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Market access: Sweden

Smaller markets like the Nordic countries have their own challenges around reimbursement, especially with the forthcoming shift towards outcome-based payment

The Sweden flag with a dollar sign transposed on top of itOver the past four years, pharmaceutical companies in the Nordic region have slashed staffing levels by 60 per cent in a bid to counteract challenging market conditions. Some companies have cut the sales force entirely; others are working to build up new skills in market access teams. Yet, during that time, the demands of the health service have changed dramatically, creating a wide range of new influencers at national and regional level.

In common with health services globally, Sweden has seen a massive shift in emphasis towards reducing the cost of drugs. There has been a significant rise in parallel imports and the use of generics, while doctors must now prescribe only those drugs on the formulary.

In an effort to follow the money, pharmaceutical companies are striving to come to terms with a very different reimbursement system. The battle is not just to get the drug approved and on formulary, but to get the right price too. Obviously companies cannot afford to undercut established European pricing levels within this relatively small market. Therefore, it is essential to create a market access strategy that addresses the requirements of the Pricing Authority effectively. 

New money
Given the rapid changes in health service structure and the creation of a new set of stakeholders, pharmaceutical companies are currently taking many different approaches to market access. Some are opting for geographically dispersed teams taking a local and regional approach, while others are focusing attention at a national level.

Irrespective of approach, these organisations must deal with a new set of Key Opinion Leaders (KOLs), who range from senior hospital clinicians to civil servants within the Medical Products Authority (MPA) and Pricing Authority and, increasingly, patient associations. They are also exploring the most effective way of directing market access activity across the product lifecycle, from pre-registration, through registration to post-registration.

With some 10,000 KOLs, including physicians, civil servants and patient advocates, to consider, it has become clear that simply being able to identify these individuals, while essential, is not enough. Organisations need to understand how these individuals interact, their motivations – which will often vary across different roles – and their relevance at different times in the product lifecycle.

Classification value
Without clear classification of these KOLs, it is impossible to direct market access activity effectively. For example, a senior clinician can have multiple national and regional roles, from the head of an infection clinic in a Stockholm hospital, to a regional position as advisor to the State Authority. With the right information classification, a pharmaceutical company will be able to target this individual in the right place and with the right messaging automatically, based on the product type and position in the product lifecycle. Without it, the organisation risks wasting time and disenfranchising a vital opinion leader.

Similarly, organisations need to consider the position in the product lifecycle when working with the MPA, responsible for the regulation and surveillance of the development, manufacturing and marketing of drugs and other medicinal products. The relevant KOLs when a product is in the pre-registration phase and the organisation is looking to achieve approval in the Nordics, Europe or globally, are totally different to those that are relevant during the final approval process, who will be focused on checking safety and pricing; or those who, post registration, are responsible for monitoring therapeutic success and behaviour of the drug.

Without the ability to automatically identify the right individuals, pharmaceutical companies will struggle to target market access strategies at each stage. Understanding this hierarchy and individual classification is essential to ensure messaging is relevant and timely.

Patient adherence and outcomes
While pharmaceutical companies are coming to terms with the current challenges of the Swedish health service, there is another significant change on the horizon. While the current reimbursement system is per pill or per pack, there is a shift towards outcome-based measurement, with reimbursement based on treatment success. This will apply to specialist drugs in hospital initially, but the model is likely to be extended quickly. The shift to outcome-based payment will obviously affect market access strategies and will require new systems for monitoring patient compliance and adherence. 

The new emphasis on performance will also increase the importance of including patient associations and patient support programmes within market access activity. In the future, when a drug is prescribed, the patient will be invited to join a support organisation to ensure the drug is properly delivered and used. While this service will be delivered by a third party, the cost may well be met by the pharmaceutical company.

With reimbursement based on outcomes, measuring and supporting patient adherence will become a key function for the pharmaceutical organisation, further extending the market access remit.

Conclusion
Having cut staffing levels and with a huge financial challenge, pharmaceutical companies now have to create market access strategies that extend from initial lobbying to health technology assessment bodies, through reimbursement processes, local prescribing policies and now patient adherence.

There is an additional challenge in this region: Sweden, like its Nordic neighbours, is a small market, especially when compared to other European countries. Companies would rather pull out of these markets than undermine Europe-wide pricing policies. Today, Denmark has only 80 per cent of the approved drugs that are available in Sweden simply as a result of the pharmaceutical companies' failure to negotiate the right price.

With limited resources, pharmaceutical companies need to achieve smart market access strategies. And with the continued pace of change, there is little leeway for finding the right strategy. Organisations already have access to in-depth information about opinion leaders, physicians and administrators. The challenge now is to build on the classification of these stakeholders to achieve timely market access throughout the product lifecycle, from lobbying through pricing to patient adherence.

Peter Norrgård

The Author
Peter Norrgård
, Nordic regional director, Cegedim Relationship Management

To comment on this article, email pm@pmlive.com







Related links

PMGroup's Country report: Sweden

 

31st August 2011

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