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Integrate: marketing and market access must come together

Published on 28/04/11 at 10:28am
Gerard Doherty
working with market access
Marketing and market access colleagues should increasingly work together

Although the words ‘market access’ have become much more commonplace in our working lives, the new clarity of its importance and the acceptance that market access is a prerequisite for success, seemed superfluous and therefore has not been totally embraced by everyone working in the brand team.

In fact, some marketers are happy to let the market access teams get on with their jobs, without getting involved in the detail and without considering the ongoing benefits to the brand.

It seems that marketers know that if access to market has not been considered, then their products stand little or no chance of any success, but they don’t always seek to completely understand what it is, how their market access colleagues are going about doing it. More importantly, how market access initiatives can help to promote the brand.

How does everyone, in fact, sing from the same hymn sheet? How could a synergistic relationship between marketing teams and their market access colleagues be exploited by the marketing team and give them an opportunity to achieve that sign of success, brand differentiation?

In the past, market access was generally viewed by marketing teams as a totally separate activity, which allowed them to subsequently “get on with the real job” of persuading clinicians to prefer and prescribe their brands. It was seen as a ‘one-off’ activity that was relevant only at the start of the brand lifecycle, which provided clinicians with the permission they needed to enable them to prescribe our brand.

The responsibility to develop and communicate necessary information to the budget holding customers (the payers) was often given to the public affairs or separate market access team, completely independently from the marketing team.

Health economics/QALYs/burden of illness models etc. are all part of the market access language, and this complex terminology can serve to reinforce the ‘otherness’ of what the market access team does - and is quite alien to those working in marketing (who subsequently need to go away and use it).

This does not therefore facilitate collaborative working, nor the understanding of the processes each have to go through and the impact of each processes the other function, all of which need to be made clear and understandable to ensure the best possible success and outcome for the brand.

In short, marketing and market access specialists have to invest time and effort to understand the others’ language and processes to ensure the overall brand strategy is joined up.

There is a very powerful argument for closer alignment between marketing and market access, given the impact the terms of market access can have on the ability prescribers have to prescribe our drugs, and in fact, we should probably have been working more closely with our market access colleagues much earlier too.

So, how do the two sides engage more closely and understand the impact of each other’s processes?

Firstly, marketing teams need to know the complexities of what market access is about and how it fits in terms of marketing, i.e. we need to understand that market access is about ensuring the data we have is packaged in the right way and communicated to the right customer groups at the right time. 

Understanding the requirements of the different stakeholders (the payers) who are involved in approving your brand will help you develop the right messages that will improve its ultimate success.

Add to that value-based pricing, which is to start by 2014 where drug prices will be set according to the value of medicines provided (drugs that demonstrate innovation and provide solutions for unmet needs which impact patients most) plus the move to GP consortia with 80% of budgets being controlled by GP commissioners, and we can now see how essential and important a collaborative approach between you and your market access colleagues will become.

There needs to be a consistency when talking to different customer groups to have a successful brand.

So how do we do that?

Simply put, what we need to do is have a common approach and firstly recognise and then understand how to integrate market access activities into our mainstream marketing, and develop a collaborative approach with all departments working in tandem by undertaking a four-stage process:

Identifying stakeholders

It is essential that we gain a common view across the team of who the key market access customers are, particularly given the changing environment within the NHS.

Who makes the decisions on prescribing?  Who are the primary care commissioning purchasers/gatekeepers? What do we have to do in order to get closer to and communicate with these new prescribers? Who makes the decisions in the changing NHS - the primary care commissioners who have the money or secondary care specialists who hold the clinical knowledge?

Identifying the key stakeholders from an external point of view holds the key to success. The patient and prescriber are the easy bit, but who the payers/budget holders are needs to be mapped very clearly and for some companies this might be more challenging. 

This poses different challenges depending on the organisation. For example, for a company like Novo Nordisk focused on the single therapy area of diabetes, the market access team will have developed an in-depth knowledge of their key therapy area and its stakeholders built over years of interactions in the field.

For a company seeking to serve four to five different therapy areas, the market access team’s focus will be much more diluted across more customers, potentially requiring a greater contribution to market access initiatives by sales and marketing personnel.

Therefore thorough stakeholder mapping is essential - to identify who the key stakeholder groups are, and who in the organisation should ‘own’ each customer.

So to whom do we need clarify and communicate the economic value of the product? 

As well as our traditional customers, who are these influencers, budget holders and policy makers? We must look more widely at who our key opinion leaders are within the changing NHS, and have a clear identification of who our ‘customers’ are and a thorough understanding of their needs.

