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Backbone of marketing

Market access is at the core of marketing and demands an integrated approach across all business functions

Backbone This year, the National Institute for Health and Clinical Excellence (NICE) celebrates its 10th birthday. Its introduction in 1999 marked the emergence of cost-effectiveness as a fourth hurdle in the regulatory approval of drugs, and heralded an explosion of the industry's customer base. More significantly, at a stroke, it irrevocably changed the face of pharmaceutical marketing.

A decade later and the industry is still grappling with new strategies to conquer the overwhelming importance of health economics in the commercialisation of a product. Until now, the main problem for marketers has been an over reliance on the traditional, but the tried and tested marketing methodologies that served pharma so well through the blockbuster drug era of the 1990s are no longer enough.

Faced with a growing band of new customers with whom it has neither history nor understanding, the industry has begun to invest more heavily in a new philosophy: market access. .

The journey towards market access has been akin to touring a foreign country – the culture is different and the people speak a different language. The industry is seeing that, as with conversational French, learning a new vocabulary doesn't necessarily mean you'll be able to apply it when it matters most. Unlike school, however, choosing another language isn't really an option.

What is market access?
Popular mantra suggests that if you don't have a market access strategy your product won't get reimbursed and without reimbursement, you don't really have a product to market. The answer? Let's do market access. The question? What is it? Is it a strategy or a customer group? Who does it and where does it sit? Is it a new directorate alongside sales and marketing, populated by health economists who can 'do pricing and reimbursement'? Is it an umbrella that sits above the marketing function, or a subset to be added to the marketing mix? With such a share of the popular limelight, is market access the new marketing?

The gap between accepting the need for market access and actually understanding what it is remains uncomfortably large. To overcome this, industry must develop a clear definition of market access and the palpable advantages of getting it right. Getting it right, or course, depends on understanding where it sits in an organisation and how it integrates with other operational aspects. Is it the new marketing? Let's find out.

Kotler's principles of marketing
Our assessment must begin with a basic examination of the definition of marketing. To establish this we turn to Philip Kotler, whose acclaimed philosophies have pervaded pharmaceutical marketing strategy since the 1970s. The market may have changed over time, but Kotler's core marketing principles still resonate. Although some of the most erudite among the marketing fraternity have made brave attempts to adapt and reinvent them over the years, the simplicity of Kotler's principles makes such efforts futile. Nonetheless, Kotler himself accepts that, while marketing will be around forever, it won't always remain the same and will be re-engineered from A-Z as the global marketplace evolves. So just what is his definition of marketing?

"Marketing is the business function that identifies unfulfilled needs and wants, defines and measures their magnitude and potential profitability, determines which target markets the organisation can best serve, decides on appropriate products, services and programmes to serve their chosen markets, and calls upon everyone in the organisation to think and serve the customer."

In fact, Kotler defines marketing as "a company's customer manufacturing department." Dispelling the misconception that often confuses marketing with selling, he describes marketing as "the homework your company does to figure out what people need and what your company should offer." Whereas selling only starts once you have a product, marketing begins before a product even exists. Marketing, he says, hopes to understand the target customer so well that selling isn't necessary.

In 2003, Kotler's Marketing Insights from A-Z explored 80 marketing concepts that he claimed every manager needed to know. Built upon the solid foundations of his legendary '4Ps', which gradually expanded to 5 before contemporary marketers rebranded them as '4Cs', Kotler listed and examined the most significant marketing concepts of our time. His A-Z found no place for market access.

This could either suggest that market access is not considered a marketing concept, or that Kotler's prophetic re-engineering of the A-Z of marketing has already begun.

If market access is not marketing, then what is it? Research across the pharma industry has unearthed an array of definitions of what individuals perceive market access to be (see box 1).


Box 1: Industry definitions of market access

"It's about us now having a new customer group that impacts on the uptake of new medicines and how we need to respond to package the data to support them in making informed decisions."

"Market access is seen as a process that is 'thrust upon us by the payers' that requires us to go away and get our best reactive forces together to do battle."

"It is the activities that involve pricing and reimbursement and HTA success."

"Market access is the team that supports HTA and re-imbursement."

"Creating and communicating cost-effectiveness and value messages."



The most common misconception is that market access is simply about reaching market access customers – 'payers'. In fact, it is about reaching all customers and communicating a common message. The confusion stems from the origins of market access, which began in earnest with the introduction of NICE. Almost overnight, the traditional customer that everyone had grown up with as the gatekeeper to the patient was no longer the decision maker. That honour now belonged to the person who held the purse strings – the payer or the commissioner. The customer base exploded as the need to develop and present an argument for cost-effectiveness became top priority.

