It is hard to believe that, prior to development of the first HIV drug, UK pharma rarely, if ever, effectively collaborated with the patient advocacy sector. The launch of AZT in 1986, however, saw the Wellcome Foundation pioneer the building of mutually beneficial advocacy/industry partnerships and now, 23 years on, pharma is highly proficient at engaging with patient advocacy groups, understanding their needs, building alignment and developing effective and long-lasting partnerships and programmes. Yet, many companies are still not applying these core principles – so critical for commercial success – fully to their newest stakeholder, the payer.
In qualitative research recently conducted with over 20 UK payer stakeholders, it was found that, in terms of overall payer interaction, companies are seen to vary from the 'very good' to the 'very poor'. Those companies that are perceived by payers to be way ahead of their competition are the ones investing in innovative and effective payer strategies. However, the majority of companies still tend to address payer engagement and the market access challenges far too late, often as an add-on to their sophisticated clinician and advocacy programmes. Payers want the many to achieve the excellence offered by the few.
Some payers are still wary and cautious of pharma and remain deeply suspicious of its motives. This is often as a result of previous negative experience. However, there have been significant improvements over the last few years. The key drivers of this have been trust and partnership.
Trust needs to be built through transparent, open and honest communication. In the eyes of payers, partnership can no longer mean 'prescribe my products'. True partnership relies on developing lasting, meaningful and mutually beneficial relationships that meet the needs of both partners.
In achieving this, the industry will need to demonstrate its commitment to improving health outcomes through investing in more than just medicines. Payers would like to explore mutually beneficial activities and for this they identified the areas of assessing and improving service design and care pathways, which will, in turn, provide a more favourable environment for medicines access.
Poor initial communications
Payers need to plan effectively for services that improve the health of their populations and budgetary management is critical to achieving this. The majority of payers feel that pharma is only 'somewhat useful' in providing them with relevant and meaningful information that supports their planning and that this information is often received too late in their planning process.
"It is important that the industry effectively plans for its market access activities, clearly detailing when and to whom they should communicate about new products," says Stuart Saw, director of finance and procurement, Tower Hamlets PCT.
'Useful information' in payer terms translates to real-life patient outcomes and cost-effectiveness data, localised where possible. These data are still conspicuous by their absence. Interestingly, many payers receive information from pharma's field-based teams that is already widely available to them through National Prescribing Centre alerts and Horizon scanning.
"Pharma has a curious habit of providing us with information that we already have. We want to see the value a new product will bring, not the p value of a trial outcome. Pharma needs to translate clinical data into meaningful real-life data and the earlier we see this information, the better. This will enable us to plan accordingly," says Michael Sobanja, chief operating officer, NHS Alliance.
Poor quality of interaction
The majority of payers find the frequency of contact with pharma 'just right' at approximately one contact per week. However, most find the quality and content of these interactions only "somewhat useful". Payers feel that pharma representatives do not understand the challenges they face, nor do they understand the inner workings of their local health economies. The majority of meetings are spent considering the complexity of the system and associated topics, rather than discussing approaches to improving health outcomes.
Payers believe this is driven, in part, by poorly trained and briefed representatives who do not understand the complexities of the healthcare system and cost structure. Indeed, there is a strong perception that the industry is not doing its homework properly. As an example, valuable meeting time is often used by representatives to obtain information on local health economies and priorities that is freely available elsewhere. The message from payers is loud and clear: prepare better, understand our needs and deliver customer value. While this is not applicable for all companies and their representatives, for many there is still much to be done.
Highly valued partner
Payers believe that the industry has an important role to play beyond the introduction of medicines, it just needs to get this right. One area in which pharma can add significant value is through connecting stakeholders.
Payers recognise that the industry has well established contacts across all health stakeholders and that pharma is expert at aligning opinion. Payers want the industry to work with them in connecting disparate stakeholders to facilitate managed product entry and appropriate use. It's one of a number of payer priorities and, therefore, represents a real commercial opportunity.
A highly praised example of such industry involvement was a multidisciplinary rheumatology educational event, the outputs of which will support improved patient management. This meeting was jointly organised by a pharma sponsor, the PCT's education and training department, local hospital consultants and PCT pharmacists. The logistical support, flawless execution and professionalism of the pharma partner was critical to this initiative's success.
"Market access schemes are often difficult to implement as they require a range of different NHS stakeholders to co-ordinate new tasks. Pharma has the skills to help this process and is ideally placed to engage and facilitate this discussion," states Allan Karr, chief pharmacist, University College Hospital, London.
There are clear differences in priorities between the budget-restricted payer and the access-driven industry. Yet, improved patient outcomes will only be achieved through the industry and payers aligning agendas and working together to tackle these competing priorities. The challenge is to find a balance that supports industry innovation, while effectively managing payer budgets.
The government's new Life Sciences Blueprint, which aims to place innovation at the heart of the UK life sciences industry, signals a step in the right direction. The industry plays a huge role in driving this collaboration and it must engage with payers, understand their diverse needs, develop partnerships, communicate in a transparent way and, above all, demonstrate the value of a product in payers' eyes. It is this value that payers are interested in.
"The value of a pharmaceutical product to an NHS manager is a balance between the effectiveness and affordability of the product. Different organisations have different drivers, not least of which in the current economic climate, is the need for most NHS organisations to reduce overall expenditure. Positive "values" that should be actively promoted include the ability to reduce hospital referrals/admissions, as well as an overall reduction in morbidity and mortality," claims Chris Town, ex-chief executive of the Greater Peterborough Primary Care Partnership.
• There are some very skilled pharma staff out there
• Things are improving and there is definitely a greater recognition of the importance of cost containment
• Some companies are able to demonstrate a grasp of my objectives and priorities
• There is more evidence of joined up approaches from specialists, sales and marketing
• Some companies are very good at engaging with all those involved in prescribing decisions
• Some representatives have extensive and in-depth knowledge of that therapeutic area
• Some companies are very good at helping payers understand particularly complex trial data.
• Progress is slow, indeed, it is non-existent for some companies
• There are still too many ill-informed and poorly-trained pharma staff
• For some companies, staff turn-over is a real issue in terms of continuity
• There is still too much focus on marketing to clinicians and not enough effort made engaging with payers
• PCTs are approached with a product only focus
• Payer efforts are often undermined by sales activities delivering different messages
• Some companies influence prescribing in unexpected and undesirable ways
• Undermining or going against official guidelines agreed for PCT areas is a real issue
• Lack of awareness of the NHS commissioning environment, tariff payment systems and poor understanding of how new drugs are agreed for use on formularies
• Total naivety of what the NHS can afford and totally misjudging the market price
• Introduction of patient access schemes that are laborious, if not impossible to administer at a local level.
Smart industry players will further invest in understanding payers' diverse needs. This will enable beneficial partnerships and facilitate meaningful two-way dialogue. In addition, payer insight can help inform a product's value proposition and provide an evidence-based approach to aligning clinical and commercial strategies.
Patient access to the right medicines at the right time is at the top of everyone's agenda. Although there have been significant advances over the last few years in the industry's market access efforts and programmes, there is still much more UK pharma can achieve.
The 2009 'Payer Report Card' verdict is: "Good effort but needs improvement."
Carsten Edwards and Sarah Giles are market access consultants, Brandtectonics Access, a Chandler Chicco Company.
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