There is no one definition for modern market access – what does it mean to you?
I come at the topic of market access as a relative outsider because I began my career working in health and social care and eventually as an analyst in NHS Informatics, Commissioning and Public Health.
I have never worked for a pharmaceutical company. I’ve never ‘carried the bag’
or launched a drug. So when I first heard the phrase, I was stumped.
I’ve had the opportunity to reverse engineer what market access means to various people from discussing their challenges; I soon discovered that it meant different things to different people.
Years ago, some thought market access primarily meant securing Health Technology Assessment (HTA) approval from NICE or similar. For others it was more about the many tactical local battles to win key opinion leaders (KOLs), get a drug onto formularies and getting ‘pull-through’. The more experienced were clear market access wasn’t just a part of their commercial strategy but actually was their commercial strategy. They believed they had to encompass every relevant factor that could act as a barrier from helping the system to adapt to a particular form of drug delivery to finding incentives that meant everyone could win, to writing template business cases. I came to the conclusion that none of them was wrong, but each answer was incomplete without the other.
It was like the Sufi parable of the elephant and the blind men. If they encountered an elephant for the very first time and each attempted to learn about it by touch alone then each would come to a different conclusion. The experience of one touching the tusk would differ from one holding the trunk, the ear, the leg or the tail.
Market access is similar in that different perspectives are inevitable based on each person’s role. The experiences of head office teams will differ from field-based teams, and so on.
This is even more true in the UK because of the fragmented and ever-changing nature of our healthcare system. The agenda to devolve power has led to Devo Manc in Greater Manchester. We already have Regional Medicines Optimisation Committees (RMOCs), and successful Sustainability and Transformation Plan (STP) footprints are morphing into Integrated Care Systems (ICSs). This is leading to pharma increasingly focussing on regional marketing.
I recently met some visiting American market access experts who could not get their heads around the fact that there was so much regional divergence in a single payer system. They left the UK wondering if the only national thing about the NHS is the name.
It’s not just the organisations. The processes too are incredibly diverse. What route should one take for reimbursement? Via NICE? Specialised commissioning or via Clinical Commissioning Groups (CCGs)? What about Patient Access Schemes (PAS), the Cancer Drugs Fund (CDF) or the Early Access to Medicine Scheme (EAMS)? With such a disjointed system and so many possibilities, there’s no wonder people have diverse experiences and therefore understandings of what modern market access entails.
No one size fits all
The PM Society has long acted as an impartial forum for marketing professionals to meet and network. It relaunched its own Market Access Interest Group (MAIG) because the only way to grasp the concept is to have a multi-functional and multi-disciplinary group form around the topic.
The MAIG is filled with a range of people interested in market access with experts in head office and field-based market access, brand teams, agency suppliers and consultants. I was fortunate to be involved when the MAIG surveyed market access professionals about their views (see pages 4 and 5). I asked if respondents could provide their own definition of what market access means. The results were surprising. There was no consensus on the definition at all. None of the 93 responses matched each other. We found that we could generate a new definition taken from the 93 replies that matched the average response length of 23 words if we ignored all the common words, for example the, and, or, and so on. We came up with the following:
‘Ensuring patients receive appropriate treatment at the right time and right price, working with the local/regional NHS and their processes based on value.’
It was interesting to compare it to the existing PM Society definition:
‘Principally market access involves preparing a positive environment which supports uptake of your product and demonstrating the ‘value’ of your product to the range of customers who influence uptake. Strategically, market access is about packaging data in the right way, for the right customer at the right time.’
We found that the new definition was similar but there were fewer mentions of a positive environment in our survey and much more around processes. While there is still no single ‘one size fits all’ definition, the emphasis on processes hints at how market access professionals are having to be less creative and stick to formal processes as they adjust to the numerous and weighty changes to the NHS landscape.
It could well be that this shifts back again so the MAIG will rerun the survey to help track the changes. All we can say for sure is that it isn’t an easy area to define and it will shift subtly in emphasis as the system shifts. We at the MAIG look forward to seeing how it will change.