NICE's refusal of Relenza in 1999 was a watershed in the history of pharma marketing. Previously, prescribing decisions were based on a combination of compelling data and the strength of your company's relationship with individual GPs. If you knocked on enough of the right doors, you'd end up with enough of the right answers. Suddenly, the industry woke up and realised that it was going to have to address a different customer, one with a financial focus. This became the driver for market access but, as a consequence, has led the industry to believe market access is solely concerned with payers.

As such, the industry generally sees market access as an issue rather than an opportunity.

Often described as "the problem of market access", the industry is ever keen to find a solution to overcome it. This emanates from a widespread tendency to view market access in isolation, rather than as the centrepiece of a rich operational tapestry. Historically, the pharma industry has operated in silos – R&D, marketing, sales etc – with limited interaction and integration between the various disciplines. The emergence of market access and its broad treatment as another silo has only exacerbated the problem. Market access should not be in an isolated role, but is instead an operational communication mindset embedded within the roles of those accountable and responsible for reducing the risk and increasing the commercial gain of assets. And that's all of us.

An integrated approach
The industry's traditional silo approach has led to another market access misconception – the disconnect between a pure clinical message and a pure health economic message. The widespread belief is that companies need to develop one message for the clinician and another for the payer – the latter generated through market access activity in pricing and reimbursement. This is not wholly true. Certainly different customers require different messages, but these must be generated from the same stock and share common data origins.

This principle should lie at the heart of any definition of market access. Market access is about effectively packaging and communicating the right information in the right way for the right customer at the right time. This applies internally as well as externally. To succeed, market access has to be an operational mindset that is consistent, irrespective of your department, operational area or function. It requires developing a story that resonates with all of your customers, whether clinical or non-clinical, prescriber or payer. In other words, market access calls for an integrated approach across all business functions, throughout the product lifecycle.

Historically, pharma has worked in a very linear fashion: R&D generates data which is handed over to the pricing and reimbursement team, who use it to get the product reimbursed. As such, pricing and reimbursement develops a value dossier without any involvement whatsoever from marketing who, in turn, develops messages for the field force to take to market. There is little communication and even less integration.

The story you develop must have a common thread, which must be understood by everyone in order for people to buy. The narrative can only be generated through a thorough knowledge of the market for which your molecule is intended, which comes from developing a robust understanding of your target customers as early as possible in the development phase. This allows for the design of clinical trials that deliver the data you want and, ultimately, the product your customers need.

Customer intimacy
If market access is about communicating a consistent message to all customers, then any thought of it sitting separate from marketing, or indeed replacing it, is misplaced. Market access is not only a subset of marketing, it lies at the very heart of it.

As Kotler says: "The marketer's goal is to build a mutually profitable long-term relationship with its customers, not just sell a product." Similarly, the key to market access is customer intimacy. The goal should be to develop a truly customer-centric organisation, where everyone – from the top down – understands their customers' mindsets and needs. The most fundamental objective in any marketing plan is to identify what your customer wants, and then to develop and communicate it. A focus on the principles of market access can provide a clear framework to achieve this.

For pharma, the typical customer need at the moment is a cost-effective drug or service. The challenge for market access is to communicate that cost-effectiveness to the right people at the right time. Critically, market access needs to address everyone. Whether your customer is a GP or government, they need to have the same cost-effective message communicated to them – just in different layers and different formats. The core message should remain the same because it is derived from the same piece of data – you simply have to package it differently to suit the customer group.

Just how customer-centric is your organisation? Despite progress in this area, and rhetoric that suggests great strides have been made, the chances are it is still not customer-centric enough. More often than not, the industry's interaction with its customers is restricted, almost exclusively, to its field force. This is a flawed approach. Developing a truly customer-focused approach requires a cultural and operational shift, and needs to be embraced from the top down. This is not a new philosophy and, again, is embedded in Kotler's thinking: "If top management is not convinced of the need to be customer minded, how can the marketing idea be accepted and implemented by the rest of the company?"

Common currency
In terms of market access in pharma, success in the future depends on developing marketers that are not only customer-centric, but also have the capability to talk in two 'currencies' – a clinical currency and a financial one. Market access may concern itself largely with the development of the cost-effective argument, but all of your customers need to hear it. An ability to understand and communicate with both clinicians and payers is essential in the modern marketplace.

With customers and communication at its core, market access is firmly embedded as a marketing discipline. Everyone in the organisation has to make decisions based on the impact on the customer.

It's not new, but it is true – the customer is king. Likewise, market access is not the new marketing, but it is perhaps, as Kotler predicted, the latest cog in its ongoing re-engineering process.

The Author
Claire Gillis is chief executive at WG Consulting. For further details call +44 (0)1494 470760.
To comment on this article, email pm@pmlive.com

23rd February 2009

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