Formulary guidance and transparency from P&T to point of care

Market Access is Getting Harder

Posted by Matt Breese on Mar 24, 2017

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Market access is getting harder.  We’ve seen this first hand with over 85 manufacturer clients and over 60 payer/PBM clients but anyone close to the industry feels the impact. Pharma pipelines expand with historical amounts of highly managed products in complex disease areas as brands launch into the market. 

Market access is a moving target with new benefit structures employed by plans and a regular flow of market events that shift access, restrictions and policies. Brand teams are tasked with staying ahead of these shifts, contracting with payers/PBMs for optimal access and then communicating a consistent message to prescribers.

Here’s what you’re up against:

  • 65% of lives are NDC blocked at launch
  • Payers apply aggressive prior authorizations, step edits and medical policies
  • HCPs are frustrated by market access complexities that delay patient therapy
  • HCPs cannot confidently prescribe your brand without accurate data and messaging

Per the Global Life Sciences Report by IMS Health, “The majority of life science decision makers cite market access as the main concern that keeps them up at night.”

Staying competitive in highly-managed specialty classes:

As the focus on specialty drugs increases, these five strategies help brand teams better understand and prepare for payer, HCP and patient responses to this changing landscape. More detail can be found in MMIT’s white paper on “Staying Competitive in a Specialty Drug Class”:

  1. Leverage therapeutic analogues and historical market access data to guide forecasting.
  2. Develop and refine a contracting strategy based on payer and PBM opportunities.
  3. Analyze payer and PBM behavior for each channel to understand the drivers of market access and restrictions. It’s not enough to know a restriction exists – brand teams need to understand how painful a step edit or PA will be for a prescriber.
  4. Arm field teams with information to overcome inevitable market access challenges from HCPs
  5. Make HCP education a priority for your field team to simplify access and restriction messaging

The added complexity of medical policies and restrictions:

Just a few years ago, all we had to understand was the formulary tier that my brand and competitors were on. This helped to understand market access position across payers and geographies:

  • Is my brand advantaged?
  • Is my brand at parity?
  • Is my brand disadvantaged?

While these three questions are still at the core of pharmaceutical brand access, manufacturers now need to answer these questions at the medical benefit, pharmacy benefit and restriction detail level. The frequency at which the market is shifting due to disruptive market events requires brand teams to track this in real-time.


Simplify HCP prescribing through policy and restriction transparency

Many pharmaceutical brand teams struggle to arm field teams with the right data and tools to effectively handle market access objections, especially when it comes to questions about reimbursement restrictions and medical policies. We’ve developed playbooks to provide best practices on tackling challenges like this:

  1. Develop a common language to communicate common obstacles for prescribing in your disease area, leveraging data that is consistent with physician sources
  2. Integrate approved coverage statements that tell a story and are specific to the prescriber based on their patient populations
  3. Remove standard generics that all products must step through (i.e. parity with competitors) that waste your team’s face-to-face time with HCPs
  4. Appropriately understand where you are promoting support (i.e. trial positioning for highly managed classes)
  5. Inform field team on areas of concern (like restriction limits) and educate them on hard-to-switch positioning


At MMIT, solving your market access challenges is all we do. We hope you enjoyed this post regarding the complexity of market access, policies and restrictions but we’re always here to discuss the major challenges facing your brand. If you’re interested in learning more about MMIT, we're happy to talk.

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Topics: Specialty, Market Access, Data & Analytics, Branding & Marketing