PharmExec Blog

Market Access is Dead: Patient Access is the New Prescription for Healthcare Marketing

by John Glasspool

Paradigms change when questions emerge the old paradigm can no longer answer. Market access has become a buzz word as access to markets is as significant a hurdle to product usage as registration itself. Initially a topic for pharmaceutical companies concerned about volume, it now affects all aspects of healthcare. We believe that the current understanding of market access will undergo a fundamental shift of perspective away from a company-centered towards a patient-centered view of the problem. This article identifies several forces that challenge the current understanding of market access and lobbies for a patient-centered, comprehensive approach that aims to address the needs of all stakeholders, but primarily create value for patients: Patient Access.

What killed market access?

There are four reasons why the current approach to market access is doomed to fail:

  1. The term ‘market access’ itself says a lot about the self-centered mindset, which is one of the reasons for the paradigm change. Healthcare companies want access to markets, revenues, and profits, and market access aims to persuade those that control access to let them in. But the market access framework often does not address the needs and goals of all the parties involved. Market access looks at the world from the perspective of healthcare companies with the ultimate goal of gaining access to markets for their products and most of their attention focused on convincing payers of the value of its products.
  2. Market access is considered a remedy to address the pricing pressures the healthcare industry is facing – a result of a marketing model that basically ignored the fourth P every marketer learns about in business school: Price. As policy-makers and payers search for ways to control cost without compromising care, the failure to communicate a convincing value proposition to these stakeholders results in being forced to compete on price. The increased use of tenders as a means of cost containment should be interpreted as a failure to communicate the value of a medication.
  3. Market access is based on a one-size-fits-all, product-driven marketing model. However, while patients have similar needs, the healthcare systems they live in go about pursuing the same common goal – improving public health – differently. A one-size-fits-all approach is not effective at addressing the different needs in each market, yet to manage market-by-market is not realistic. A practical approach is to define market archetypes and address the needs of each archetype effectively while leveraging limited resources efficiently.
  4. Traditional marketers tend to focus on lagging metrics such as number of patients diagnosed and number of patients receiving treatment (often illustrated as a waterfall chart), but they fail to understand and appreciate the patient and payer journey: Why does the market look the way it does? What are the incentives and success metrics? Marketers need to focus on understanding the ‘why’ instead of the ‘what’.

It is all about the patients

We suggest focusing on ‘patient access’ as a remedy for a marketing model that was for a long time geared towards addressing the needs of a single stakeholder – the professional writing the prescription. Patient access is a mindset that focuses on providing patients with access to the medicines they need at acceptable prices. Providing patients with access is the one common goal all stakeholders can agree on. While each healthcare system differs in how its patients, providers, professionals, payers, and policymakers go about improving public health, a patient access mindset helps to develop a compelling value proposition aimed at addressing the needs of the various stakeholder groups, tailored to the needs of the local market yet based on a well-understood positioning. Most importantly, patient access provides a unified focus for healthcare systems and companies.

What are the changes a healthcare company has to make as it moves from a market access to a patient access mindset?

  1. Drop ‘Market Access’. Words matter. One needs its organizations aligned on researching, developing, and delivering the products that improves people’s lives. A company has to recognize that its goal is to demonstrate the value proposition.
  2. It is uniting focus of all stakeholders in a healthcare system, since it is everyone’s goal to achieve improved patient outcomes.
  3. Patient access focuses on actual product usage. Market access is oftentimes tasked with obtaining strong pricing and favorable reimbursement status, but this mindset ignores real product uptake.
  4. Breaking the traditional development paradigm: ‘Registration is all that matters’. Market access today is often just paid lip service to as a ‘commercial function’, as opposed to ‘patient access’ – aligning internal stakeholders from ‘research to representatives’ towards a new principle: ‘A product only matters when a patient uses it’. The journey from R&D to sales becomes smoother as all the internal stakeholders are aligning towards a common goal.
  5. Patient access re-orients marketing analysis from looking beyond patient flows from diagnosis to treatment adherence towards a comprehensive understanding of the payer flow: Where are the costs are incurred? Who stands to gain or lose financially? A patient access centered mindset aims to understand the patient and provider pathways, with the ultimate objective to ensure those patients who can optimally benefit from a product have access.

Patient access is a chance to reset the clock

Instead of a win/lose mindset at the core of market access, patient access tries to create win/win/win solutions that lead to value for patients, companies, and the healthcare system at large.

The first step is a change of mindset. What is the objective? ‘Get products to those patients who can benefit from it’. Educating the internal and external stakeholders is a key. Beyond that, here are some suggestions to consider:

  1. Embed patient access as a guiding principle across all functions. Clarify how each function impacts patient access.
  2. Develop a deep understanding of the goals and key performance indicators of all stakeholders. Map the complete patient journey. Understand the payer flow. Ask yourself: What is the healthcare system trying to achieve? How is the healthcare system funded? How does this intervention help? Could this intervention create concerns? Make sure your plans address these issues.
  3. Develop a clear and compelling value proposition for each stakeholder group.
  4. Create a formal framework for understand the impact of decisions on patient access. Get payer input and advice early on.
  5. Look for metrics that matter to all stakeholders, for example ‘Percentage of people using the product for the designed use ’ or ‘Percentage of physicians freely choosing the product for a certain therapy’

Conclusion

“The future has already happened, it’s just unequally distributed”, the famous quote from the acclaimed science fiction author William Gibson, helps to explain the various pathways healthcare companies are exploring as they struggle to come to terms with the end of the blockbuster era. Almost every healthcare company has created a market access function. Many have started to look at the competencies required to communicate the value of their products in a language payers and policy-makers understand. But to be truly successful, healthcare companies are well advised to consider patient access as the overall objective and adopt a multi-stakeholder approach that aims to meet the needs of all the critical decision-makers. It is not about “we used to look at physicians, now we look at payers.” Patient access uses a system view with the patient at the center.

