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3 Keys to Unlock Market Access – Part I

September 6, 2016
Posted by: Joe Martinez, RPh, PDE, PPC

Market Access depends on the answers to two very important questions: What is your product’s story? And, how do decision-makers perceive your product’s value proposition? The spotlight is on the word “perceive”, as positive perception is crucial to achieving the end goal of market access and utilization.

It is also essential to bear in mind that your product is constantly being reviewed by healthcare decision-makers (HCDMs) to determine its value to their organization in terms of controlling health care costs and revenue. These assessments can occur formally in a quarterly or annual product review or informally as part of a closed-door discussion on therapy utilization or market basket/utilization breakdown.

In the end, there are a number of agendas at play. These factors will ultimately determine the perception that will impact the market access decision for your product. And from there, market utilization and revenue will flow or not.

With our eye on the perception donut, here are three steps that, if strategically executed, will lead to successfully defining the value of your product in the minds and hearts of the HCDM.

1) Build and refine an overall Market Access strategy.
Assess and identify the marketplace, the competitive landscape and applicable policy initiatives impacting the therapeutic area. Remember, your product or device isn’t the only choice in the therapy spectrum. This doesn’t need to be a Harvard Business Review case study but does need to provide a basic, unbiased and fact-based observation of the real world.

2) Develop and create compelling clinical and medical evidence.
You can’t discuss what you don’t have! Well, maybe you can, but it will not go well. Now for the good news, the size of your budget does not determine the quantity or effectiveness of your value data. Step #1 will identify areas of interest and opportunity, so that you can now plan to prioritize your data creation needs. Many times, you will not the have time to develop specific data from a randomized controlled trial (RCT) format. That’s okay because real-world evidence (RWE) and retrospective database review can make the same points and be just as compelling in most situations.

3) Effectively communicate the value that matters to your internal and external stakeholders.
It is very important to train your team on the data. Not just what the numbers are, but most critically, what do those numbers mean to the person across the table. Simply stated, how does that data answer the questions: What’s in it for me? And, why should I care? And just as important, this needs to be summarily communicated in 30-seconds or less to gain their attention and then gain more time.

So, we ask ourselves: how do you communicate product information in a compelling manner so that the HCDM will understand and perceive the value of your product in the therapeutic area and also as compared to competitive therapies?

From my experience, it’s about developing a value-based market access strategy that communicates complex medical information in a compelling manner for someone to take action. The definition of ‘compelling’ will vary by your audience and their agenda items of the day. This means that you need to know your audience, have relevant and available information to discuss, and then to check for understanding before asking for an action.

As an example, a National Account Director (NAD) was asked to bring in his Managed Care/Health Outcomes person to talk with the Medicaid Pharmacy Director of a large state plan. The goal was to share new medical information in advance of an upcoming formulary review meeting. While not too far into the conversation, it became apparent that one of the primary metrics for product access and coverage was the cost per A1C reduction.

The Managed Care Liaison noted this and was able to switch his conversation from new medical data to relative efficacy rates for the category as whole and the current consensus therapy guidelines. An engaging conversation focused on accurately measuring competitive products efficacy from published studies. The NAD then had a discussion about costs separate from the medical discussion that the Pharmacy Director greatly appreciated. Ultimately, the formulary decision was successful for product access and coverage but only after addressing the specific value agenda items of the HCDM.

I will address steps 2 and 3 – -Clinical/Medical Evidence and Value Communication – in blogs to be posted next week and the following. Stay tuned!

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