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Novel narrative

Access marketing plans must bring tailored stories to distinct audiences of customers

An open book with pages flying from it in the form of birdsWhile salesforces and marketing departments are being downsized, market access specialists are being pampered like the newborn babies of our industry. However, before market access managers settle in too comfortably, they should look at the lessons learned in marketing and sales, where the customer is king.

In contrast to the views of marketing and sales people, in market access the customer (the payer) is still perceived as a 'hurdle' that has to be 'overcome' before the commercial life of a pharmaceutical product can begin. 

These 'hurdles' can include national and regional reimbursement agencies, formulary committees in hospitals and Health Technology Assessment (HTA) agencies, like the National Institute for Health and Clinical Excellence (NICE) and the Scottish Medicines Consortium (SMC) in the UK. Generally, knowledge about the various needs of these agencies is often low, as is the willingness to learn more about their thinking.

Current approaches
Think about whether you would consider a medical doctor a hurdle because you have to convince him/her before a patient can take a drug?

All the major pharmaceutical companies put a priority on market access. However, it tends to take the form of an ill-defined collection of different specialities, often in separate departments, including health economics (HE), public affairs, pricing, HTA and key account management. In some companies all these departments are service providers to each other; in others, they provide services on demand to a product director. The product director is often primarily focused on branding, positioning and selling the product, which are all activities that only make sense if the 'nasty problem' of market access has been overcome. 

There is a lack of understanding generally about what good market access is because it is not easy to define. So, perhaps the best approach is to identify what is not good instead.

One problem is that some senior pharmaceutical managers regard market access as a one-off event and not as a continuous process. This makes it difficult to convince them to invest in the groundwork necessary to be able to really target the dossiers to the needs of the payer. 

Instead of an integrated approach, which enables access to payers, patients, channels and medical doctors, payer access is handled separately. Most companies treat payer access as if it has no influence on the other stakeholders. Rather than a holistic approach to the launch and management of a product, separate managers 'manage' separate silos.

Imagine that the payer is your investor or customer. Would you treat him or her differently?

Making the move from 'market access' to 'access marketing' must begin with a shift in mindset. This is similar to the evolution of marketing over the last 40 years, which has developed from Philip Kotler's '4Ps': product, promotion, price and place, to Koichi Shimizu's '7 Cs': company, consumer, commodity, cost, communication, channel and circumstances, which put the customer at the centre of the marketing approach.

While focus on the customer is standard in pharmaceutical marketing, market access remains mainly concentrated on the company's need to overcome the hurdle of payer access. Several exponents still seem to be convinced that the industry can decide alone on the value a product delivers to the patients and social system. The payer is often seen as an entity that pays the invoice, not as an organisation that values a product or service.

Why are payers rarely described as customers in the same manner as medical doctors, nurses or pharmacists? This should be a natural step once the patient is seen as the consumer in marketing terms, as some pharmaceutical companies accept.

Once the payer is placed at the centre of thinking, together with medical doctors, pharmacists and nurses, this forces a different approach to the relationship and communication with these stakeholders. 

Then, the company has to build a long-term relationship, taking the payer's needs into account. Rather than defining the value of the compound solely from a company's perspective, payers and other customers can be regarded as partners who introduce different perspectives on the value a product or service delivers. Instead of leaving this customer to the whims of specialists like health economists and pricing managers, a company is well advised to have a holistic approach that consolidates the needs of all stakeholders.

This does not mean, though, that a naive approach should be taken towards payers. They do have different interests from pharmaceutical companies and the particular needs of these customers should also be addressed in a commercially interesting and sustainable manner. But how far away is this from the approach made to a medical doctor?

Access, as described here, as a continuous process of facilitating the opening of doors at all levels, from payers, via medical doctors to nurses, will be one of the keys to future success. A product cannot skip one of the customers (the hurdle!) but should add value to each of them to be able to capitalise on the potential of the product and market.

Access to a drug means, therefore, more than payer access alone; it is local, regional and national payer access, but also channel access, patient access and access to medical doctors, pharmacists and nurses. All access perspectives should be taken into account when building the brand; compromises have to be made over the different access levels, ie choosing a broad access level involving medical doctors and delivery channels has direct consequences on price, formulary restrictions and profitability. 

This is especially evident in life cycle management, where new studies and/or new data can jeopardise formulary access and price levels. A smart approach can capitalise on the total lifetime potential of a drug. Therefore, it is important that all access perspectives are analysed, insights consolidated and decisions made about which access mix the company wants to achieve at an early stage of development (phase I-II).

Understanding market access as marketing for a specific stakeholder gives scope for using marketing tools and concepts like Prof Shimizu's 7Cs in the market access environment. Transferring Shimizu's model in a market access context into a pharmaceutical access marketing mix results in a concept with eight elements. All of these should be balanced around the needs of customers and consumers.

The elements are:
• Customer
• Consumer
• Competition
• Channel
• Costs
• Compound
• Communication
• Circumstances.

They should be organised around the customer and consumer. The concept can be laid out in a diamond formation (see figure).

 

The diamond of pharmaceutical access marketing

The diamond of pharmaceutical access marketing

 

This diamond is embedded in an environment that is governed by elements like current competitors, competitor pipelines, substitutes and current and future circumstances. For example, government health care budget deficits can have a significant influence on the access marketing mix in a particular country. The diamond itself consists of the variables the company decides upon actively surrounding the nucleus of the customer/consumer combination.

The value of the compound is defined in a target product profile, which covers indications, outcomes and other tangible and intangible product attributes. The costs heading covers both monetary and non-monetary costs, such as lack of convenience. Channels, through which the product is distributed, and the communication mix should be chosen subject to the other elements.

At the end of this process, the key result is a uniform story that a drug can tell that touches each customer consistently. Plus, it should be the customer who drives what story should be told. It is irrelevant whether the customer is a payer, a medical doctor or the end user (consumer). The story may emphasise slightly different elements for the various customer groups depending on the perceived value of the drug to them, but the company's work should provide a story that can reach all. An HE model, market or payer insights or marketing messages are nothing more than elements of the overall story.

A pharmaceutical company that still discusses separate market access, pricing and HE functions, instead of focusing on its customers through access marketing will find itself left behind.

In access marketing, account management is the pivotal point around which the rest of the organisation is built. Marketing managers do not build the story of the brand within the company and transmit it outside; rather, the account manager translates the needs of the various accounts into a story around the brand. The specialists, like the pricing and product managers, analyse the possibilities of the brand to deliver those needs.

A senior account manager leads a team of these specialists, be they clinical, pricing or operational marketing. Depending on the portfolio and size of the company, a project group can focus on one product or a portfolio of products targeted at the main customers. During the life of a product, the main customer, and therefore also the project lead, can change. In early phases, the account manager could have a research or development background, whereas in the later phases the sales account manager should be in charge.

It seems logical to conclude from this that the product life cycle is managed on the basis of a product-customer-combination plan, in which the focus can shift during the life cycle. The development or marketing plans should be nothing more than parts of this master plan. 

Most importantly, all departments and hierarchies in a pharmaceutical company should start to accept that the value delivered by the company and product is defined by the value of the product as perceived by all stakeholders and that it is this that should ultimately drive the development and introduction of new products.

The Author
Jan Posthumus is general manager Benelux and global head of market access at Basilea Pharmaceutica International

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

4th October 2010

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