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An industry-based working group presents a common standards and definition framework for “Access” competencies in pharma-as a starting point in solving the current shortage of talent and leaders for this widening set of activities.
A nearly universal challenge faced by pharmaceutical companies today is the increasing shortage of competencies and talent in market access. In contrast to well-established functions like marketing and finance, the role of “Access” is often ambiguous and lacks a common nomenclature and standard. The fact that Access has evolved rapidly in the past decades and continues to span an ever broadening set of activities only adds further to the lack of clarity around Access. At the same time, Access becomes increasingly business-central as the topics that fall within its purview fundamentally impact and are critical to the core of a pharmaceutical company’s business and success.
The Boston Consulting Group (BCG) Market Access Roundtable is a forum that brings together senior pharmaceutical leaders in market access and serves as a platform for interactive discussion on industry level topics.
In light of the changing role of market access, the Roundtable members created a working group with the goal of developing a common set of standards and terminologies for market access competencies of the future. This paper summarizes the outcome of the work conducted over the past year.
Access: An increasing shortage of competencies and talent
There is a shortage of Access-related competencies and talent. While most people would agree that Access is becoming increasingly important and pervasive, it could be considered ironic that the definition of the term “Access”-the activities that fall within its broadening scope, and the role they play in today’s pharmaceutical industry-are anything but clear or consistent.
The ambiguity of the role and activities of market access becomes even more striking if one compares Access with other functional domains such as finance and marketing. Those functions today benefit from clear definitions of their roles and activities, and are part of an established nomenclature and standard.
In general, a typical finance or marketing career path is relatively well-defined, has been trodden by many over time, and has well-marked entrances and exits. Consequently, training such as MBAs and specialist courses have emerged to develop talent and prepare its students to step into these clear career paths by assuming expert or leadership roles within those domains. We would venture to say that the current status for such roles can be attributed to clarity as to the roles, activities and competencies that are required within functions like marketing and finance.
In contrast, Access has historically been far more difficult to define, especially as it has changed significantly over the past decade. It has become increasingly important, moving beyond a pure technical role to a far more business-critical and central role. Despite this, the transition into and out of market access roles remains vague and can be summarized simply as difficult to get into, difficult to get out of. We believe these challenges demonstrate a need for the industry to provide clarity on what Access covers, as well as the competencies that are required to support it.
Toward a common terminology and standard
We believe a common set of standards and terminology could serve as a first step for the pharmaceutical industry to define and develop Access talent-development. This would enable company managers, in general, and HR practitioners, specifically, to better understand the Access domain, where it fits within an organization and how to make more informed and better decisions on developing Access talent. Finally, we would also see this as a crucial first step in establishing a minimum standard toward which organizations, both within the industry and potentially also academic institutions, could aim.
Few would dispute that Access as a discipline is continuing to evolve at a tremendous rate. Historically, Access could be characterized as an art and it was primarily focused on stakeholder relationship management. During the 1990s and 2000s, it shifted toward the technical and scientific side, particularly with its economic focus on assessment models that could be used to demonstrate product value. Today, Access has arguably evolved even further, and in some respects has come at least partially full circle-back toward being an art form that blends technical requirements and the need to shape and influence a multitude of diverse stakeholders.
Today, Access increasingly assumes a central role as the topics that fall within its purview fundamentally impact and are critical to the core of a pharmaceutical firm’s business and success (see Figure 1 below). We see Access considerations and their importance occupying a far greater role in the future, and would venture to say that in five years, if it is not already, it will be perceived as a functional pillar that is as significant as commercial and medical are today.
Illustrative trends such as increasing real-world evidence (RWE) requirements (often following conditional approval and early benefit assessment), increasing price transparency, the rise of high-value combination therapies, disease chronification and the emergence of more curative therapies are all illustrations of Access issues at the core of how modern pharmaceutical companies need to organize, strategize and execute.
Viewed through a product lifecycle lens, Access is also becoming a far broader discipline (see Figure 2 below). While Access initially focused on the period immediately prior to and during launch (e.g., to synthesize evidence to support reimbursement applications), Access requirements have spread to encompass both earlier periods (e.g., providing input into R&D on evidence requirements, providing key inputs into business planning during development, shaping assessment methodologies and identifying and shaping policies to positively affect change) and later periods (e.g., engaging with sub-national payers to overcome local and regional concerns, shaping tender and contracting policy and managing pricing during loss of exclusivity).
Within the context of this steadily growing span of activities and business-critical topics, it is more difficult to define exactly what Access stands for, and what types of competencies it requires. To facilitate a common understanding, we believe it is important to embrace three changes in our general understanding and definition of Access competencies (see Figure 3 below).
First and most critically, we see an increasing need for identifying a new type of competency that would allow an individual to effectively operate as an organizational point person for Access. Operating within a matrix-like structure, we see this as a necessary competency to provide the connectivity with technical access domains and the rest of the business (e.g., marketing, medical, development, etc.). Previously, such roles were not explicitly visible, and were often roles at least partially assumed by experts within pricing and reimbursement or health economics and outcomes research (HEOR) functions. We see this as a highly strategic competency that is critical for better integrating and enabling collaboration of access activities and issues into the business mainstream.
Secondly, we would propose to split the spectrum of responsibilities that fall within pricing and reimbursement into two new competencies: a pricing competency, that embraces all activities around developing and executing strategic and operational pricing, and an evidence (e.g., health technology assessment [HTA]) synthesis competency, which includes many of the activities and competencies previously falling under the broad banner of reimbursement (such as the development of value propositions to obtain successful payer and HTA appraisals).
Finally, we suggest reclassifying HEOR and acknowledging that it accommodates two very differing competencies. Much of the health economics component (e.g., HTA, epidemiological models, etc.), we would argue is more akin to an evidence synthesis competency, while outcomes research is a distinct competency unto itself that could be classified as evidence generation.
Our intent in laying out the following competency descriptions is to define the core competencies that fall within the remit of an Access domain. We have deliberately avoided any form of prescription through job definitions or titles, as we recognize that different pharmaceutical firms will divide and blend these competencies as their needs require. Our intent is to describe the core competencies that we believe every successful global market access organization will need to exhibit.
As a starting point, we have selected a set of five competencies that cover the majority of roles and activities that we see in Access today: Access lead, policy, pricing, evidence (e.g., HTA) synthesis and evidence generation. We believe that these competencies are universally applicable across all pharmaceutical companies, although we would see them as the global level competencies that are typically required in mid-to-large organizations. In many companies, and in particular at the regional and local levels, many of these core competencies can and will be conducted by the same person with multiple competencies.
1. Access Lead
Objective: Leads access strategy and implementation through:
Shaping and developing strategy
Enabling cross-functional collaboration
Building access capabilities
Objective: Creates a positive and beneficial access environment by:
Objective: Develops and executes strategic and operational pricing through:
4. Evidence synthesis
Objective: Develops product value propositions to obtain successful payer/ HTA appraisals by:
Demonstrating value proposition
Submitting evidence and engaging
5. Evidence generation
Objective: Supports the identification and generation of evidence that will support optimal access by:
We recognize that the setting of standards and definitions will not by itself solve the current shortage of access talent and leaders. We hope it serves as a first step for at least three stakeholders to take action:
Collectively, we are confident that tackled from multiple angles, the increasing need for Access practitioners and for an increased understanding of Access more generally can be achieved.