Market access has for some years been one of pharma’s most widely used buzzphrases. But now it is one of its highest priorities. New data shows the industry know it can no longer pay lip service to the notion of market access. It can, and must, do better. Chris Ross reports.
An overwhelming majority of pharmaceutical companies across Europe have conceded the need to make improvements to their market access strategies, a new report has shown.
The Cegedim Dendrite Market Access Industry Report, based on a survey of almost 200 sales and marketing executives from across Europe, says that 88% of organisations acknowledge the need to change their approach to market access, and that 75% have earmarked resources to invest in its improvement in 2010/11.
The vast majority of pharmaceutical companies have already moved to a Key Account Management (KAM) model as they seek to align sales and marketing methodologies with the demands of the modern marketplace. This is borne out by the Cegedim Dendrite survey which shows that 83% of companies have taken the KAM approach. The poll, conducted last month, indicates that many companies believe the shift towards KAM will deliver the greatest benefit to market access strategies. But, faced with a future without blockbuster drugs and with a European-wide reduction in healthcare spending having a major impact on marketing budgets and sales operations, successful market access will require much more than a restructured field force.
According to the research, the industry has a number of current concerns. The most fundamental fear is, of course, the global economy –with 24% of survey respondents citing it as the most significant challenge facing market access. The tough economic climate has, in turn, been the catalyst for a whole raft of other concerns for pharma. Primarily, companies are worried by the growing influence of HTA bodies and the increasing shift in influence from prescribers to payers. Likewise, the fragmentation of decision-making across regional bodies with increasing influence on pricing and reimbursement locally is a further cause for concern. The developing trend towards the globalisation of pharmaceutical strategies is another major worry for market access managers; while reinforcing brand image may work at a global level, the report says that successful market access cannot be achieved in an increasingly fragmented market if organisations do not take into account that local market differences will cause problems.
A cross-functional responsibility
So how is pharma responding? Well, companies are deploying a variety of approaches (see figure 1), as indicated by the Cegedim Dendrite survey. Examination of the respondent profile (see ‘Survey Methodology’) shows that market access responsibilities now extend across the pharmaceutical organisation. Historically, market access has been considered the preserve of roles in health outcome research, but as the concept has evolved, the involvement of sales and marketing executives has grown considerably. The fact that market research, business intelligence and business development roles are also represented in the survey demonstrates the extent to which market access strategies are now a cross-organisational concern.
The evolution mirrors progress within the industry’s customer-base. The vastly expanding range of stakeholders now involved in health provision and able to influence decision-making, which includes charities and patient bodies at national level as well as pharmacists and nurse practitioners locally, has underlined the importance of market access strategies that span the entire product lifecycle. With the emphasis now so heavily focused on cost, it is becoming increasingly important to communicate with HTAs earlier in the product development lifecycle, to gain insight into a product’s marketing potential. At the other end of the product lifecycle, ongoing communication is essential since the pricing and reimbursement rates can be reset at any time, while pressure from generic prescribing is ever present.
Key Account Management
Research demonstrates that companies are embarking upon health outcome measurement in development and post-launch (61%), leveraging physician peer networks and interactions (61%) and the promotion of health and well-being over treatment of illness (43%). But the most common response has been the move to key account management. Across the industry, companies have responded to the shift from prescriber to payer and the declining influence of local clinicians by dramatically cutting their field forces and implementing smaller, more strategic sales teams. But, say Cegedim Dendrite, creating a new workforce is only the starting point. Market access teams need new skill sets and the ability to communicate with a range of individuals – from commissioners to formulary managers in regional authorities and directors of local healthcare units, as well as hospital doctors and, in some regions, primary care physicians. “These individuals expect business-led discussions about a product’s efficacy, its ability to deliver a financial return and its role in the overall care pathway,” notes the report. “In addition to new communication skills and a very different cultural approach, KAMs must be supported with excellent information that identifies the relevant stakeholders in these regional and local authority organisations.”
