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Particularly at young biopharma companies, senior executives may not themselves know what they need. Biopharma companies need to ensure they have a market access strategist in place much sooner than was true even a few years ago—probably three to four years before the company expects the product to go to market. Working on identifying a market access strategist six months to a year before product launch is now too late.

Then, eventually and unfortunately, the VPs of marketing and/or sales get the boot, since product sales are not growing. The market access function is an important one, but based on my experience, it is often misunderstood and the timing of when it should be added to the corporate leadership team and organization can vary greatly. View our comprehensive Payer Profiles that include detailed books-of-business segmentations, employer and vendor affiliations, geographic lives allocations, and Medical vs. Rx lives breakouts. View parent and payer relationships via clear hierarchy listings and access our proprietary dataset of key decision makers for all target accounts. The EU’s market access strategy, removing of tariff barriers and non-tariff barriers such as technical barriers to trade and sanitary and phytosanitary measures. Look for a partner who can focus on integrating and understanding the needs of both payers and the manufacturers.

Market access is a critical function of a drug’s development and go-to-market strategy, as it sets the stage for a successful product launch. The stagnant developed markets have forced pharmaceutical companies to focus more on the emerging markets, which are touted as being the next engines of growth. Thus, growth for any pharmaceutical company will depend on its performance in these markets. A customized market access strategy integrated with the right processes and talent can help mitigate these challenges, allowing effective commercialization and increased drug accessibility for patients.

Many specialty drugs straddle this division, as they are often managed across both the medical and pharmacy benefit structures. To reduce expenses, some payers practice cost-splitting, in which they process the cost of the drug itself under the pharmacy benefit, while processing the cost of physician administration under the medical benefit. To succeed in their hunt for the right market access executive, leaders must start their search much earlier than ever before, understand in detail the skills and expertise they’re looking for, and broaden their focus.

For payers and Health Technology Assessment (HTA) organizations, the incremental cost-effectiveness ratio (ICER) is used to determine in which quadrant a medical technology falls. In this article, I’ll share five tips to help you not only get started but also succeed in your market access journey. These tips are universally applicable, whether you find yourself in a multinational pharmaceutical or MedTech company, a consultancy, or at the helm of a startup.

Ensuring market access—and the right type of access to the right payers—means more than throwing money at rebates. People with strong commercial backgrounds who have been involved in product launches for complex drug therapies from a marketing perspective normally do well in a market access role. The more launches candidates have under their belts, the better prepared they are; no two market access strategies are alike, but overall expertise helps.

how market access works

For example, because Medicaid is administered by the states, the maximum allowable cost for drugs may differ from one state to the next. In the life of a prescription drug, success hinges on market access—otherwise known as getting paid. One of the biggest challenges pharmaceutical and biotechnology manufacturers face is ensuring they can bring the right treatments to the right patients at the right price.

how market access works

Understanding Health Technology Assessment (HTA) authorities’ requirements throughout the product development phase is crucial for a successful market access strategy and planning. This will increase the likelihood of receiving a fairly priced product and a positive reimbursement decision from the HTA authorities. In this blog we will walk you through the key steps to creating a successful market access strategy for your pharmaceutical product. HEOR plays a critical role in this process by providing the data and evidence needed to support these activities. Through HEOR, pharmaceutical companies can demonstrate the value of their products, justify their prices, and ultimately make their products available to patients who need them. This highlights the importance of HEOR in market access and underscores the critical role that market access plays in the pharmaceutical industry.

Longitudinal lab data can reveal if a patient’s condition is deteriorating over time, which can help manufacturers identify prime candidates for their therapy. By analyzing claims and coverage data in parallel, manufacturers can arrive at a deeper understanding of the patient journey—and determine how to intervene. For example, when a patient is moving from a first-line to a second-line therapy, what’s influencing this shift?

It involves a range of activities, from product development and regulatory submission to pricing and reimbursement negotiations. Each of these steps requires a deep understanding of the market landscape, the competitive environment, and the needs and preferences of patients and healthcare providers. Reimbursement What is Direct Market Access Dma refers to the process by which drug costs are covered by health insurance providers or national healthcare systems. A successful reimbursement strategy ensures that a drug is included on the list of drugs that are covered by insurance companies or national health systems, making it accessible to patients.

The final goal is to determine the lowest out-of-pocket costs for patients and cost to payers. Coverage will also impact how this product will affect the provider and patient experience. The right partner can simplify this process by helping to develop a targeted message while getting in front of the payers necessary to drive market access. Although setting up these meetings can be difficult, the right partner opens doors, helps define a market acceptable message, and facilitates the conversations that are frequently out of reach for the smaller pharma and biotech companies. Reference pricing is typically used by payers to cap prices or reimbursement rates for a particular drug based on certain comparative criteria. Internal or therapeutic reference pricing incorporates prices for other comparators within that particular market, whereas external or international reference pricing (ERP/IRP) would look at prices for the same product in other markets.

  • In truth, Market Access is doing everything necessary to ensure medicines and medical health technologies are available to clinicians when the patient needs them.
  • For many pharmaceutical companies, planning for commercialization only begins in earnest when a drug has been submitted for FDA approval—which is far too late.
  • Amid unprecedented uncertainty and change across the industry, stakeholders are looking for new ways to transform the journey of care.

Pharmaceutical companies will need to effectively manage this extremely challenging group of stakeholders to succeed in the market (9). Addressing fundamental payer questions requires a timely and long – term strategic plan as well as a team with cross – functional expertise and unparalleled understanding of the stakeholder enviornment and access strategies. We are prepared to undertake any challenges due to our vast range of services that start with the initial steps of market access strategy & planning all the way to patient access to the innovation. Throughout the product timeline we also complete pragmatic value dossier, pricing and reimbursement assessments and stakeholder management.

how market access works

Traditionally, R&D, sales, and marketing have been the predominant drivers of commercial success for pharmaceutical companies (2, 3). This traditional market access approach is very linear and involves engaging with physicians, pharmacies, and regulatory bodies for greater product uptake (4), but it includes only pricing and reimbursement activities. However, we define market access as a process that ensures all appropriate patients have rapid and continued access to the product at the right price. This indeed is a broad concept that includes multiple functionalities from a company’s commercial, regulatory, supply chain, marketing, medical, and corporate functions. There has already been a recent shift in the makeup of stakeholders to also include patients, payers, and advisory groups due to their increased role in treatment decision making. These changes have forced an evolution in market access to a value-based approach from the traditional price-based perspective.

how market access works

Gaining insight into which asset will launch the fastest is important so you can funnel your resources into new assets or research as quickly as possible. A market access specialist often serves as the technical expert within the market access team. They are responsible for collecting and analyzing data, researching healthcare policies, and providing insights that shape the company’s market access strategies. Specialists work closely with other team members to ensure that strategies are grounded in solid evidence and align with the company’s goals.