3 Success tips for Life Science Commercial teams: Market Access, Part 2

 

Address Payer Concerns, Cost and Efficacy in Advance 

Considering the pressure to demonstrate effective patient outcomes at low cost, payers consider cost and efficacy when making decisions about which therapeutic interventions to add to their formulary. In addition to results from clinical trials, market access teams need to dedicate significant efforts to source RWE insights to bolster efficacy claims, while addressing any side effects/limitations.  On the cost side, in addition to submitting pricing considerations data, it is important to keep in mind, generics and or similar therapeutics that may impact the price, a payer will reimburse. 

Conduct Extensive Competitive  Landscape Research

 

 

This research identifies opportunities to showcase similar product therapeutic interventions in the market or in late stage development, their cost profiles, manufacturer,  provider feedback (if available) and efficacy. The key goal of this research is to highlight how the therapeutic in development is superior to alternatives with a cost-benefit. Payer HTA teams dig through multiple evidence that focus on a clinical indication and the lowest cost therapeutic that can treat that indication. In today’s value based paradigm shift, there are many instances where a payer will suggest a non drug approach to treating a patient’s indication. It is imperative that this insight is captured in the landscape. For example a payer, may not find Roche’s Xenical (weight loss drug) medically necessary for the treatment of obesity considering the high cost, side effects and treatment efficacy, but may find that bariatric surgery, while an expensive  one-time cost, may be more suitable longer term on a case by case basis (under a prior authorization).  On the other hand, Xenical has multiple indications as it can be used for hypertension as well, so, it’s competitor landscape profile would capture that.

 

Capture RWE data insights after the Product has launched

Even after product launch, there is still work to be done. Manufacturers can generate real-world evidence (RWE) from tapping claims and EHR data to demonstrate how a product works with different patient populations. RWE data provide insight into ER and inpatient stays, treatment costs, provider prescribing patterns and patient outcomes. Post clinical trials RWE bolsters the commercial viability for therapeutics as it presents even more data that payers can use to evaluate formulary additions and or changes.