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Market access: Austria

Here, drugs take one of the longest times to get to market of any country in Europe, but the process can be accelerated by using information on stakeholders

Magnifying glass over Austria

While every nation is looking hard at the escalating health costs caused by an ageing population, there is massive additional pressure in Austria, which has seen its state-funded health service costs more than triple over the past 20 years.

For pharmaceutical companies, this has created a market with drug prices already well below the EU average. Furthermore, the country has a rigorous drug assessment, review and pricing process that has created an average time to registration of 400 days (in 2008) – rising to 500 days for retail drugs – which is one of longest times to market in Europe and twice the time taken in neighbouring Switzerland.

The reason for this extended time to market is the number of organisations involved in assessment and pricing decisions. At the top is the Hauptverband (HV), which is part of the umbrella organisation of the Austrian Social Security, Health, Accident and Pension Insurance institutions and takes the ultimate decisions on reimbursement and pricing.

HV assesses each product on the basis of its pharmacological, economic and medical attributes. It also receives input from a number of independent bodies, including Heilmittel-Evaluierungs-Kommission (HEK), comprising scientists, physicians, pharmacologists and social security representatives. HV allocates drugs to one of three boxes: 'green', 'yellow' or 'no'. Since this scheme was introduced in 2004, pharmaceutical companies have requested the registration of around 2,000 drugs, of which over half have achieved green box status. However, the vast majority, around 1,000, were generic products: only 130 innovative drugs have been awarded green box status.

Controlling physicians
For the 80 per cent of GPs that operate within the state-funded insurance scheme, to which every individual in the country must contribute, a drug's box status has a clear impact on prescribing and reimbursement. Drugs in the green box can be prescribed at any time by physicians and will be fully reimbursed; those in the yellow box can only be prescribed under special conditions that meet tightly defined rules for reimbursement; while physicians prescribing drugs in the 'no' box will find it extremely hard to get reimbursement.

Furthermore, Austria has recently introduced an economic prescribing tool providing physicians with real-time access to a range of medicines information, including indications, treatments and prescribing recommendations. Critically, however, the drugs are listed in price order, with generics at the top, and physicians must follow these to get reimbursed.

On top of this, one state, Salzburg, has had such success with its highly restrictive follow-up for prescribing practices that it is now being presented across the country as the way forward. If there is national adoption of the so-called Salzburg model and every GP signs up, it will significantly reinforce central control over pricing-led prescribing.

So how is the industry responding to this increasingly price-sensitive model? There is certainly an emphasis on driving down the time to market and attaining more insight into the decisions being taken throughout the product assessment and pricing processes. Pharmaceutical companies now recognise the importance of communicating with the HV, HEK, doctors' associations and independent commissions during the drug assessment process to maximise the chance of getting a green light and the right price.

The question is how to create a market access programme that delivers the right message, at the right time, in the right way to the right decision makers in these multi-layered organisations. This applies not only to existing products but also new indications, which will often take companies towards an entirely new set of opinion leaders.

Pharmaceutical companies need to research information that identifies the key stakeholders, maps their interactions and reveals their roles within the drug approval and pricing decision-making throughout the complex product registration process. They need to understand the interaction between national bodies, such as HV, and the regional health insurance companies and ensure that communication with these individuals is both relevant and consistent throughout the market access programme.

Over the past year, growing numbers of pharmaceutical companies in Austria have opted to re-allocate hospital-based key account managers (KAM) to a market access role. Using their experience with drug commissioners and senior consultants, these market access KAMs must be able to communicate effectively to individuals involved in pharmacological, medical and economic decision-making.

In addition to accurate information about decision makers, they need to understand how best to approach these individuals and tailor messaging, whether that is to an expert within a doctor's association or head of the commission for oncology.

Today, less than five per cent of pharmaceutical company personnel are involved in market access programmes in Austria. But, with the decline in importance of a sales force targeting physicians who are increasingly forced to comply to the economic prescribing model, the emphasis is shifting fast towards market access.

An average of 400 days is a long time to market, but it is also a short time if pharmaceutical companies are not able to target the right message effectively at key decision makers. With rapid access to in-depth information about stakeholders and their influence networks and role within the decision-making process, they can drive down that time to market.

The Author
David Nalbant
is commercial and marketing solutions director for Cegedim Relationship Management Austria

2nd December 2011


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