DEFINING PAYER TYPES FOR SUCCESSFUL MARKET ACCESS

Transcription

1 DEFINING TYPES FOR SUCCESSFUL MARKET ACCESS

2 THE GROWING GAP BETWEEN FUNDING AND MEDICAL COSTS Healthcare payer organisations worldwide are focused on managing the gap between funding and medical costs, often in the context of a changing regulatory environment. Healthcare costs are being driven up by a combination of factors including demographic changes, the increasing cost of medical technology and a shift in the types of diseases suffered by people in rich countries 1. Furthermore, with a declining birth rate and longer-living populations, the developed world is aging at a very fast rate. This is compounded by the fact that aging to date has been modest compared with what is projected to occur in the future 2. THE RISING INFLUENCE OF THE In response to these increasing cost pressures, healthcare payers are exerting more influence over market access decisions. In the past, market access depended almost exclusively on promoting the efficacy and safety of new treatments, but a changing healthcare landscape has prompted a keener focus on cost-effectiveness. The economic justification for a drug has now become just as important as its clinical efficacy and safety. FIGURE 1 - DEMOGRAPHIC CHALLENGES Age pyramid of actual and projected population, 2008 and 2033 United Kingdom and over 95 Males Females Reference: Office for National Statistics Population (000s)

3 FIGURE 2 - INFLUENCE ON THE RISE 3 Understanding payer priorities, needs and decision-making processes is vital for successful market access and it is clear that pharmaceutical companies must align their drug portfolios and prices to match the scope of the core services and the priorities of the system in which they compete. Q Which PERCENT OF ALL ANSWERS stakeholder was most influential in the past 5 years and which will be most important in the future? FIGURE 2. INFLUENCE ON THE RISE Reference: Monitor survey of 236 executives from large and mid-sized pharmaceutical companies 5 0 Payers Specialists Key opinion leaders Others General Practitioners WHAT DOES COST-EFFECTIVENESS MEAN TO A? Minimising costs for payers isn t just about the cost of a drug, pharmaceutical companies also need to show that they can reduce non-drug-related costs to keep overall therapy costs down. Payers are becoming increasingly interested in minimising costs across the pathway, such as staff and location costs. HEADS, MEDS AND BEDS It is broadly accepted that the consumables budgets are the easiest to address as they are more readily quantifiable and do not have political impacts such as staffing reductions or the closure of unnecessary hospital facilities. The challenge therefore is to define the optimum patient journey that ensures all appropriate steps are taken and implemented effectively, whilst reducing unnecessary staff or location costs objectively and defensibly. HEADS [ PEOPLE] MEDS [ DRUGS] BEDS [ VENUES]

4 POSITIONING YOUR BRAND TO S In the words of Ries and Trout, Positioning is not what you do to a product. Positioning is what you do in the mind of the prospect. That is you position (place) the product in the mind of the prospect 4. How payers see the product i.e. how it is positioned in their perception is what matters and what forms the basis for a successful market access strategy. Therefore, understanding the target market and anticipating its need is vital. UNDERSTANDING YOUR TYPES Payers come in various guises, from Medicines Optimisation Leaders to Commissioners and Service Managers. It s very clear that one-message-fits-all doesn t apply to the payer audience. Based on Triducive s extensive knowledge and experience of working closely with payers, we ve defined some different payer types that will enable you to: communicate in a consistent language to different payers create value propositions that speak to individual payer needs understand the evidence needed to back up your value stories understand the relevant guidance and policy to position your brand s reason to believe. It is important to remember that payers are often a mixture of more than one type and so communication should always be aligned accordingly. THE INNOVATOR THE PATIENT THE COST-EFFECTIVENESS THE BUDGET MAXIMISATION THE BIG THINKER THE PROCESS FOLLOWER

5 THE INNOVATOR THE PATIENT THE COST- EFFECTIVENESS Description: Driven by the desire to be innovative across budget management and project delivery Evidence required: Past examples of working innovatively with other healthcare partners NHS Innovation, health and wealth; CQUINS; Joint working with NHS Description: Driven primarily by the desire to demonstrate the best possible patient outcomes and experience Evidence required: Patient experience; Patient reported outcomes (PROMs); Care Quality Commission policy Description: Driven by comparing the value for improved outcomes, either within a therapy area or across therapy areas Evidence required: Comparative effectiveness data, including PROM and observational data to inform pharmaco-economic models and cost-effectiveness analyses; Cost per quality-adjusted life year (QALY); Head-to-head RCT data; Threshold NICE guidance and technology appraisals; All Wales Medicine Strategy Group; Scottish Medicine Consortium THE BUDGET MAXIMISATION THE BIG THINKER THE PROCESS FOLLOWER Description: Driven by ensuring the budget is optimised across the care pathway. This includes location and staff costs Evidence required: Payer medicine wastage; Medicines optimisation NICE guidance for medicines optimisation (due March 2015) Description: Driven by the ambition to strategically move the NHS forward and to leave a personal legacy Evidence required: Resource allocation model; Service specifications; Medicines optimisation; Joint Working with NHS NHS Five year forward view Description: Driven primary by a need to show a rational business case to their line-manager. This type of payer looks for a package that can be implemented easily, with minimal effort Evidence required: Integrated care pathway NHS Outcomes Framework Listening to the individual payers you re targeting will enable you to understand their needs and customer drive as payers can fall into various types according to the scenario and their expertise. Aligning your messages with these individual needs will ensure you make every payer communication count.

6 Triducive works with a network of over 500 payers, so we have an indepth knowledge of their needs. As a payer communications consultancy with over 50 years combined experience working with payers, we are skilled at aligning marketing activity with payer needs to ensure our clients maximise the opportunities facing their brand. To further discuss the issues in this White Paper or to organise a meeting with Triducive to talk about your payer communications challenges, contact us on: +44 (0) or info@triducive.co.uk REFERENCES 1. Jonathan Anscombe, A.T. Kearney, Healthcare out of balance: How global forces will reshape the health of nations, The Office for National Statistics 3. Monitor survey of 236 executives from large and mid-sized pharmaceutical companies 4. Ries and Trout, McGraw-Hill, Positioning: The battle for your mind, 1981