Solving Access Challenges in Today’s Market

April 30, 2020

New drug launches face more marketplace scrutiny today than a decade ago. Brand success requires not only communicating the clinical value to providers and patients, but also demonstrating the cost-effectiveness to payers in a real-world setting.

 Solving Access Challenges in Today’s Market

New drug launches face more marketplace scrutiny today than a decade ago. Brand success requires not only communicating the clinical value to providers and patients, but also demonstrating the cost-effectiveness to payers in a real-world setting.

This can be particularly challenging when these three stakeholders have different perceptions of the value of the therapy. To navigate these complex realities, manufacturers must focus on market access-a very broad term that encompasses everything from distribution to formulary status to contracting, across benefit designs and within specialty and traditional drug therapies.

Many times, market access isn’t thought about until the therapy goes to market. This needs to change. It must be discussed as early as possible in a drug’s life cycle, which means during clinical development or before.

Roshawn Blunt, managing director of 1798, a Fingerpaint company, and Andy Pyfer, partner at Fingerpaint, shared insights into the current market access landscape and explained why it’s important to have a clear understanding of the topic.

What are the top two access pain points when it comes to launching a new drug, and how do companies overcome them?

Roshawn Blunt: There are two market access pain points applicable to most, if not all, new drug launches. The first is achieving the broadest payer access at the best possible margin. The manufacturers must establish a price that reflects the drug’s value and achieves shareholders’ expectations. Payers have a variety of tools that can be implemented to control therapy utilization; they employ those tools if the net cost does not reflect the value.

To mitigate the risk of pricing incorrectly, manufacturers must understand the amount of control payers exert on a drug’s market basket-as well as the prescriber specialty’s willingness to navigate those controls to obtain access for patients. A drug could have a strong therapeutic effect, but if providers are unwilling to take the necessary steps to qualify patients for therapy, the value of the drug is lower.

Predicting how payers and providers will behave in a real-world setting ensures that the cost is based on the perceived value-measured not only by providers, but also by payers. This is the first step toward access.

Further, those data allow pharmaceutical manufacturers to develop the gross-to-net analytics needed to calculate the return on investment.

The second is patient affordability. Even patients with insurance might not be able to afford the copays for medication. At a drug’s launch, it’s critical to ensure that a patient’s inability or unwillingness to manage out-of-pocket costs will not affect a physician’s decision to prescribe a certain brand.

Moreover, it’s critical to ensure that cost does not impact a patient’s ability to remain compliant with that brand’s use. Manufacturers must have a clear understanding of patients’ total cost exposure-for both the newly launched medication and any concomitant medications-in order to inform price as well as any investment in copayment assistance and free drug support.

Why is it important for an agency brand team to have a thorough understanding of these pain points?

Andy Pyfer: When you are developing a commercialization plan, you have to deeply understand all of the factors that will impact a therapy’s success in the market, and that includes access issues. An agency can develop the most creative work imaginable, but if there are access barriers faced by the healthcare provider, or a patient can’t go to their pharmacy and get their prescription filled because it’s not covered or not affordable, then we have failed.

Working closely with access experts, like 1798, and grasping the pain points can also help creative teams develop materials. We can develop solutions to help move the conversations by being aware of those pain points and leveraging them. In some cases, it might mean addressing them head on in marketing materials or developing resources that move the needle in the access discussion.

By working together and creating a comprehensive and cohesive commercialization plan, it can ensure success for all stakeholders.