The market access myth
(See also the first piece by Chris Rose “The top model in pharma”)
The idea that market access is a single role within the pharma business has evolved over recent years as the power of the “payor” has increased.
This is a misapprehension.
Market access is a mindset supported by a process based on clear marketing principles.
Why has this misapprehension evolved and why have marketers distanced themselves from market access?
I believe there are a number of origins for this misapprehension including:
• The product and brand positioning being developed reactively, in silos.
• The buying process is not fully understood or identified by marketers.
• The clinical effect is still seen as the overriding argument for product development.
The idea of asking medical to write the clinical strategy, market access to write the payor strategy and marketing to write the marketing strategy should be consigned to the waste bin!
“Market access is a mindset supported by a process based on clear marketing principles.”
The key to good market access is to build a strong position for the brand based on proactive product positioning:
Proactive product positioning involves the cross functional team (medical, market access and marketing) making a conscious decision on where the product will fit in the treatment algorithm. This could simply be a decision to “follow” the competitors and existing perceptions of where a product would fit based on the guidelines and reimbursement criteria or it could be to forge a new path and identify a strategy to create a new category.
The product position must resonate with all of the customers (a position for “prescribers” as 1st line when “payors” will position the product as 2nd line would not be viable!) The launch product positioning and the life cycle management product positioning must be included as part of an integrated strategy to achieve access and sales.
This is in contrast to brand positioning which looks at the value proposition for each relevant customer and translates this to a unique position you aim to occupy in the customers mind (fig.1). Ideally the brand positioning will encompass the product position as it evolves throughout the lifecycle (fig.2). Gaining insights into the customer’s needs and using this to identify both product and brand position is the essential first step for effective market access and ultimately effective marketing.
Fig 1: Relationship between Product and Brand positioning.
Fig 2: Relationship between Product and Brand positioning through the life cycle.
Understanding the buying process and the roles of different influencers in the process is the next step to ensure successful market access. Typically pharma marketers have concentrated on the “Users”, the “Consumers” and the “Providers”. More recently the “Enablers” and “Purchasers” have become the responsibility of the Market Access specialists (fig.3).
(The “Gatekeepers” i.e. EMA and FDA are also an important customer group however there is an important distinction from other customers. The Gatekeepers involvement is typical transitory during the time of marketing authorisation and usually only revisited under exceptional circumstances e.g. if a safety concern is raised or if a new indication is sought. All other customer groups regularly revisit their decisions!)
Fig 3: A simplified buying process, Influencer maps for each customer are required for a full understanding of the market access process and to develop a comprehensive strategy to maximise the opportunity.
Joining the strategy up for these influencer groups and making them part of the same plan is essential. The trick to good marketing is to appreciate the skills and capabilities everyone can bring to the party! Marketing should bring specialist skills in customer insights and segmentation as well as needs analysis and branding, Medical should bring specialist skills in interpreting clinical data, insights into life cycle management clinical needs as well as ethics and customer insights, Market Access typically bring skills related to understanding the process and the people involved as well as health economic and patient reported outcome (PRO) skills. Individually these are all important but with the whole team working across the functions these become truly powerful!
Unfortunately in reality it is very infrequent that the team all sit together and work together.
The third significant barrier to successful market access and good LCMAM (Life Cycle Market Access Management) is the enduring belief that good clinical data will overcome all. Clinical data is the bedrock of the pharma industry but showing safety, efficacy and usability is no longer enough.
The customers will take our data and consider:
• Which patient population does the product “fit” (tolerability, efficacy, effectiveness, economic viability, usability etc.) This is especially important if a sub-segment of patients respond better than the entire population studied.
• How does this product compare to those already available. Effectiveness and clinical, rather than statistical, significance are key. Comparisons versus competitors will be made even if the data is not available!
• Enablers will review data and look at the “national” impact while Purchasers will take into account the local impact and local needs, these are not necessarily in accord! Data needs to be interpreted and translated for the relevant target customers.
The data is still important but it is even more important now how we plan and execute clinical studies, how we interpret the results and what parameters we set out to measure, understanding who the target audience is for a clinical study and what their specific needs are, identifying what will be the benchmarks at launch, both nationally but very importantly locally! Above all else we must understand the changing behaviours of all our customer groups (“finite budgeting” as opposed to “indicative budgeting” has caused a dramatic change in physicians’ behaviour in the UK and is currently significantly influencing the behaviours of German physicians)
“The trick to good marketing is to appreciate the skills and capabilities everyone can bring to the party!”
Pharmaceuticals are no longer simply targeting an unmet medical need but need to be viewed in the wider healthcare needs of society.
All of these challenges point to a solution based on combining excellent marketing, medical, health economic, statistics and patient reported outcome skills in a cross functional global/local team. The need to gain insights into all customers and work together as a true team is what will make the biggest difference defining success or failure.
Market access is a mindset which requires innovative thinking, excellent analytical skills, strategic and conceptual thinking competencies combined in a team of individuals willing to put market access at the centre of their activities.
I believe it is time for the marketers to step forward, embrace market access, not use payors as the “hurdle” or “scapegoat” for failure, set realistic expectations, write comprehensive marketing plans, sit together and work with cross functional colleagues and last, but most important of all, engage with all customers throughout the product life cycle.
About the author:
Chris Rose has worked in Sales and Marketing roles within the Pharmaceutical Industry for over 20 years leading the launches of primary care and specialty products. After recently leaving the position of Business Unit Director at Nycomed, Chris is currently working for SAM, a specialist recruitment company and is a Partner in Roses, a Marketing Consultancy company based in Sweden.
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