The most notable example of the growth of ‘payer influence’ in the UK is, of course, NICE – which has frequently led the way in European HTA. The disparate nature of European healthcare markets has so far prevented the development of a pan-European NICE, but despite regional differences, the wider market faces common health economic challenges that are driving the need for market access strategies. “”The fundamental Market Access driver for all markets is the need to demonstrate real value to the Care Pathway,” says Thibaut de Lataillade, Global Marketing VP, Cegedim Dendrite. “Even though European markets are at different levels of maturity, all of them are implementing Health Technology Assessment bodies, with a similar key driver to ensure that the cost of new treatments delivers acceptable ROI to the local Health Service.”
In the UK, the rapid increase in payer influence has propelled a steady decline in the number of sales representatives targeting traditional clinicians. The new coalition government says it aims to design a ‘clinically-led NHS’ that will give power back to prescribers – but, in a marketplace constrained by considerable economic imperatives, it seems highly unlikely that the high-volume, high-frequency model of sales will ever return. Instead, the smarter, leaner KAM approach will establish itself as the norm. “Of course, there will always be a role for the ‘traditional’ primary care field force to educate and inform healthcare professionals,” says David Round, General Manager, UK, Cegedim Dendrite. “However, the current shift towards Key Account Management teams will continue and these KAM teams will rely on specific and increasingly detailed knowledge of their local health economies, as they seek to influence the key market access stakeholders.”
While pharmaceutical companies have undoubtedly identified many of the key changes required to address a new, complex healthcare environment, the question remains as to how effective their responses have been to date. The key to success is the effective identification of market access stakeholders. According to Cegedim Dendrite’s survey, while pharma companies appear fairly happy with their ability to identify key stakeholder, only 7% strongly agree that they can identify them. This raises questions about the type and quality of information the industry gathers about its key customers. Does it support the complex, multi-dimensional market access strategies that are now required? Critically, how much information do companies collect to determine stakeholder roles within the fragmented, multi-tier regional health environment?
So what do pharma companies need to do to ensure they respond to market needs more effectively? “Based on our experience, and the detailed results of the survey, the most important thing that pharma can do is the implementation of an organisation-wide Key Account Management strategy, with a CRM tool which shares information effectively across the whole organization,” says Stefan Janssens, President EMEA, Cegedim Dendrite. “This must be built on a detailed understanding of the key drivers of the market access stakeholders that pharma seeks to influence.”
The future: KAMs at the centre
Pharmaceutical companies face an even tougher marketplace across Europe in the future. A combination of the increasing influence of non-clinical stakeholders and the vagaries of the global economy means that companies face huge challenges to create and deliver effective market access strategies. Success will depend upon building strong relationships with every stakeholder across national and regional health organizations, as well as the growing number of associated stakeholders such as patient groups, charities and pharmacists. But, says Cegedim Dendrite, identification of these clinical and non-clinical stakeholders is just the beginning. Robust segmentation and targeting that reflects peer networks of influence and tailored messaging can only enable effective market access if backed up by strong communication across a highly motivated and skilled KAM teams.
Therefore, the role of the field force, as part of a cross-functional organization-wide effort, remains ever crucial. The effective consolidation of market access activities across organizations is key to supporting a drug throughout its lifecycle, from initial pricing and reimbursement decision-making, to delivering access to regional markets. As the Cegedim Dendrite report concludes: “it is those organizations that understand the new stakeholders and their networks of influence, that create the 360 degree customer view and then leverage that information to deliver innovative service that truly reflect the underlying drivers, that will create the most successful market access strategies.”
Key account managers will sit at the centre of these strategies. At present, progress is being made as companies begin to prioritise market access. But for now the industry, in the words of my fifth form geography teacher, ‘could do better.’ Sadly, I couldn’t. But you must.
For a copy of the full white paper, The Cegedim Dendrite Market Access Industry Report, visit www.cegedimdendrite.com/ma-report.
The Cegedim Dendrite survey was based on online interviews with 194 individuals from countries across Europe. The respondent group worked for companies across the pharmaceutical sector, with 23% in organisations employing fewer than 100 people, 38% in companies with between 100-500 staff, 20% in the 500-2000 category and 19% in companies with more than 2000 employees. Respondents were executives from marketing, market access, market research and sales departments.