As Ludwig Hantson, the president of Baxter Bioscience, puts it, “At Baxter, we have a strong history of focusing on patient needs.  But as we pursue our goal to be a truly great company, we recognized we must look at all the P’s: payers, providers, professionals, policy-makers, as well as patients.”

John Glasspool is the Global Head of Emerging therapies and Market Development at Baxter Healthcare Corporation. He is based in Chicago and can be reached at john_glasspool@baxter.com.

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5 Comments

  1. Anita p. Roque
    Posted November 1, 2013 at 9:27 pm | Permalink

    Apparently my last post went mssing so I am compelled to post again.

    Market Access is alive and well and an important strategy in adopting a multi-stakeholder approach. Once Once again Market Access is misunderstood…really John Glasspool are you just trying to make a name fir yourself. Again the silo mentality of pharma executives is demonstrated. Market Access is not just about pricing.

    Just a quick definition for you Mr. Glasspool. Market access is actually about an integrated approach to dealing with multiple stakeholders including payers, healthcare professionals and patients. Despite each of these stakeholder groups having very different concerns and priorities – the common goal is a positive outcome for the patient. This involves engaging the relevant stakeholders, not just payers, at the right time with the right message.

    Have pharma executives never been to an ISPOR meeting? Has the research done on patient reported outcomes been ignored.

    Gaining access to markets depends on the answers to two straightforward and legitimate questions.How well does something work in comparison with what we already use (clinical effectiveness)? How much health gain do we get for the money paid (cost effectiveness)? The patients are at the heart of these Market Access questions. Without addressing the patients needs in these areas it is all dead!

    No Market Access is not dead. It is alive and well and if you would like to learn more enquire about the European Market Access Diploma (EMAUD).

    There is no paradigm shift nor do we need to change the terminology- patient access has aways been a part of the definition. It just has been difficult to reach out to patients due to regulatory concerns but now patients have the internet and they are reaching out to biopharma and that will expedite understanding of their needs in order to improve our market access strategies. The term patient centric has already been used for several years now. Next there will be calling for HEOR to be changed.

    It is not complicated so don’t make it complicated.

    It sounds like he needs some new people on his global team… people that understand what market access is and I just happen to know many.

  2. Mark Dodd
    Posted November 14, 2013 at 2:30 am | Permalink

    Market access is a term. Like many others it is what you do within the role and how it is interpreted that counts. Since it’s inception the term and role has been sometimes diluted and corrupted and often hijacked by board members to try and deliver sales and marketing agendas that it was never designed to do at the outset. It can be totally patient centred with multiple positive health gain outcomes. I would argue the term is less important than the co-operative will to jointly make significant positive outcomes always patient centred.

  3. navin Sharma
    Posted December 11, 2013 at 12:54 am | Permalink

    I agree with Mark Dodd. We are unnecessarily trying to create a devide. Market Access final Aim is to reach products and services to patients/consumers.

  4. Mike Doodson
    Posted December 27, 2013 at 3:28 pm | Permalink

    Market Access is the successor term to the old “Pricing and Reimbursement”, and as such is an improvement because it reflects the increasing complexity of the healthcare systems. I agree with the previous commentators that it encompasses consideration of all of the stakeholders including patients. We have to be careful with the term patient access. It implies that we are going around the physicians and payers to directly influence the patient, which brings its own connotations. Think about DTC advertising and the recent revelations that charities that help patients meet co-pays are largely funded by pharma companies. So by all means let us understand the full market map, and all the barriers to and enablers of adoption at the physician, payer and patient level,(something many of us have been doing for some time) but let us not overstate how we plan to intervene directly at the patient level lest we be understood and regulated against.

  5. Peter Brener
    Posted February 20, 2014 at 12:05 pm | Permalink

    This article is awesome, as evidenced by the passionate discussions triggered in the comments. What amazes me from comments below is that still people think Market Access has nothing to do with business and is totally unrelated to sales! If that is true, and it’s just patient access, well that’s very easy, just give medicines away for free or sell them at a very low price, end of the discussion. Access achieved!.

    Society has to decide how much monetary support it’s willing to give in order to compensate for the benefit it receives.

    The point is pharma often produces products offering (in clinical trials) three additional months of survival, for example, with a premium price over the standard of care. Are you kidding me? Products that just give QoL but no clinical benefits? The day that a product cures a disease is the day you get access, no question. The rest is basically a technical (HEOR) way to try to demonstrate value when you don’t really have it.

    Hope this triggers more discussion!!!

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