Pricing and reimbursement challenges in most western markets have evolved over the last 15 years with a corresponding evolution in the market access response from the pharmaceutical industry. However, securing product access and commercial success in Western European healthcare markets is becoming increasingly more difficult: 2012–15 will be a defining period for the long-term success of the industry, according to commentators, including PriceWaterhouseCoopers and Dr Brian D Smith.
Demands on healthcare budgets are growing as are demands on healthcare systems to provide appropriate treatment and care. In this context, payers across Western Europe are demanding not only that companies demonstrate that the products add more than incremental value to patients but also offer a package of supporting services that can secure patient outcomes (see Market Access 5.0 opposite).
If there is consensus on the hypothesis that pharma needs to demonstrate that its products add value to patients, how does pharma re-engineer itself to be able to provide integrated product solutions?
The pharma industry is at different stages in terms of response to this challenge. Sir Andrew Witty of GlaxoSmithKline (GSK) articulated a sales strategy that is based on shifting away from ‘white pills in western markets’. If pharma is not selling ‘white pills’ then what should be its focus? Where has it been and just where does it need to get to by 2020?
Germany – key players believe industry has a way to go to reach Market Access 5.0
“The pharma industry still has a long way to go to reach a Market Access 5.0 level. Experience shows that most of the pharma players continue to feel ‘superior’ to payers. In many negotiations there is not an atmosphere of partnership but of confrontation. In an extreme example a US-based pharma company refused to participate in the innovative integrated care model proposed. It was of the mind that the payer wanted to get a rebate (which the company would not give under its global pricing strategy) and failed to listen carefully to the proposed model and the fact that it would provide more services to the patients financed by a rebate on the product. The mindset and capabilities of big pharma is still behind. In order to be more patient-centric and service minded, big pharma still needs to do its homework. This means that top management needs to be brave enough to take risks and to implement new business models outside of the well-known one to sell pills. In this context it is important to note that the new business models will have different margins for sure – this needs to be understood and accepted. The alternative to stick to the old business model is not an option but will lead in the mid-term to an end. On the other hand, pharma also needs to create the structure to be in a position to run new business models. AMNOG (SGB V § 140b) made it possible for pharma companies to be a true partner in integrated care models. For this purpose companies are well advised to operate such contracts via a management holding. However, the reality is that only few pharma companies have such a management holding at the moment and therefore aren’t in a good position yet to run managed models.”
Director of integrated services at one of the largest health insurers in Germany (responsible for budget of pharmaceuticals, remedies and medical care)
Modelling the market access 5.0 roadmap
1. Continued expansion of payer insight into integrated strategic plans from an early stage
- Brand planning processes that integrate strategic payer insight into shaping the design and scope of clinical studies
- Payer value dossiers reflective of the ‘real’ care paradigm
- Value propositions aligned to healthcare agendas and priorities
- Development of planning processes that enable individual market variables to be taken into account
- Co-create solutions with national, regional and local payers
- Bridge the ‘trust’ issue with payers and demonstrate a capability to work in a partnership engagement model with local and regional payers. Perhaps the industry should consider a quality standard accreditation?
- Entering into strategic partnerships with local/regional payers requires a commitment to three-year service delivery agreements. How can pharma take a longer-term approach to RoI?
2. Greater understanding of care pathways and decision making around the position of the medicine – patient profile, stage of disease
- Develop consistency on the care pathway approach
- From data rich to insight rich: extract meaningful data from internal and external systems to effectively transform the way brands/services are positioned and patient benefits are delivered
- Reaching consensus on the scientific value of real-world data
- Processes to allow for innovation to develop clinically meaningful measures
- Customer marketing approach detailing the value package and not just the brand.