These may include commissioners, prescribing advisors, heads of medicines management, NICE implementation leads to name but a few.

Adding additional impact and highlighting the need for market access and marketing to become more closely aligned will be the payers, who will be separated out from the traditional PCTs and with the advent of GP commissioning and GP consortia; where some of our traditional clinical customers i.e. the GPs are also becoming the commissioners.

The maps are changing with the payer and prescriber becoming much less separate and the need for single consistent messages to all stakeholders being crucial in this fragmented market.

Mapping may need to be undertaken at a much more local level, for example to primary care commissioning groups, and input from market access and marketing will be crucial to get a clear understanding and avoid duplication of effort.

Identifying goals and objectives

The next step is to identify and understand the goals and objectives of each of your market access stakeholders.

You need to understand what the payer wants to purchase and what their motivations are and what is important to them. This means considering outcomes beyond the QALYs etc. required to gain NICE approval, to understand where your brand could fit on the political agenda of the local commissioning group. 

And although important, it is not just about demonstrating cost-effectiveness of the product. If you are a primary care commissioning group, you may be more interested in those companies providing added value to your local services.

Success will come, where companies identify and then demonstrate improvements for a local population that weren’t there before, allowing the new organisation to show the value they have added for the local population, or help to support the priorities of the local health providers, rather than just selling their drugs.

A good example of this is Fresenius Medical Care, who offer dialysis services in partnership with the UK and run 53 clinics here and in Ireland, providing regular dialysis treatment for over 3,500 NHS patients. Rather than selling dialysis drugs they contract to provide the management of dialysis needs for patients in the local area. For the commissioner this can avoid the need to develop an infrastructure of clinics with staff and premises in a time of limited budgets.

Develop the optimal value proposition

The third step in the process is to look to develop the optimal value proposition of your brand. 

Companies need to ensure that they are aligned with the move by the start of 2014 to value- based commissioning. The three aims outlined in the Department of Health’s consultation paper are summarised as: better access for patients to drugs, more innovative drugs and better value to the NHS.

What are the unmet needs your brand addresses? What do you provide that is truly innovative. What does the commissioner want to buy? To do this we need to highlight the impact of illness that amplifies the value of the brand. 

Increasingly this necessitates looking from the patient point of view.

If the value-based proposition of the brand is based on the impact of the disease on the patient, it could attract a premium. For example, if you have a drug that has a specific impact on the patient and there is an unmet need, the government intends to pay a premium under the value-based pricing system from 2014.

Therefore, the patient voice will be very important and we need to think of ways to raise the profile of the therapy area and also the conditions our brands treat effectively, where appropriate.

We need to add value that is worthwhile, and have clearly identifiable and logical tie-ins between the service you are providing, and the drug. This is not just about breaking down barriers but increasing the value of your offering. Novartis who produce Lucentis (ranibizumab) for treating patients with wet AMD, developed a scheme whereby if patients required more than the six doses their evidence suggested (in contrast to the 14 doses in accordance with NICE TA155), the company would reimburse the drug costs associated with additional further injections reimbursed by the company.

This ranibizumab reimbursement scheme clearly demonstrates how companies and the NHS can work together to ensure that patients prescribed drugs such as Lucentis, receive the best possible support whilst providing cost-effective care within a managed budget. Novartis demonstrated their commitment to patients and confidence to prescribers that their drug works, whilst containing unforeseen costs.

Implementation and communication

The final step is to ensure that communication to the key market access stakeholders (purchaser, prescriber and even the patient) is closely aligned, particularly given their increasing geographical proximity. 

Knowing what your customer looks like and wants to hear, and then making sure that within your organisation everyone is communicating to the key stakeholder groups with the same messages is the key to success.

This moves away from the small, super-specialist market access group talking to NICE whilst the sales force talks to prescribers with different messages.

This internal alignment within your organisation means that you are interacting with primary care organisations at a disease level, and makes sure everyone is communicating the same message to the key market access stakeholders.

PHARMA COMPANIES NEED TO:

• Think about how market access and marketing need to work closely together to both remove barriers to prescribing, and build a strong case to allow prescribers access to their brands

• Understand that the approach might now be more fragmented than in the past, and therefore the need to work together is even more important to clearly define how your brand meets the aims and objectives set out by the government and NHS

• Ensure that your organisation is clearly aligned alongside the needs of all your stakeholder groups

• Remember great brands are based on a brand vision, which is consistent across time and customers. Communicating consistent value to payers and prescribers is the necessary starting point to building a great brand.

Gerard Doherty is managing consultant at the MSI Consultancy. For further information visit: www.msi.co.uk

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