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Provision for payers

Convergence in market access policy means global communications can give local support

Animation of illuminated people connected togetherNo one would argue with the benefits of global communication campaigns that deliver consistent strategies and messages across markets. Yet, when it comes to payers, the perceived wisdom is that access communication strategies and programmes are best left to the markets, with headquarters providing the information to support these.

Historically, this approach may have offered the best return on investment – delivering best access outcomes across multiple markets and making use of global expertise. Now, smart companies are recognising that convergence of medicine cost control measures across markets means that there is a commercial benefit in the provision of global access communication strategies. Global initiatives can provide a common voice, while being flexible enough to adapt locally.

Worldwide, payers have become the most influential gatekeepers of patient access to medicines. Their mandate is to manage budgets effectively while improving the health outcomes in their population. The pressures on healthcare budgets are intense and set to increase as the economic downturn continues to take its toll. In this environment, medicines are an easy target – after all no official wants to be responsible for making staff redundant in a global recession.

Countries may be at different stages when it comes to medicines but cost control, cross-border cooperation and excellence exchange are driving convergence. Significant variations exist between markets, but there are also clear similarities – such as lists of selected drugs to be reimbursed, decision making being devolved to regional, local and third-party level and health technology appraisal (HTA) practices.

HTAs were first introduced more than 10 years ago and today their influence in decision making impacts all major EU markets.

In addition, the successful launch of the UK's National Institute for Health and Clinical Excellence (NICE) International Policy Consulting in 2008, the activities of the European Network for HTA (EUnetHTA) and the Obama administration's proposed health reforms, clearly signal a continued global trend towards cost- and comparative-effectiveness in reimbursement decisions. For the payer, efficacy, safety and quality are a given; it is a product's value that they want to see and understand. 

The trend towards convergence provides the opportunity to develop and deliver global payer communication strategies to support the markets. A global strategy can provide a common thread to link payer programmes and ensure that a product's value proposition is consistently communicated across markets.

Internal alignment
A recent study by IMS states that: "Companies can enhance success by eliminating the inconsistencies that arise between the goals of clinical and commercial teams, and between global teams and affiliates." This holds true especially when considering a company's approach to market access. Internal stakeholders must recognise the influence of payers and be aligned under the common goal of achieving optimal market access.

Real alignment across the clinical/commercial divide to address payer needs is crucial. Often, a systemic shift is required to achieve this and disciplined matrix management is key. Global cross-functional teams should unite in their thinking and work in consultation with regional and market teams to design a strategy that accommodates global and regional pressures. A 'market access strategy team' of relevant disciplines – including marketing, communications, clinical research, health economics, medicine, corporate strategy and regulatory affairs – should be established to work with an 'in-market' consultation group, comprising key regional/market players.

Once the global strategy is defined, it is important to communicate effectively its principles, objectives and aims internally through regular information alerts, internal briefings and open, honest dialogue.

Engage with payers
Developing programmes based on market evidence is essential for access success. Payers wield unprecedented power and have different needs to other decision makers. Companies must plan for serious financial concerns in an attempt to meet these needs. Payer insights will inform global strategy, help to define a meaningful value proposition and engaging messages and provide ideas for local implementation.

Undertake stakeholder mapping exercises in collaboration with regions and markets to gauge opinion, assess relations and inform payer contact programmes. Testing messages and seeking guidance on how to present asset data are important. Critical to access success is the ability of industry to answer the following simple payer questions:
• Do we need it? What clinical and other benefits does a new product have over existing products?
• Do we want it? How relevant are these benefits in clinical practice?
• How much better is it? Can we treat patients better with this new product?
• Do we want to pay for it? Do we think it is worth the additional money?

Most payers are keen to work in partnership with industry, guiding us on how better to meet their needs. Qualitative research and payer advisory boards are two tried-and-tested approaches to securing such input.

Market similarities
Although access challenges across markets vary, it is important to draw on common ground and appreciate that many payer needs are universal. Medicines expenditure is controlled across markets through a range of supply-side instruments, such as HTAs, international reference pricing, national pricing negotiations and demand-side instruments including:
• co-payments
• reimbursement restrictions
• formularies and guidelines
• devolving responsibilities.

There are many similarities between these budget control approaches and these should help in defining a product's value and how to present cost- and comparative-effectiveness data. Decentralisation of budget control has led to a battle for pricing and market access at different levels. These approaches must be understood and accounted for in the global strategy and addressed through local implementation.

Understand team strengths
Successful payer programmes are not a matter of luck. Access success relies on superior insight, communication and programme delivery from those with appropriate skills. With this in mind, assessing the market experience, skills and capacity of in-market teams should assist the development, and subsequent delivery, of global plans.

The status of markets will determine the level of support required from the global perspective. All markets will benefit from information on the global strategy, core payer messages and a breadth of relevant materials and data – all of which can then be adapted to meet local needs. Less developed markets may benefit from detailed step-by-step guides, action plans and timelines – along with ongoing counsel in areas such as stakeholder mapping, building payer partnerships and achieving positive tenders.

Global payer tools
Support local markets in their delivery of a winning market access strategy by developing a global market access toolkit that sets out the core strategy and provides resources which can be adapted to meet specific local needs. Flexibility will result in flawless execution and programme success. During development, work in consultation with the markets to identify the resources and formats they have found useful. Tools vary depending on needs and might include:
• market access planning aids that support internal alignment, planning and resource allocation
• the value story and payer value messages
• evidence summary and formulary data
• the business case, including cost-calculator and advice
• stakeholder mapping template and guidance
• tips on running a payer advisory board and qualitative research methodology
• patient disease pathway template and  information 
• ideas for setting up doctor-led health outcomes studies.

Engage and implement
Global strategies developed in consultation with regions and markets will have gained 'ambassadors' through the strategy consultation group. These people will be key to driving successful implementation. Hold an internal multimarket programme launch meeting, at the end of which markets should have a clear action plan for implementation. Regular multimarket virtual meetings are also essential to maintain momentum and share learning and success.

Evaluation of payer programmes is critical to assessing effectiveness. Your efforts should set the gold standard in payer communication strategies – continual learning is a core component of this. Set clear evaluation parameters to assess progress of programme delivery. Closely monitor performance of payer programmes to enhance further organisational understanding of the payer audience. Measure payer opinion, the impact of innovative initiatives and the level of internal alignment.

These metrics help teams to identify issues faster and provide more time for corrective action – as well as presenting a more reliable assessment of return on investment.

Supporting success
Fully supporting payers in their considerations is critical to a product's commercial success. The global perspective is important to help in-market teams achieve this and involves more than the provision of information.

As experts in the development and delivery of global communication initiatives, head office teams can support their markets. This won't be without its challenges, but through internal alignment, superior insight, effective planning and a commitment to partnerships, it can build foundations for market access success.

The Authors
Carsten Edwards and Sarah Giles are market access consultants at Brandtectonics  
To comment ont his article, email

13th October 2009


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