Access Denied
Further embedding market access into the organization: We look into talent and organizational considerations.
As financial pressure on payers has increased, and evidence-based pricing moves up the agenda, market access has become one of the single biggest challenges pharmaceuticals companies face. If companies misread signals from payers or misjudge their likely approach to a product, the mistake can bite deep into the bottom line.
This means that embedding the voice of market access into pharma has never been more important, as executive search firm Egon Zehnder’s report ‘Managing Talent to Meet Pharma’s Next Great Challenge: Global Market Access’ points out.
Its interviews with more than 200 global and regional market access executives identify some urgent questions about how the industry views market access and what should happen in order to embed the function in pharma businesses.
“There is some variation in how people think about market access,” says the firm’s principal consultant Alyse Forcellina. She identifies several different but overlapping areas: pricing and reimbursement is the core “because it will indicate what that means for your volume”, closely followed by the face-to-face relationship building of account management. Market access also includes public affairs, government affairs and policy, as governments are increasingly the primary “payer” of pharmaceutical therapies. Big Data might fit into this too. “Analytics and RWE is a relatively new area: it’s an offshoot of HEOR but where it sits is to be determined - but they all have to work in concert: that’s the most important thing.”
Things have changed
Forcellina, a veteran of IMS Health and the life sciences practice at McKinsey & Co, suggests there is a universal acceptance in pharma that things have changed. “Everybody understands that the world is a much more challenging place: there is a need for more information for stakeholders before approval and more investment required after the product is approved to defend the product and pricing.”
Many companies could do this better, she believes. In their research, fewer than 10% of CEOs, heads of region, and R&D bosses had spent any part of their career in one of the market access disciplines. “Twenty years ago, the people who made it to the top started in sales,” she explains. “There is nothing wrong with that, but physicians have less and less influence every day on what is being prescribed. Understanding the payer is vital.”
It makes sense, therefore, to give senior leadership teams some experience in market access. “Some companies encourage their leaders to spend time in human resources or manufacturing, for instance, on the basis that future leaders need to understand how other parts of the business operate. The industry acknowledges that payers are an important (if not the most important) customer – so why shouldn’t market access be one of the “must have” functional experiences in the development of tomorrow’s leaders?” In effect, Forcellina makes the case for a spell in market access becoming seen as a kind of accepted rite of passage in the corporate world.
The industry acknowledges that payers are an important (if not the most important) customer – so why shouldn’t market access be one of the “must have” functional experiences in the development of tomorrow’s leaders?
Broadening experience
There is a logic to this, and the framework already exists. There is a strong precedent in the industry for rotating early career professionals through a variety of experiences – for example, between and among functions, as well as between and among regions. At this time, however, there are few companies that explicitly encourage taking either a local or global “market access” as a part of their development program. But there is progress, as the report laid bare.
In their analysis, 31% of global market access leaders have an average of just three years’ market access experience, demonstrating that companies are drawing from talent outside the function. Half of these executives came from the commercial side (such as marketing and sales), while the others came from a variety of backgrounds, including R&D, government or corporate affairs and consulting.
As Forcellina has already pointed out, an experience in sales tends to be valued more than experience in market access, although both roles are meant to help people better understand the customer. “But why isn’t a career in market access so sought after, or seen as the most important place to spend your career?” she reflects. One executive who went from marketing to market access told Egon Zehnder researchers that it was both a challenging and engaging move. He said: “It brings together all of the pieces of the puzzle - regulatory, clinical, commercial, and policy - and it requires a high degree of competence in developing strategy, getting results, and collaborating with people in other functions and influencing them.”
Difficult questions
One of the main challenges with market access is that it starts with a very difficult question – or rather two questions: what unmet clinical need are we going to meet with this product? And is there a desire to pay for it? “You need to be asking the latter question earlier in the process rather than later,” points out Forcellina. “Most of the money spent in development is in Phase III – so if there is not a really good reason to believe there is a desire to pay, then the investment thesis does not work. Or perhaps even more challenging, the company sets expectations internally and externally about the uptake of a product that is not achieveable or realistic .”
The report suggests that often market access executives may find themselves “defending a price point that does not match the perceived value of the asset by others in the organization, and/or become known for ‘killing’ a deal”.
As a result, market access can often be seen simply as the bearers of bad news, and speaking out can be difficult in a room where the organization is enthusiastic about a product’s scientific and commercial possibilities and no-one really wants to hear about problems. In the report, one anonymous executive laid out the problem: “Providing input to senior teams sometimes feels very risky to my career, even though I believe it is the right decision for the business.”
“Along the way in the development process, the market access representatives will be challenging the business based upon input from customers, for example saying: ‘We’re talking to payers and they don’t buy it’,” says Forcellina. “It can take a lot of courage. Market access folk could find themselves in very heated debates internally, and need to have sophisticated influencing skills that allow them to present the facts and shape the debate.”
Seat at the table
The ideal, she continues, would be to ensure a healthy debate and tension between the advocates of a product or investment (usually R&D and Marketing) and the customer perspective (which would include market access). In order to achieve this goal, market access should have a seat at the table on key investment decisions – such as Phase III trials, M&A discussions and launch planning strategies. While the industry has made strides in organizing multi-functional teams, market access is “sadly” very often not in the room when these decisions are made and/or the market access/payer perspective is not well represented.
Quite apart from being seen as a bearer of bad tidings, another issue may be that market access does not have such a distinct identity and structure as do other functions. “Market access is aa business function, in some ways no different than HR and finance,” she says. “As such, it needs to develop the ability to speak the same language as the rest of the business, serving its needs but also challenging.”
To complicate matters, Forcellina points out, in many companies, the heads of reimbursement, HEOR and government affairs/policy may all report to different people, which could minimize the impact of the function unless these disciplines work closely together. Forcellina acknowledges, however, that the diverse make-up of global pharma organizations means that there is no “right” or single way of organizing a market access function. “Companies need to understand their culture and norms,” she suggests. “Is it a regional structure or a business unit structure? Are you HQ-centric or distributive?”
Preaching the gospel
The bottom line, she goes on, is that whoever does head up market access needs to be a visible member and contributor to C-suite discussions. “It is about whether or not the market access person has a real voice on the team, has built up their credibility, and is seen as a peer. And ideally, it is someone who could be seen moving into another role within the organization.”
She has placed “a lot of very capable market access executives in the last five years”, she concludes. “We still have further to go: the function needs to be building its profile, recruiting talented individuals into the function – and perhaps even more importantly sending talented market access executives back into the organization to preach the gospel. By moving people in and out of the function more regularly, it can enhance the function’s ability to influence the organization’s decision making".
So there are many questions to be answered when it comes to market access’ place in the pharma firmament – and companies cannot afford to ignore them.