Reflections on a Discussion About Market Access Challenges with Top Pharmaceutical Executives

On April 11th as part of a Pharmaceutical Executive roundtable, I had a chance to sit down with many of the leading thinkers in the biopharma industry to discuss many of the key challenges they are facing today and how their organizations are adapting to the changing face of healthcare. While each had their own strategies to tackle these challenges, there were three underlying themes that struck me upon reflection of that discussion on my flight home.

Manufacturers Must Be More Conscious Balancing Access and Innovation

Balancing Access and Innovation will be the preeminent challenge biopharmaceutical manufacturers will face in the rapidly evolving US reimbursement landscape. While ‘value’ is a term that has been on the tip of everyone’s tongue for some time now, what that means and how that will manifest itself in the market remains a fairly ambiguous goal. The enhanced uncertainty regarding the market that new products will be entering is amplified by the extended clinical trial process. Put simply, it is hard to develop a solution when you are not sure what problem you are trying to answer.

Based on our discussion, it is clear that manufacturers are taking a range of approaches to solving this issue that will take these organizations in very different directions. While these approaches are certainly not all-encompassing, we did have a good representation of the different strategic approaches, which included:

  • Moving beyond biopharma and thinking more from a total treatment solution angle;
  • Owning a vertical in a given condition or patient group;
  • Doubling down on science and enhancing focus on innovation.

Regardless of the strategy, the key takeaway for me is that there is hardly consensus on how to approach this new market, which is leading to a focus on experimentation and diversification of approaches to allow for a nimbler and more responsive industry going forward.

Payers Are Top of Mind and Will Remain So for the Foreseeable Future

One theme that is undeniable and something that was a focus from beginning to end was the focus on payer influence on how biopharmaceutical manufacturers engage the market. Once considered table stakes, product coverage/access is no longer something that manufacturers are taking as a given for new products entering the market in the US. Payer marketing and strategy are moving to the top of the list during the launch planning process.

Payers are even impacting the nature of provider engagement, once considered the lynchpin of a success therapy within the US market. Manufacturers are increasing their sophistication around their physician targeting efforts based on local payer market dynamics. The most sophisticated firms are modeling payer influence on physician sub-types to better inform contract strategy through RWE and product coverage data. The game has changed for manufacturers as payer exclusionary tactics have increased.

Real World Evidence Has a Major Role to Play, Details to Follow

To an individual, the subject of incorporating real world data into the standard work flow is top of mind and will be part of their future commercial decision making process. The benefits are clear and the opportunity seems endless for how data can be used to increase efficiency and improve commercial decision making. As illustrated above, there are many circumstances where manufacturers are enjoying small wins by using RWE but those examples are limited.

While there is wide consensus on the value of RWE, how RWE will play a role in all of these functions continues to be a work in progress. While data is present in an abundant manner, struggles remain on how to incorporate data into the daily workflow that is seamless and presented in a fashion to drive action. This is where much of the effort is being placed by these leaders. What are the decisions we are trying to make, what are the inputs that we need to make those decisions, and how do we package these inputs in a way that enables us to transform data to information and information to insight and, finally, insight to impact?

Having sat with these great industry leaders, I was struck by their energy and excitement in facing these new challenges head-on. As the market continues to evolve and change, the challenges facing the biopharma industry will only grow and I am excited to have a seat at the table in helping to find new solutions to shape the nature of our industry going forward.

 

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DRG and Zephyr Health announce a new analytics technology, Provider Market Access, to aid sales and account teams in rapid physician engagement based on advantageous formulary shifts.