Agencies need a holistic approach to create value for healthcare professionals and patients

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The new era of drug marketing must take market access into account.

“It’s not really something that you can just Google.” – Dan Sontupe, Partner, Managing Director, The Bloc Value Builders

A few weeks ago, I felt like I was going to wander the proverbial dense forest of Market Access, do some research and quickly come out with a clear vision, wielding a wonderfully distilled proclamation that you , the reader, could consume. This proclamation would explain why more and more agencies are deciding to add market access expertise through acquisition, bolstering their existing offerings through investments, or building from scratch. It didn’t quite turn out like that. My initial idea was to define market access from R&D to clinical development, through value proposition strategy, reimbursement negotiation and drug lifecycle management, and then see how it is intrinsically linked. to a complex supply chain, made up of manufacturers, distributors, pharmacies, healthcare. professionals (HCP), patients, insurance companies, other payers and pharmacy benefit managers (PBMs).

I enlisted the help of three Market Access Professionals with over 50 combined years in the business: Dan Sontupe, Partner, Managing Director, The Bloc Value Builder; Rosshawn Blunt, Managing Director, 1798, a Fingerpaint Company (a market access agency acquired by Fingerpaint in 2020); and Josh Phillips, executive vice president, customer services, Cyan Health.

“More and more in the pharmaceutical industry there are products where there is this magical third hand, and you have to deal and negotiate with that partner as well as with suppliers and patients.” – Blunt

Blunt refers to the set of third-party intermediaries representing large employers, insurance companies, and government entities (Medicare, Medicaid) who prioritize prescription drugs approved for reimbursement and continually update their lists as new ones become available. drugs appear. New drugs are considered over existing products in their therapeutic class for safety, efficacy and patient compliance. PBMs also negotiate “discounts” with drug manufacturers that reduce costs for their customers. This exchange of key information and a little bit of scrambling can make or break a drug’s coverage or its placement on the formulary, and brand success.

“Market access is fundamental to the potential of a product. You can have a product that is safe, effective, approved, and available, but if the payer does not see the value in covering the product, the supplier will have to make an effort to prescribe it. The payer could implement restrictive use management tools such as editing steps or prior authorizations or simply exclude it completely from the form. Patients would bear the full cost of the drug, so use would likely be very limited. It would be a disaster for the drug, which took a lot of time and money to develop, and the manufacturer. “—Phillips

When the Affordable Care Act was enacted in March 2010, it put pressure on healthcare providers to reduce costs while providing better quality care. This is essentially what shifted the prescribing power from healthcare professionals and their patients to payers, and catapulted the importance of a market access strategy. According to a Manhattan Research survey in 2017, “16% of U.S. doctors now say they always prescribe their treatment of first choice, with the remaining 84% saying they usually or always follow the directions on the form.”

“It’s about convincing doctors to write a drug that is sold in pharmacies, that is not controlled by the pharmacy, but controlled by the health system and the PBMs. Advertising in this space is the communication of value. We are in a strange space where we have to establish communications for the payer to create value and show why they should cover our product. At the same time, we must approach and create tools for the doctor, who must understand how the product is covered: How will patients be reimbursed? How can they get help with copay? Finally, the patient must understand what all of these complexities of coverage are. “—Sontupe

Despite the pressure to change following the pandemic, pharma is still a slowly adapting industry that resists change. It is now the agency’s responsibility to provide a holistic approach to marketing that includes market access alongside traditional HCPs and mainstream marketing in an overall campaign strategy. The good news is that market access teams are entering the fray much earlier, which can inform those same strategies. Despite the teams’ differences in approach, “the whole agency should want to be able to sing from a unified score,” as Blunt so poetically puts it.

Fran Pollaro is editor-in-chief for Pharm Exec. He can be contacted at
fpollaro@mjhlifesciences.com.


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