The challenges of integrating the payer into brand building

Kim Hughes ponders the challenges of integrating the payer into pharmaceutical brand building in our market access themed month.

We are all now aware of the need to take account of Payers as well as HCPs and Patients in building and maximising pharmaceutical brands.

Yet there are many forces like Market Access (MA), Health Economics Outcomes Research (HEOR) and the Marketing Mix of brands pulling these stakeholders apart, not least of which is the current fashion of separating departments and budgets.

Other elements which contribute to the 'dislocation' of stakeholders are the need for MA / HEOR to work with specialist organisations on Health Technology Assessments (HTAs) and the need to understand in detail the process of Market Access in each market and develop the launch sequencing and individual country programmes appropriately. Specifically what types of programmes can be effective in securing reimbursement in different countries all add to the MA / HEOR separateness.

"Given these developments, research must deliver tangible benefits that Payers, and not just HCPs or Patients, can appreciate..."

As we shift from creating Target Product Profiles (TPPs) to creating Target Reimbursable Product Profiles (TRPPs) Payers must be integrated into the very fabric of brand and clinical trial design at an early stage.

If we add to this that many companies are looking at the overall positioning of their brands to emphasise outcomes beyond just the clinical benefits and investing quite heavily to make this a reality, then an integrated approach to brand development becomes even more important.

Given these developments, research must deliver tangible benefits that Payers, and not just HCPs or Patients, can appreciate.

In today's changing, more cost-conscious environment it is unhelpful to have two points of commissioning for similar market research studies with the same Payer target groups but for different internal audiences – the MA / HEOR teams or the marketing teams. Granted the subject matter can sometimes be different, more message orientated for marketing and more TPP / TRPP or HTA orientated for Market Access / HEOR, there are nonetheless often large areas of overlap.

The Pharma industry has had to innovate in Market Access. The use of Risk or Performance-Based initiatives are notable in the UK and although these can be seen as later, tactical approaches there is much that can be done to enable an integrated target approach if clinical trials are designed appropriately. This calls for Payers' needs to be fed into Brand Planning at an early stage. Within oncology we have seen the benefit of faster access through the use of planned performance-based agreements. Successful approaches, e.g. the Cimzia (UCB) 12-week agreement can sometimes be created through post-hoc analysis of data but if options are built in from the beginning then this can be most successful. Other countries are also heavily involved in different Risk or Performance-Based schemes. Australia, for example, has the most published schemes in place currently with 80.

"We may see Payers as restrictors of access to branded drugs - but from our work, this is not how they see themselves."

Another example of the need for alignment was the see-sawing on NICE's decisions on Xolair (omalizumab, Novartis). In 2007 Xolair's use was first supported by NICE; then, in 2011, NICE rejected its use in their draft guidelines, initially in children but then also in adults ... only to be overturned again when data was presented that aligned with the decision needs.

Where to then for market research?

Payer research can potentially form the bridge between HEOR / MA and brand development by being jointly designed and debriefed to multiple stakeholders. As we move towards Payers becoming a core part of brand development, integrating their research at an early stage will be not only helpful but essential. It is clear that market research providers and Business Intelligence units have an important role in helping to create this important link to integrate the payer fully into HEOR / Market Access and Marketing.

So what do we know about Payers? Do we really understand what drives them? We may see Payers as restrictors of access to branded drugs - but from our work, this is not how they see themselves. And how do they make and take decisions? We know that clinicians say they take treatment decisions based "entirely" on clinical evidence; yet if we examine their behaviour, this is clearly not always the case, similarly, Payers have drivers beyond the rational that we need to understand.

One of the most significant bridges between HEOR / Market Access and marketing is the development of Brand Value Propositions. For this we can learn from positioning research: where the positionings are difficult to test directly with physicians because they are internal documents that will never be seen by the physicians, so clever research techniques have to be developed to take this into account. The same principles apply to Value Proposition testing, where value propositions are the strategies rather than the message and should be treated using equally sophisticated techniques.

"...we are early in a long journey which will take us away from treatment and towards prevention..."

On the broader picture, we are early in a long journey which will take us away from treatment and towards prevention – with genomics, proteomics and personalised medicine all playing important and overlapping roles. Preventative approaches, whilst potentially costly, could well lead to a paradigm shift in how procedure and medical costs are evaluated by Payers so, in the longer term, this need to integrate the Payer viewpoint with brand development looks set to remain and grow.

Going forward, if we want to maximise value, we must ensure our brands deliver tangible, integrated benefits that the "triumvirate" of Physicians, Patients and Payers find motivating. It is not if, but how we effectively integrate HEOR / Market Access with Brand communication to help create real value in the future, and the best bridge to use to start this process could well be Market Research.

About the author:

Kim Hughes is the Managing Director of THE PLANNING SHOP international (TPSi) – a market research-based brand consultancy.

Kim gained a background in consumer marketing whilst working at Beecham including more latterly a stint as Assistant General Manager, Scandinavia, following a dual Economics and Business Studies degree.

Transferring to advertising as a strategic brand planner with Bates Advertising London, Kim helped to establish the planning department in this international agency. This was followed by a role of strategic planning director for the Fortune group of advertising agencies in Australia (Dancer Fitzgerald Sample, the Weston Company, Schofield Sherban Baker and Hammond Advertising), the latter being a Healthcare specific agency.

Returning to the UK in 1987 Kim established The Planning Shop with Tina Berry, another strategic planner. Kim pioneered the company's HealthCare division and eventually bought it out and established it as a separate company.

Kim is known in the industry for presenting papers and leading debates at conferences, as well as pioneering innovative approaches to market research.

You can contact Kim on +44 (0)20 8231 6888 or at kim.hughes@planningshopintl.com

How can we integrate the payer into brand building?