Managing many parts
Market access is still a relatively new function within Big Pharma. What are the key elements of a successful market access
program, from both a strategic and operational perspective?
Parks: By definition, market access is a cross-functional activity. It requires pooled expertise from clinical development, commercial
affairs, and professional relations, among other functions. Most important, it must carry forward a global perspective that
incorporates a detailed awareness of conditions in individual target countries. What really distinguishes a successful program
is the capacity to communicate and engage with stakeholders who can build out messages that promote the value of the product.
The point is to create a groundswell of support for a new product, ensuring that key players like the patient community are
aware of its benefits and how it can help them.
Stefanacci: Market access is not a project that should be launched at the 11th hour. Everyone knows that, but still most companies come
to the table too late. It is amazing as a payer representative to see companies visit us for the first time when they are
well into the Phase III trial process. At that point, it is too late for our viewpoint to have much impact on the value proposition.
We wonder why we are being consulted.
Barnett: Our work indicates a key differentiating factor for successful companies is that senior management truly "gets it." They
have a strong understanding of payers and market access. These executives ensure the realities of payer and market access
dynamics are reflected in commercial processes and the way their companies conduct business with payers. It all has to tie
together from a clinical and marketing perspective, leading ultimately to a strong value message that differentiates the product
and justifies the price point.
It's a race car: but who's driving?
McLellan: Market access is not really a function; it's a goal. We all know the goal must be defined early on in the process. The challenge
is that even when the goal is agreed, the incentives of the internal players are often very different. Clinical development
people are vital, yet their organizational mandate is to maximize the number of molecules that make it to registration. It
is hard to get them to think beyond that marker of success. The elusive target here is integration of the market access strategy.
Yet you will find many companies are still working within a model of over-specialization around small parts of the process.
It is like designing a race car, where one expert pushes the accelerator, another applies the brakes, and still another turns
the steering wheel. This race car is unlikely to reach its goal anytime soon and more likely will crash into a wall. Expertise
in pricing, reimbursement, outcomes research, real-world data, and other relevant functions sit on the same team, with the
same reporting lines and priorities. Pfizer is now working toward such an integrated model.
Clinton: This approach can have a damaging effect because it leaves the impression that the essential objective in market access—a
strong value proposition and access of technology to patients who need it—are some other function's problem. In reality, every
part of the development and commercial process should be asking the question: What is the value of this drug to patients who
have the disease and how can we improve on that?
Shah: I would call market access both a business function and an enterprise capability platform, spanning many activities. The
objective is to ensure that as an enterprise we create value during the entire product lifecycle, starting with early phase
drug development, and compete across the full continuum of healthcare, not just the pharmaceutical benefit in isolation. The
value proposition is going to fail if it is confined only to the pharmacy benefit "silo."
Sharma: Every market access leader should have two major strengths. The first is the ability to think like a lawyer on the bench—you
must know the rules, inside and out, and methodically define what the options are. The second is putting all the disconnected
strands of activity together into a set of arguments that will deliver results, and be communicated in a way that stakeholders
can understand. Another aspect of this role is how important it can be to avoid the conventional wisdom. The best practitioners
in this field are those with the ability to think outside the box—because in market access, there is no box.