In-market access, optimising the brand value proposition

Cassandra Rix

The MSI consultancy

The cost-constrained healthcare environment continues to demand that pharma demonstrates convincing incremental brand value. At the same time the hurdles to gaining reimbursement or coverage and allowing clinical uptake are becoming more complex and without doubt the absolute requirement to engage more payer stakeholders in launch preparation is clear.

We are all well aware that launching a product with a compelling Brand Value Proposition that resonates with multiple stakeholders has become fundamental to gaining reimbursement across Europe and insurer coverage in the US. With some success, pharma has risen to this challenge, designing better clinical platforms to generate the evidence to demonstrate the outcomes required by an ever-changing customer base, and subsequently bringing new brands to market more effectively even within diverse healthcare systems.

But what of those brands that have been successful in meeting the requirements and negotiating the hurdles to achieve reimbursement and coverage at launch or soon after but then fail to meet the projected financial expectations? After rigorous, evidence-based processes to demonstrate the value of our brands, why does this happen? Surely the imperative (at least in England) of funding nationally approved treatments should guarantee local uptake? Unfortunately, the truth of the matter is that it does not. The same legislation that requires NHS payers to provide funding for treatment approved by NICE also demands the balancing of ever tightening budgets. National market access, whilst increasingly well understood and achieved through the demonstration of evidence-based cost-effectiveness, is not the only game in town.

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"...NICE or SMC recommendation does not prevent local payers from challenging funding for brands based on the question of affordability and real world value."

A new set of rules

National level endorsement, approval or even recommendation of a particular treatment or product is no guarantee for local access or clinical uptake: a product that makes health economic sense might not be affordable at a local level and the information that drives national support does not necessarily compel stakeholders in different regions to agree to local funding.

In the UK, NICE or SMC recommendation does not prevent local payers from challenging funding for brands based on the question of affordability and real world value. The rationale applied by NICE for example does not always translate in a similar way to local commissioners and payers required to manage a specific population with specific needs. What does a QALY mean to a local commissioner or pharmaceutical adviser who has to weigh up the benefits of a new intervention for the population in their region, against the cost of other interventions competing for the same scarce resources? It seems not as much as industry has been led to believe.

Playing the game

To agree to fund a brand within their local population, stakeholders need to understand the financial impact of use in specific patients. If use of the brand in addition to or rather than the current standard of care calls for financial investment, payers need to consider where they are within the current annual planning cycle. For example, it may be necessary to apply for additional budget mid-year (unlikely to meet with success) or divert finance from other sources (a considerable challenge in its own right, for discussion in another article). To increase the likelihood of success, it is therefore much better to prepare stakeholders for a budget impact in the midst of their financial planning for the next year.

This may seem like a simple solution, however we need to remember whenever this is undertaken, considerable resource and effort from stakeholders is needed to drive the process. Persuading these individuals to take action when there are many other priorities to consider is a real challenge. Therefore, they will do this only if they believe there is true value in what they are committing to pay for.

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"A multitude of factors drive value for each stakeholder audience based on their local health economy’s financial situation, their personal needs and current understanding of the given therapy area."

What is value?

As described earlier, providing clear information on the financial impact of a new treatment is a key success factor in gaining interest from local stakeholders. However, this is not the only key step. Local stakeholders must also be convinced of the brands value to motivate them to find available budget within cash constrained environments.

Perception of value for these stakeholders depends on both their local health economy situation and their personal objectives. Successful communication of the Brand Value Proposition relies heavily on them feeling considered and understood as individuals and what drives their decision-making being evident. Only once they believe you understand their individual challenges and can help solve them, will they be likely to consider the potential value that your brand could bring to their patients.

A multitude of factors drive value for each stakeholder audience based on their local health economy’s financial situation, their personal needs and current understanding of the given therapy area. Only by uncovering and speaking to the individual value drivers of each stakeholder can we develop a Brand Value Proposition that will resonate with them collectively and be flexible enough to motivate them individually.

Mapping the right message to the right stakeholder

Generating in-depth understanding of market dynamics is vital to uncovering these diverse stakeholders’ value drivers. It is possible to identify common value drivers across different customers and to segment stakeholders according to their characteristics, much as Pharma has traditionally achieved with clinicians. This stakeholder understanding and segmentation facilitates the development of segment specific Value Messages that can then be used to build a relevant story that both consistently communicates the Brand Value Proposition and addresses the different needs of each stakeholder group.

The core Brand Value Proposition should reflect the ‘essence’ of the brand whilst underpinning a flexible communication approach that can be moulded to appeal to different customers and form the ‘shape’ of conversations led by field-based teams.

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"Clearly, successful implementation of brand communications depends above all on matching the right messages to the specific needs of individual customers based on their role in decision making."

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Furnished with this insight and a route map through the Value Proposition, teams can then use their local knowledge to match customers’ needs and value drivers to the most relevant and resonant messages. This will lead to compelling communication of the Brand Value Proposition, supported by appropriate financial information to demonstrate budget impact and appropriately presented clinical data.

Whether at launch or at different stages into the life cycle of brands, developing a Value Proposition and a suite of associated Value Messages that all stakeholders can identify with is essential in order to generate local market access and drive product uptake.

Clearly, successful implementation of brand communications depends above all on matching the right messages to the specific needs of individual customers based on their role in decision making. Pharma are beginning to understand that to meet this complex challenge it needs to get under the skin of their customers and work in partnership or co-creatively to create Value Propositions, Value Messages and indeed the models that demonstrate financial impact to ensure resonance with them - which will ultimately drive success for our brands.

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