3. Continued up-skilling of organisation and customer-facing employees to develop strategy and bridge implementation successfully in an environment of increasing complexity at a local/regional level
- Accelerate the evolving mindset of pharma leaders to embrace fully market access 5.0
- Review marketing expenditure to ensure the right proportions are being spent in the right areas. For example, disproportionate spend on payer and patient insights in the market research budget
- Extend/develop a customer-centric culture to include payers and patients
- Managing internal change to align what is meant by value, value proposition and value assurance. Having processes in place to achieve this systematically
- Redesign competency frameworks and commit to on-going knowledge and skills training
- Performance management: smarter metrics as measures of success
- Innovative incentive schemes that reward the ‘right’ behaviours.
France – evolution of healthcare
“Selling medicines is not compatible with providing services to patients. What are the true motives of pharma in wanting to partner with us? The industry is currently negatively influencing the ability of the health system to do the right thing for patients. The healthcare systems in France will need to evolve with the demographic changes in population leading to difficult choices. Pharma is seen as part of the problem and not part of the solution to budgetary issues. There is a growing role for pharmacists in supporting care pathways. The pharma industry needs to partner with those closest to the medicines agenda, eg, pharmacists, to provide innovative product-enhancing services. Understanding regional influencers will be key to delivering the vision of market access 5.0”
Public Hospital Director (Directeur d’Etablissement sanitair)
4. Improving RoI per patient – focus on patient outcomes and increasing patient adherence
- With value-based pricing requiring a clear and convincing communication of the benefits of a medicine at launch and beyond, pharma needs to ensure that the benefits seen in clinical trials are also seen in a real-world setting
- Pharma needs to support a more holistic approach to improving patient outcomes
- Patient engagement: with approximately 70 per cent (BUPA Health Pulse 2010) of people using the internet to access information on medicines, how does pharma make sure it gets accurate information and the support it needs?
- Patient engagement: with >10 per cent of people in the UK posting comments and questions online, how will pharma take part in the debate?
- In 2008 it was estimated that approximately 15 per cent of marketing budget was spent on patient communications (Cutting Edge Information, 2012). Does that truly reflect a patient-centric approach?
- As individuals are able to access their own data the doctor–patient relationship will change to become more of a partnership. How does pharma further evolve from a prescriber-centric approach?
5. Collaboration and strategic alliances with other companies – pharma and non-pharma – to improve outcomes
- Allocate budget and resources to this type of business development
- Partnerships to design improved patient services
- Incorporate relevant telehealth and other technology led opportunities
- Develop clinical trials models to assess the full service package.
If these points serve as a checklist for the commercial platform in Western Europe, how ready are you for Market Access 5.0?
UK – NHS and pharma; bridging the trust gap
“This is a rapid period of change, on a scale never seen before in the NHS – this alone is a challenge for anyone wishing to work in partnership. It is clear that pharma companies need to move to looking at a longer window for RoI as it takes a long time for the effects of medicines on hospital expenditure to be realised and the NHS needs to deliver large QIPP savings. Medicines can proactively assist with the QIPP programme, but their costs need to be built in. This understanding is key to MA 5.0. There will be over 200 new customer groups, with new people at the helm – good for pharma in some ways as it will be clinicians, but difficult in another way as they will be responsible for budgets. Relationship management and delivering value-based outcomes are the key drivers for pharma over the coming five years and more, and the NHS will need to work in a more proactive way with pharma as well, so bridging the trust between both parties will be key.”
Chief Operating officer, first wave CCG
There is increasing agreement that the old pharma commercial model is no longer fit for purpose. The sales and marketing model is being forced to move to one that is much more complex in a Europe-wide environment of change with incredible pressure to reduce budgets. Successful companies will be the ones that focus their organisations on delivering real, demonstrable value to the patients they serve in collaboration with payers.
Market Access 1.0
|
 |
Market Access 2.0
|
|
Market Access 3.0
|
|
Market Access 4.0
|
|
Market Access 5.0
|
The Authors
Sabina Syed is Managing Director and Mo Nazir is non-executive director at Visions4Health