market Access Budget for Managed Markets: Account Management Activities from 2013 to 2014

111         Figure 2.38: Percentage of Projected Change in Market Access Budget for Managed Markets: Marketing Activities from 2013 to 2014

112         Figure 2.39: Percentage of Projected Change in Market Access Budget from 2013 to 2014: Medical Affairs Activities

113         Figure 2.40: Percentage of Projected Change in Market Access Budget from 2013 to 2014: New Product Planning Activities

114         Figure 2.41: Percentage of Projected Change in Market Access Budget from 2013 to 2014: Pricing Activities

115         Implementing Market Access Activities to Achieve Strategic Goals

116         Market Access Activities

117         Figure 3.1: Involvement of Functions with Market Access by Phase

119         Figure 3.2: Percentage of Companies Involving Dedicated Market Access Teams in Each Development Phase, by Company Type

120         Figure 3.3: Percentage of Companies Involving Dedicated Market Access Teams in Each Development Phase, by Region

121         Figure 3.4: Percentage of Companies Involving Comparative Effectiveness in Each Development Phase, by Company Type

122         Figure 3.5: Percentage of Companies Involving Comparative Effectiveness in Each Development Phase, by Region

124         Figure 3.6: Percentage of Companies Involving Government Affairs in Each Development Phase, by Company Type

125         Figure 3.7: Percentage of Companies Involving Government Affairs in Each Development Phase, by Region

125         Figure 3.8: Percentage of Companies Involving Regulatory in Each Development Phase, by Company Type

126         Figure 3.9: Percentage of Companies Involving Regulatory in Each Development Phase, by Region

127         Figure 3.10: Percentage of Companies Involving HEOR in Each Development Phase, by Company Type

128         Figure 3.11: Percentage of Companies Involving HEOR in Each Development Phase, by Region

129         Figure 3.12: Percentage of Companies Involving Patient-Reported Outcomes in Each Development Phase, by Company Type

130         Figure 3.13: Percentage of Companies Involving Patient-Reported Outcomes in Each Development Phase, by Region

131         Figure 3.14: Percentage of Companies Involving HOLs in Each Development Phase, by Company Type

132         Figure 3.15: Percentage of Companies Involving HOLs in Each Development Phase, by Region

133         Figure 3.16: Percentage of Companies Involving Managed Markets: Account Management in Each Development Phase, by Company Type

134         Figure 3.17: Percentage of Companies Involving Managed Markets: Account Management in Each Development Phase, by Region

135         Figure 3.18: Percentage of Companies Involving Managed Markets: Marketing in Each Development Phase, by Company Type

136         Figure 3.19: Percentage of Companies Involving Managed Markets: Marketing in Each Development Phase, by Region

137         Figure 3.20: Percentage of Companies Involving Medical Affairs in Each Development Phase, by Company Type

138         Figure 3.21: Percentage of Companies Involving Medical Affairs in Each Development Phase, by Region

139         Figure 3.22: Percentage of Companies Involving New Product Planning in Each Development Phase, by Company Type

