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Winning in the 20s: How access needs to evolve.
Access has become the front and center topic for the pharmaceutical industry. Majority of pharma companies now have explicit goals and commitments to patient access at the executive level and in their mission statements. Simultaneously, “Access” has become part of the agenda of multiple functions and the role of the Market Access function is rapidly evolving to become that of an orchestrator of Access across the organization.
“Access as corporate objective” is increasingly used in the industry, without necessarily a precise definition of what it actually means or entails for the Market Access function itself. This paper proposes one way to structure the discussion on what Access in the New World could look like. With that objective in mind we discuss the following themes in this paper:
In this paper, we consistently use the term “Market Access” when we refer to the function, and the term “Access” when we more broadly describe the ambition to reach as many patients as fast as possible.
Many developments within and beyond health care impact patient Access, and the Market Access functions. Without claiming completeness, the BCG Market Access Roundtable believes Seven trends particularly influence Access going forward:
The internal role of Market Access functions has evolved and is expected to provide more strategic leadership for the organization across all functions that are touching on Access relevant topics:
In the past, it was primarily a technical excellence function that was outside of the core areas of clinical development, regulatory approval and commercialization. Today, Access is on the agenda of many functions and Market Access has created strong interfaces, typically as a core member of development and brand teams, providing expertise and being accountable for key parts of the development and commercialization strategies and plans.
The trends that we discussed above will only accelerate this transformation: Access will become even more critical to the corporate and brand strategies, functions like clinical development and commercialization will have shared goals with the Market Access function and take accountability for selected deliverables and capabilities required for Access, This then poses the natural question – what role should Market Access be playing in the future?
The 2019 Market Access Benchmark conducted every three years by the BCG Market Access Roundtable revealed three key insights relating to the evolution of the Market Access function1:
1. Market Access functions went from a period of growth to a state of flux
2. Many companies are "experimenting" with alternative organizational models for Market Access (e.g., BU structures, agile project-based models), based on approaches the rest of the organization is taking
3. New skills relating to external and internal stakeholder engagement and co-creation seen as key capabilities going forward
These changes are expected to have profound implications for the Market Access function. We expect to see changes in scope, role and capabilities in the next ~3 years.
1. Adapted scope, role and capabilities in the next ~3 years
Market Access will still be focused on core Access topics such as value, pricing and evidence at a product and portfolio level, as well as policy shaping in areas like value frameworks, health system strengthening and affordability. The function will continue to drive internal capability building and experience sharing of the ongoing changes in the external environment. In addition, Market Access will help the entire enterprise understand the pricing and affordability dynamics globally and how this impacts Access in the short term and innovation in the mid to long term.
Furthermore, Access is increasingly impacted by developments broader than health care. For example, more patient and disease data is collected through innovative tools like sensors and wearables, and by different stakeholders. To leverage the real world data to help accelerate and sustain Access, companies will need to consider Access to and use of real world data in the context of data privacy regulation – a domain that has largely been dominated by consumer companies where the considerations are different. Thus, purview of “Access” naturally expands, and health policy aspects become increasingly important.
To achieve the Access objectives in this broader setting, Access leaders will also need to become more adept at translating complex Access themes into simple messages and become effective communicators internally and externally.
Based on the above the Roundtable identified three complementary roles Market Access will need to play in the future:
2. Broader potential organizational implications with a longer time horizon
In the context of the above the Roundtable explored potential future operating model options for the Market Access function. We explored addressing the challenges and opportunities across multiple dimensions:
Combining the different dimensions, we explored six different operating options that are depicted in Figure 4 below.
In the first option, the Market Access function will further expand its remit and build capabilities and resources that champion the Access, HTA and payer perspective across commercial, medical and regulatory functions.
Some companies may follow the option 2 in which the Market Access function will focus on core Access activities around value, evidence and pricing, while activities that are closer to commercial (e.g. key account management), medical (e.g. integrated evidence planning and real world data) and regulatory (engagement with regulatory and HTA stakeholders) will be covered by these respective functions under the overall leadership and coordination of the Market Access function.
This may even obviate the need for a dedicated Market Access function, if the Access objectives can be integrated into those functions (option 3).
Certain activities within Market Access and Medical could be combined, around integrated evidence planning, scientific advice and production of dossiers submissions for clinical scientific assessment (option 4).
Aspects around pricing and payer engagement could be integrated with traditional commercial functions (option 5).
And there could be an organizational design where traditional functions will be abandoned in favor of agile approaches that provide capabilities around commercial, Access and medical to drive a fully integrated development and commercialization strategy (option 6).
As always, no one size fits all. Companies will need to articulate the overall Access strategy, which will drive the required technical and leadership capabilities and guide the design of the Market Access function in the context of the overall organizational vision. Critical points to discuss include:
How will the chosen structure facilitate better collaboration and shared goals while maintaining clear accountabilities?
While we recognize all options are viable there was a general consensus within the Roundtable that option 1 where the Market Access function builds on its existing core expertise and takes on the role of coordinating and driving key trade-off decisions related to Access across functions – was the preferred option for most companies.
The BCG Market Access Benchmark 2019 demonstrated a further maturation of Access as an objective, and Market Access as a function across all companies. While the focus in the past was around scope and size, it has now shifted to new capabilities and cross-functional leadership. In order to win in the 20s, Market Access functions will need to succeed across a number of roles: Experts delivering excellence for core Market Access plans and deliverables, Stewards for Access within and outside of the company, and as Integrators & Drivers of strategic trade-offs to deliver on company Access objectives. There will not be one organizational blueprint to achieve this and a lot will depend on the extent to which Market Access function can build their new and evolving capabilities, Leadership in driving Access related trade-offs. Companies will likely move towards joint ownership of key Access objectives, and along the way experiment with different organizational designs in the coming years. While we have discussed many options in this paper the one that seems most compatible with future needs seems to be one where we can combine – core functional excellence with strong ability to coordinate and drive trade-off decisions. Market Access functions globally would be well served to initiate soon internal discussions on the Role of the Access in the New World.