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Are you reaching your customers?

Published on 03/01/07 at 11:31am

The NHS is changing, and it's doing so at a rate faster than at any time in its history. Huge swathes of reform have characterised the health service under the Labour government, now six years into its 10-year programme of investment, and its plans  have been set out in three Department of Health publications - The NHS Plan, Health Reform in England: update and next steps, and the White Paper Our health, our care, our say.

The aims of these publications are to confront the challenges of an ageing population, to promote the ongoing revolution in medical technology to manage disease, and ensure consistency in the safety, quality and delivery of healthcare in  the UK.

A new NHS is emerging. For the pharmaceutical industry, the old way will no longer work. The traditional, linear approach of concentrating marketing efforts on prescribing clinicians is not enough. Likewise, a reliance on the delivery of key product messages based on safety and efficacy will not be enough to satisfy the needs of the growing band of commissioners and payers that can determine the success and failure of a product.

What is market access?

The prescribing landscape has changed, and only those with broader horizons and a sharp understanding of the bigger picture will enjoy the view. The new NHS provides great opportunity for the innovative pharma industry; the question is: how do you exploit it? The answer is equally innovative, but surprisingly simple: by establishing market access programmes.

Market access is about considering the implications your product may have on the wider healthcare market and, in turn, the impact the changing healthcare market will have on your product. Both the NHS and the independent sector are prone to change and constantly evolving - aligning your product with a moving target is a challenge, and only by understanding the needs of all the stakeholders involved in the adoption, positioning and funding of your product will you be able to develop and deliver messages that improve its chances of success.

The function of a market access programme is to prepare the whole market for the use of a product. This preparation is not restricted to the launch phase  it can, and indeed should, occur at any point during a product's life-cycle. As we know, the NHS is in a constant state of flux, and its evolution is continually mirrored by the market through expansion and contraction. The rapid NHS reform has driven the need for market access. Success depends upon exploiting the reform agenda, and understanding the environmental policy triggers that will impact your therapy area. The reconfiguring of strategic health authorities (SHAs) and primary care trusts (PCTs) has reached completion, while practice-based commissioning activities are gathering pace. In fact, encouraging practices and PCTs to use their knowledge of local communities and patient priorities in order to make the most appropriate commissioning decisions for their locality provides a wonderful opportunity for pharma marketers.

Effective PBC can offer gift-wrapped information to pharma companies seeking to align their products with the needs of their customers. Likewise, areas such as national service frameworks (NSFs) and modernisation programmes provide further clues for the positioning and delivery of your product, while the emergence of new customers offers additional options to promote the benefits of your treatment. Developing an understanding of all these customers is pivotal.

Identify and communicate

To develop such an understanding, it is imperative to clearly identify all the key stakeholders and influencers in your therapy area. As the NHS has changed, so too has the customer-base - the market for promoting pharmaceuticals has enlarged dramatically in the past few years. The clinician is no longer the sole stakeholder in the prescribing equation; service managers, lead clinicians, prescribing advisers, supplementary nurse and pharmacist prescribers, commissioners and other payers all play significant roles in the uptake of products.

Equally, other barriers have emerged that can restrict access to products post-launch, most notably NICE and the SMC.

An understanding of health technology appraisals (HTAs) and the workings of the process for ratification in the NHS is critical. A NICE appraisal is not limited to pre-launch, it can occur at any point during your product's marketable life -  communication across the breadth of your customer-base through market access will provide valuable insights into the kinds of information required to deliver a successful outcome from a NICE submission.

It is increasingly clear that the traditional, linear marketing methodology directed at either GP or consultant is now outdated in the new environment. Dialogue with these individuals remains highly valuable, and ultimately, the clinician will still write the prescription, but the decision will have been influenced by a number of individuals and factors from outside the immediate patient/physician environment.

Stakeholder mapping is central to market access. A full comprehension of the different perspectives and agenda of all the stakeholders is a powerful weapon. The first battle is to identify them, and the next is to communicate with them. Of course communication is a two-way street  with market access, emphasis in the first instance is placed on listening rather than informing. For example, service managers have their own agenda within the NHS, according to their areas of speciality. Market access is about discovering what those specific agenda are, and tailoring messages that describe how your product can help to support them.

These messages will undoubtedly include the clinical and pharmacological data that distinguishes your product; however, if you have effectively identified your customers' priorities, messages can also include information that demonstrates how your product can support their agenda. Can your product reduce referral to secondary care? Can it speed up a pathway or reduce waiting lists? Can it release resources by being prescribed by someone other than a consultant or GP? Does it correlate with any of the government's major healthcare targets

Influencer mapping

While the number of stakeholders within the NHS has increased, they have differing weights of influence, determined by the nature of their roles. Understanding these various influences and their significance again provides great opportunity for customised messaging.

Once more, the restructuring of PCTs could act as a stimulus for the promotion of your product. At the very least, it will have an impact on its subsequent uptake: it seems highly probable that some PCTs with long-standing drug and treatment guidelines will be forced to amend them in the post-merger era. What difference will this have on your product? More importantly, who can you talk to at a local level who can interpret and communicate these implications to support your product?

Clearly, the latest wave of NHS restructuring will have major repercussions for marketers across the industry. However, fluctuation in the nature and identity of influencers is not simply connected to wholesale market restructuring - the advent of new treatments, new stakeholders and evolving policy means that influencing factors should be reviewed routinely and regularly. This further underlines the notion that market access activity needs to be a constant, rather than a milestone.

Entry then access

It is important to make the distinction between market access and managed entry programmes. Although the industry has, through evolutionary necessity, built up a degree of familiarity with managed entry activity over the past decade, there is often confusion between the two. Managed entry is part of market access, but it concerns only the activity that takes place before a product becomes licensed.

Once it has been launched, it becomes market access because you can only access the market when you have a product. Managed entry is the activity that leads to a clear and defined understanding of the market you are about to enter once your product is approved.

Managed entry activity comprises the materials and communication platforms that allow you to understand the market you are seeking to enter, and to prepare your prospective customers for its usage. Key opinion leaders (KOLs) play a common role in the managed entry process, although even this is changing: whereas KOLs have historically come from the clinical environment, in the new era, the increased importance of funding and budget management has led to a growing number of KOLs coming from outside the clinical sphere. Fundamentally, the managed entry aspect of market access is crucial. It is impossible to conduct a successful market access programme without having first gone through a thorough managed entry process.

Piecing together the puzzle

Market access is emerging as an important component in the marketing strategies of pharmaceutical companies throughout the UK. The reasons behind this are clear and simple: in the modern NHS, developing an understanding of the growing customer-base and delivering products and services that align with its needs is a prerequisite for success.

Yet while the concept appears to be common sense, delivering it is much more challenging. The prescribing landscape in the NHS has indeed changed, and marketers are now confronted by a jigsaw puzzle which is more complicated than ever before. Success requires adopting a multi-disciplinary approach that encourages dialogue with and between a composite of all the key stakeholders across the entire breadth of the health service.

Accessing such a range of influencers is perhaps the biggest challenge, but achieving it provides the biggest opportunity. One missing piece and the jigsaw is incomplete, but complete the puzzle and the picture is there for all to see  that is, of course, until the market changes yet again.


Dr Richard Morton is the managing director at WG Consulting. For more information, visit:

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