Improving Market Access Across Europe

By Arnault Billy

Biopharmaceutical companies across Europe are facing an increasingly challenging marketplace — from the world economic climate to the growing prescribing influence exerted by health services and the diminishing domain of traditional prescribers. As Arnault Billy, senior director of data optimization solutions for Cegedim Dendrite explains, companies need to make tough decisions to create and deliver effective market access strategies.

The biopharmaceutical industry in Europe is at a tipping point as companies wake up to the extraordinary changes in healthcare provision and prescription decision making. According to a survey conducted by Cegedim Dendrite in Europe during the spring of 2010, 88% of organizations say they need to make changes to market access strategies. The good news, however, is that despite strong concerns about the impact of the economic situation, companies are able to address the shifts in health service delivery from a position of financial strength.

While the majority of companies (83%) have already been through the considerable pain associated with drastically cutting the field sales force and creating key account management (KAM) teams, today’s increasingly complex, fragmented, and payer-led health economy is presenting new and very real challenges.

One of the key concerns is the extraordinary market fragmentation. While every European country is following the trend toward the creation of national Health Technology Assessment (HTA) bodies and payer-led decision making, each market retains an essential local difference that will require a very specific approach.

For example, a sales presentation created specifically for National Institute for Health and Clinical Excellence (NICE) in the United Kingdom may not be reused for the Scottish Medicines Consortium (SMC) in Scotland, let alone for The German Institute for Quality and Efficiency in Healthcare (IQWIG) in Germany. Pharmaceutical organizations creating global market access strategies may be able to achieve a broad improvement in brand awareness, but to accomplish the highest level of improvement, in-depth country-by-country insight will also be critical.

Furthermore, companies are rapidly discovering that regional bodies within countries also operate very differently. Some lead the way in drug evaluation and pricing processes and procedures, while others prefer to either follow or allow physicians greater decision-making ability.

Extended Model
This new, highly regionalized, payer-led healthcare economy has prompted European pharmaceutical companies to consider market access strategies far earlier in the product life cycle, with organizations looking for feedback on product potential and pricing as early as Phase 2 of product development. Indeed, many organizations have opted to cancel development in recent years as a result of feedback that has indicated the product will not achieve the required pricing level.

The new model also has introduced new people into the market access process, including clinical R&D personnel. It has created a need for new style key account managers as well as commercial teams focusing exclusively on the health insurers and politically focused teams working closely with the national bodies.

These individuals not only require a strong medical background but also the ability to discuss both economic and health-related issues, while embracing a new role both as trusted advisors to the health agencies and lobbyists for new products. As these individuals become an integral part of the market access community, pharmaceutical companies need to ensure that critical information on market access stakeholders is being shared effectively.

Best Practices
There is a growing volume of in-depth information about European regional structures as well as different committees, health commissions, and departments. But, how should companies best leverage that information to determine market access stakeholders and then deliver relevant, timely communication?

Many companies are looking closely at the current experiences within the mature UK market. Certainly, the sophistication of information gathering has enabled organizations to address the first key component of a market access strategy, the identification and segmentation of those people who either decide or influence what is prescribed. To date, companies have been less successful in communicating with these individuals to influence and change behaviour.

Indeed, according to Cegedim Dendrite, only 12% of survey respondents claim the company is able to influence market access stakeholders well or very well. And, one of the key lessons surmised is that pharmaceutical companies are still experiencing difficulty addressing this complex, overlapping network of influence as single points of contact.

Identifying Networks
In this complex, overlapping environment, everyone in the market access team — from research and development to key account managers — will have interactions with stakeholders across every level of the health service that can and will affect a multiplicity of people across the network. Without the ability to identify these networks, track interactions, and critically measure the impact of these interactions, pharmaceutical companies will not achieve coherent or consistent market access.

For example, a regional commission will include clinician stakeholders who are also senior figures in a hospital, while local practitioner stakeholders may also play a key influence role within a scientific council, regional, or national body. A single oncology expert may have an advisory role in an HTA, a strategic position within a hospital, as well as positions in various research/support groups.

This integral information must be reflected in the market access data to enable a pharmaceutical company to ascertain the best, most effective way of interacting with this individual, whether that is through the commission, hospital, or other committee/council. And, close to 2/3 (61%) of companies are now leveraging physician-peer networks to leverage personal relationships that can help expand the reach of their market access strategies.

But, in addition to creating a 360-degree customer view, it is also essential to share this information across all involved in the market access process to ensure everyone understands the importance of each stakeholder in the overall influence network, not just the specific operational/organizational role. Yet, today, only 14% of companies claim to share information well or very well across the business.

Understanding Drivers
Furthermore, while organizations can leverage the depth of information available to successfully identify and segment decision makers, to effectively exert influence requires excellent local intelligence. Gathered intelligence needs to extend far beyond the traditional contact and specialist information to incorporate a deep understanding of the underlying drivers that steer decision-making. For example, a public health director may be concerned with health inequalities, while a director of finance will be primarily concerned with cost containment and value for money.

Most European market access managers believe that understanding drivers is one of the most distinguishing factors in the effectiveness of their market access strategies. Yet, according to the survey, only 35% of companies are capturing information about what drives decision making for those stakeholders.

Consolidation Of Market Access Activities
There is no doubt the European marketplace is quickly changing, requiring flexibility and adaptability. The growing influence of regional bodies combined with the escalating financial pressures will undoubtedly affect prescribing policies. Managers recognize the need to develop more specialized marketing teams to address local market differences. They are creating more focused teams to enable market access managers to customize strategies to address the drivers within each market and, thereby, more effectively influencing decision makers. They are also reflecting the shift toward payer-led decision making, with 70% of pharmaceutical companies changing messaging in response to the need to demonstrate return on investment to health providers.

But, it is the effective consolidation of market access activities that is key to supporting a drug throughout its life cycle — from initial pricing and reimbursement decision making to delivery access to the regional market. It is those organizations that understand the new stakeholders and their networks of influence that create the 360-degree customer view and then leverage that information to deliver innovative services that truly reflect the underlying drivers that will create the most successful market access strategies.

About The Author
Arnault Billy currently serves as the Cegedim Dendrite OneKey solutions director and will move into a new role as senior director, data optimization solutions for the United States. Arnault will be responsible for U.S. business development activities in support of the entire Data Optimization Solutions business unit.