It is not simply a question of determining how much
payers will pay for drugs, but the value of and economic justification for a given drug.
In the face of rising health care costs, payers (including
insurers, pharmacy benefits managers, and government agencies) are exerting greater influence over pharmaceutical markets and demanding insight into a drug’s cost effectiveness compared with
alternative drugs and generics.
To achieve desired results, pharmaceutical executives should
consider revamping the way they develop and market drugs—making market access planning an integral part of their organization—and balancing clinical and economic value in product development and
Executives at pharmaceutical companies should integrate the
payer perspective throughout the suite of decisions they make. It is not sufficient to “bolt on” a new market access or payer plan to an existing set of brand strategies.
Based on experience with our clients, we have
identified six requirements to help manage the increasingly complex market access environment:
- Decisions based on economic value begin in the development
lab. Early-stage drug development decisions should be informed by an understanding of the commercial potential of the compound, not just the ability to meet a medical endpoint. A new product should
be pursued only when both clinical and economic value is strong; if not, this may need to be acknowledged early on so plans can be developed accordingly.
- Pricing and value propositions should be built around
quantified economic value. Many organizations fail to embed economic valuation early enough in the decision- and strategy-making process. This causes missed opportunities to collect the proper data
during Phase II and III trials in support of value arguments. As a result, many of today’s value propositions to payers are “message heavy” and “data light.”
- Payer and market access strategy should be approached with the
same rigor, process, and insight-driven analysis as traditional commercial strategy. Too often, pharmaceutical companies set strategic goals to understand willingness to pay and to “optimize” price
rather than to understand value drivers and influence willingness to pay. Typical payer strategies only scratch the surface, do not emphasize economic value, and do not think creatively enough about
how to impact a payer’s business.
- Companies should have insight into payers’ decision making and
the processes and criteria they use, as well as the skills to use these insights. This is a challenging task for pharmaceutical companies skilled at communicating with doctors and patients. The
questions required to better understand payers are different, as payers have more complicated decision-making processes. The information sources used to gain insight into these processes are
dispersed and not always reliable. The analyses and analytical tools required are new (such as quantifiable data about the value of a drug).
- Market access strategy should be integrated with other aspects
of bringing a drug to market. In many organizations, market access strategy is developed separately from brand strategy and the two are combined at launch (often awkwardly and sometimes at
cross-purposes). A disconnected approach will likely miss opportunities for collaboration and spending trade-offs across the brand. Furthermore, the lack of strong supporting capabilities and
processes often leads to poor and episodic engagement with payers.
- Organizational structure should support market access insight
generation, collaboration, and strategy development. Market access is often a disconnected island, not part of the strategy development process. Pharmaceutical companies typically engage market
access three to six months before a new drug launches, when contracting tactics are typically decided. That’s too late to develop effective, data-supported, and value-driven insights for payers to