140         Figure 3.23: Percentage of Companies Involving New Product Planning in Each Development Phase, by Region

141         Figure 3.24: Percentage of Companies Involving Pricing in Each Development Phase, by Company Type

141         Figure 3.25: Percentage of Companies Involving Pricing in Each Development Phase, by Region

143         Figure 3.26: Involvement of Functions with Market Access by Phase: Pre-Clinical Through Phase 2

145         Figure 3.27: Involvement of Functions with Market Access by Phase: Phase 3

147         Figure 3.28: Involvement of Functions with Market Access by Phase: Registration and Launch

149         Figure 3.29: Involvement of Functions with Market Access by Phase: First Year on Market

150         Figure 3.30: Involvement of Functions with Market Access by Phase: Second Year on Market

151         Figure 3.31: Involvement of Functions with Market Access by Phase: Third Year on Market and Beyond

152         Market Access Strategy

153         Figure 3.32: Reasons to Reevaluate Market Access Strategy

154         Figure 3.33: Reasons to Reevaluate Market Access Strategy, by Company Type

155         Figure 3.34: Reasons to Reevaluate Market Access Strategy, by Region

156         Figure 3.35: Scheduled Frequency of Market Access Strategy Reevaluation

157         Figure 3.36: Market Events that Prompt Market Access Strategy Reevaluation: All Companies

158         Figure 3.37: Market Events that Prompt Market Access Strategy Reevaluation: Top 10 Companies

159         Figure 3.38: Market Events that Prompt Market Access Strategy Reevaluation: Top 50 Companies

160         Figure 3.39: Market Events that Prompt Market Access Strategy Reevaluation: Small Companies

161         Figure 3.40: Market Events that Prompt Market Access Strategy Reevaluation: Device Companies

162         Figure 3.41: Market Events that Prompt Market Access Strategy Reevaluation: US

163         Figure 3.42: Market Events that Prompt Market Access Strategy Reevaluation: EU/Aus/Can

163         Figure 3.43: Market Events that Prompt Market Access Strategy Reevaluation: Emerging Markets

164         Outsourcing of Pharmaceutical Market Access Activities and Budget

166         Figure 3.44: Percentage of Market Access Teams that Outsource Market Access Functions

166         Figure 3.45: Percentage of Market Access Teams that Outsource Market Access Functions, by Company Type

167         Figure 3.46: Percentage of Market Access Teams that Outsource Market Access Functions, by Region

168         Figure 3.47: Average Percentage of Market Access Activity and Budget Outsourced: All Companies

169         Figure 3.48: Average Percentage of Market Access Activity and Budget Outsourced: Top 10 Companies

170         Figure 3.49: Average Percentage of Market Access Activity and Budget Outsourced: Top 50 Companies

171         Figure 3.50: Average Percentage of Market Access Activity and Budget Outsourced: Small Companies

172         Figure 3.51: Average Percentage of Market Access Activity and Budget Outsourced: Device Companies

173         Figure 3.52: Average Percentage of Market Access Activity and Budget Outsourced: US Teams

173         Figure 3.53: Average Percentage of Market Access Activity and Budget Outsourced: EU/Aus/Can and Emerging Markets Teams

174         Overcoming Market Access Challenges to Navigate Complex Global Trends

175         Roadblocks to Gaining Optimal Pharmaceutical Market Access

177         Figure 4.1: Perceived Significance of Specific Operational Challenges to Market Access: All Companies

179         Figure 4.2: Perceived Significance of Specific Operational Challenges to Market Access: Top 10 Companies

181         Figure 4.3: Perceived Significance of Specific Operational Challenges to Market Access: Top 50 Companies

182         Figure 4.4: Perceived Significance of Specific Operational Challenges to Market Access: Small Companies

184         Figure 4.5: Perceived Significance of Specific Operational Challenges to Market Access: Device Companies

186         Figure 4.6: Perceived Significance of Specific Operational Challenges to Market Access: US

187         Figure 4.7: Perceived Significance of Specific Operational Challenges to Market Access: EU/Aus/  Can

189         Figure 4.8: Perceived Significance of Specific Operational Challenges to Market Access: Emerging Markets

193         Figure 4.9: Perceived Significance of Specific Market Trends to Market Access: All Companies

195         Figure 4.10: Perceived Significance of Specific Market Trends to Market Access: Top 10 Companies

196         Figure 4.11: Perceived Significance of Specific Market Trends to Market Access: Top 50 Companies

198         Figure 4.12: Perceived Significance of Specific Market Trends to Market Access: Small Companies

200         Figure 4.13: Perceived Significance of Specific Market Trends to Market Access: Device Companies

202         Figure 4.14: Perceived Significance of Specific Market Trends to Market Access: US

204         Figure 4.15: Perceived Significance of Specific Market Trends to Market Access: EU/Aus/Can

205         Figure 4.16: Perceived Significance of Specific Market Trends to Market Access: Emerging Markets

209         Figure 4.17: Perceived Significance of Specific Emerging Markets Challenges to Market Access: All Companies

211         Figure 4.18: Perceived Significance of Specific Emerging Markets Challenges to Market Access: Top 10 Companies

213         Figure 4.19: Perceived Significance of Specific Emerging Markets Challenges to Market Access: Top 50 Companies

215         Figure 4.20: Perceived Significance of Specific Emerging Markets Challenges to Market Access: Small Companies

217         Figure 4.21: Perceived Significance of Specific Emerging Markets Challenges to Market Access: Device Companies

219         Figure 4.22: Perceived Significance of Specific Emerging Markets Challenges to Market Access: US

220         Figure 4.23: Perceived Significance of Specific Emerging Markets Challenges to Market Access: EU/Aus/Can

221         Figure 4.24: Perceived Significance of Specific Emerging Markets Challenges to Market Access: Emerging Markets

222         Measuring and Demonstrating Market Access Team Success

223         Figure 4.25: Methods to Gauge Success of Market Access Efforts

224         Figure 4.26: Methods to Gauge Success of Market Access Efforts, by Company Type

224        Figure 4.27: Methods to Gauge Success of Market Access Efforts, by Region

225         Figure 4.28: Perceived Effectiveness of Market Access Activities

226         Current Market Access Trends and A Look Forward

229         Market Access Group Profiles

231         Figure 5.1: Company A Profile Overview

232         Figure 5.2: Company A Profile Activities

233         Figure 5.3: Company B Profile Overview

234         Figure 5.4: Company B Profile Activities

235         Figure 5.5: Company C Profile Overview

236         Figure 5.6: Company C Profile Activities

237         Figure 5.7: Company D Profile Overview

238         Figure 5.8: Company D Profile Activities

239         Figure 5.9: Company E Profile Overview

240         Figure 5.10: Company E Profile Activities

241         Figure 5.11: Company F Profile Overview

242         Figure 5.12: Company F Profile Activities

243         Figure 5.13: Company G Profile Overview

244         Figure 5.14: Company G Profile Activities

245         Figure 5.15: Company H Profile Overview

246         Figure 5.16: Company H Profile Activities

247         Figure 5.17: Company I Profile Overview

248         Figure 5.18: Company I Profile Activities

249         Figure 5.19: Company J Profile Overview

250         Figure 5.20: Company J Profile Activities