Learning to fly

Historically, a pharmaceutical company only needed to answer three essential questions to achieve reimbursement for its products: Is it effective? Is it safe? And is it of sufficient quality? The modern, efficient world presents a new question: Is it good value for money?

In these times of significant annual budget deficits and mountainous national debts, austerity measures are being implemented globally and governments are scrutinising healthcare costs to ensure economic feasibility. Increasingly, the power is with the payers, who value medicines which treat a clearly defined group of patients, or whose use will lead to savings elsewhere in the system, enabling them to make best use of their budgets. As a result, market access teams no longer provide a supporting role but fundamentally contribute to product strategy throughout the lifecycle in order to ensure that the best case is ultimately presented in pricing and reimbursement negotiations.

A medicine that demonstrably improves patients' quality of life has inherent value to payers, physicians and patients. The role of market access is to communicate this value to the range of customers who will affect its adoption. Today, that's not just physicians, but budget holders, policy holders, national and local decision-makers and, in some cases, political bodies, so targeting the message to the appropriate group is essential. Understanding the interplay between the effect of the product on the healthcare system and the impact of the healthcare market on the product is a further layer of the market access remit.

A senior market access manager, from a large pharma company (not named for confidentiality purposes), said: "Despite the complexity in gaining market access for pharmaceuticals, our ultimate goal is to ensure the technology we develop is accessible to the appropriate patients in need. We achieve this key objective through clear, concise and effective communication of our value messages to our target stakeholders."

Taking the payer perspective
Traditionally, pharma communications with stakeholders have been segmented into three 'product-centric' areas: medical, marketing and market access. Now, these areas need to integrate more in order that preclinical strategies capture, and cater for, the future needs of market access gatekeepers. The value case needs to be integral to the overarching strategy and plan for a compound to ensure it has the best potential for reimbursement at launch, since payers and physicians increasingly demand real-world data to augment and demonstrate the value of a product.

Pharma needs to identify which evidence ensures a convincing data-driven value proposition and how best to present this evidence. Market access teams need to map how payers think, and what motivates them, to be able to influence their decision-making. For example, 'real-world data' advisory boards help to understand the type of data requested by payers, review existing data, and identify where further research is required.

Pharma should always keep the payer perspective in mind – this means thinking of economic valuation early during the planning, decision and strategy-making process, eg, designing trials with clinical, economic and patient-sided end points. Furthermore, a forward-thinking market access strategy should also predict accurately what the payer landscape may be in three to 10 years' time, when a new chemical entity might come to market, in order to have the best data for a convincing value case.

From molecule to market
The communication of a product's value by pharma to payers requires strategic partners whose knowledge is both deep and broad. An understanding of the core science and therapy area, as well as marketing strategies and the concerns of payers, is integral to understanding and developing a value proposition from the ground up successfully.

Specialist healthcare communication agencies who fully understand the scientific data on a product, from the mechanism of action to the analysis of clinical trials, are able to identify and present the right data to answer payers' questions. For example, if a cost–benefit proposition is based on end-of-life care but quality-of-life data is not available, they can strengthen the argument with benchmarking and a clear product rationale.

There are also new internal pharma personnel and departments whose role it is to evaluate and construct value-based pricing and reimbursement strategies. These internal specialists are able to amalgamate scientific understanding, health-economic data and real-world applications of products beyond the data from traditional randomised controlled trials.