Reimagining healthcare market access strategies post COVID-19

Healthcare market access

The current pandemic has led to a period of continued uncertainty across global healthcare markets, increasing the barriers to market access. Pandemic-induced market slowdowns have stalled product launches or rendered many unsuccessful as the focus shifted to overcoming immediate challenges presented by COVID-19. In such trying times, reimagining healthcare market access strategies through reliable data and insights will enable healthcare organizations combat the challenges presented by the current healthcare crisis. 

Before getting started, market access strategists first need to get to grips with the impact COVID-19 has had on Healthcare Technology Assessment (HTA) and other payer agency activities. The current reality is a virtual-focused one. There is a heavy reliance on digital technologies to make up for restricted human contact amid the coronavirus pandemic.

Market access has gone digital

Social restrictions and health concerns due to COVID-19 has caused significant changes in the way the healthcare industry operates. As healthcare market access strategies need to take provider, patient, and payer preferences and needs into consideration, they must embrace digital technologies as their new normal.

For instance, many committee members of the National Institute for Health and Care Excellence (NICE) include National Health Service (NHS) frontline workers, who are grappling with COVID-19 guidelines. In light of the current environment,  the organization has switched to virtual committee meetings. The Italian Medicines Agency (AIFA), Gemeinsamer Bundesausschuss (G-BA), Germany, and Pharmaceutical Benefits Advisory Committee (PBAC), Australia, are also focusing on virtual meetings.

Market access strategists are ultimately going to have to master influencing stakeholders through virtual meetings, while developing value propositions that take present needs into consideration. Additionally, developing timely and relevant resources is crucial during these uncertain times. This can be done by disseminating COVID-19-specific content across digital platforms directed to payers and organized providers.

Key market access challenges post COVID-19

The global crisis has disrupted the healthcare industry in many ways, with certain functions more affected than others. Companies are also under pressure to reallocate their bandwidth and funding to pandemic-related product development, affecting innovation in other fields. 

Product launches are being affected by delays in R&D processes and regulatory approvals due to the global pipeline of new COVID-19 treatments, as well as pressure on the supply chain due to lack of available resources. In IQVIA’s April 2020 update on COVID-19 in the EU5 markets, it was revealed that at least eight product launches have been delayed, disrupted or otherwise impacted by COVID-19.

To keep up with these challenges, firms need to optimize their healthcare market access strategies through a holistic perspective of the market landscape and current trends. This includes analyzing the level of competition and other therapeutic area (TA) dynamics that can impact the use of payer tools to govern access. Now is the best time to prioritize the fields which are therapeutically critical. It’s always good to remember that the idea of a good strategy is to maximize profits, while creating the best possible market access route.

Market access trends post COVID-19

Once the pandemic is contained, partnerships with bio-pharma manufacturers would be the way to go for health systems, with focus on health plans and pharmacy benefits management (PBM). Such partnerships can assist in effectively managing high-risk patient populations with underlying diseases. Maximizing this opportunity will also ensure message continuity and resource optimization across organizations. 

Let’s take a look at other key trends that are affecting market access strategies in the current times.

1. Tighter and more fragmented payer management

Managed Care Organizations (MCOs) and Pharmacy Benefit Managers (PBMs), are utilizing more stringent approaches to management, such as closed formularies and formulary exclusion policies to manage different fields of medicine. Such formulary exclusions prove to have a huge impact on market access strategies.

Payers are becoming more opportunistic across different fields of therapies. This can ultimately lead to a slower uptake of new products for companies. To minimize losses, companies need to prepare export teams to begin an early engagement, and negotiate with providers directly for access. For this, they also need to stay ready with proper evidence of the clinical and cost-effectiveness of their products.

2. Greater price transparency

Due to public pressure for stricter pricing scrutiny, several new legislations are being developed across the globe to provide price transparency and help the government deal with the rising cost of healthcare. For instance, the US state of California has passed a drug pricing transparency law that dictates pharma companies to provide 60 days’ notice to the state government if their drug prices are raised more than 16% over a two year period. Such laws signal a change in the market perspective as a whole.

Companies that increase their prices excessively will face major backlash from the public, especially on social media. Keeping pulse on social media conversations will be key in helping industry players gauge how regulations impact product perceptions, and find a way to keep up their performance in spite of it. Such cohesive insights will help marketers develop a clear value story and value communication strategy.

3. The rise of value-based models

Value-based payment models are expected to gain momentum even after the pandemic has been eradicated. Companies will continue to focus on eliminating hurdles surrounding regulations and data barriers. The current focus on digital will continue to strengthen with further technological advancements. Structured value-based payment frameworks will become dominant in the industry. Thus, HCPs will be pushed to improve the quality of care for patients and improve patient outcomes.

The Centers Medicare & Medicaid Services (CMS), US, has started to push the idea of value-based models through their quality initiatives with the aim to connect improved provider performance to provider payment.

Patient group value framework approaches have also begun to enter the market. In October 2019, Partnership to Improve Patient Care (PIPC), together with more than 50 major patient advocacy groups, submitted a joint letter to the Institute for Clinical and Economic Review (ICER), US, regarding its draft 2020 Value Assessment Framework.

The healthcare industry will have to continue to collaborate with leading value-driven organizations, to ensure that their models provide ample access to innovations in the field of healthcare.

4. Integration of medical and pharmacy benefits

Traditionally, payers have had limited visibility into medical benefit management (MBM) programs. These programs not only help reduce the cost of care, but also improve outcomes and manage risk.

Increasing focus on MBMs has resulted in the industry taking steps towards the integration of medical and pharmacy benefits. A study by Aetna shows that when such integration is achieved through a single health plan, medical costs decrease and patient outcomes improve.

With this objective, PBM firm Express Scripts has acquired Evicore, a company that specializes in medical benefit management. According to Express Scripts, PBM plans that implement MBM services have recovered up to 15% of their specialty drug spend each year. Similarly, Aetna, with its CVS Health merger, has promised better benefit management.

Specialty medication spending under medical benefit is also on the rise. As such, payers are becoming more focused on investing in new programs and partnerships to better manage the medical benefits for specialty drug spends. This makes it crucial for PBMs to have a comprehensive cost management strategy across all benefits.

5. Higher patient out-of-pocket payments

Currently, payers transfer a high percentage of costs to patients through out-of- pocket payments (OOPs). This is a major cause of concern, especially in countries where public healthcare isn’t free of cost. As Drug manufacturers have been actively engaging in finding solutions to relieve this stress for patients.

They are working on improving their patient assistance programs (PAPs), to provide financial assistance to patients, so that they can access drugs more easily. Gilead Advancing Access Program, Pfizer Patient Assistance Program, and GlaxoSmithKline (GSK) Patient Assistance Program, are some of the largest PAP initiatives. Govt organizations and companies need to put more focus on formulating new multilateral agreements with payers, including limits to patients’ OOP costs. For instance, in 2020, the Insurance Regulatory and Development Authority of India (IRDAI) modified the guidelines on proportionate deductions under health insurance policies, to reduce patient OOPs.

Looking ahead

Market-access strategists and account managers currently have a unique opportunity to assist their payer and health-system customers with timely and relevant resources that extend the effectiveness of their new initiatives and capabilities. Payers usually exhibit similar behavioral patterns across different markets. Understanding these patterns through qualitative and quantitative research is imperative for developing successful healthcare market access strategies. 

As healthcare decision makers embrace new digital platforms and ways of working, strategists and account managers need to proactively address forthcoming affordability and market access issues that are likely to impact markets once the pandemic has been eradicated. Realistic goals must be set when defining the level of market access that can be achieved, while ensuring profitability.

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