07

Market Access and Reimbursement (PH189)

Demonstrating Product Value to Meet Payer Demands
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Published 2013
250 Pages
500+ Metrics
180+ Charts and Diagrams

Build an Industry-Leading Market Access Team to Negotiate with Payers and Communicate with Product Teams.


This report analyzes current market access trends and advises companies on the most effective market access strategies and timelines for incorporating these teams into the product lifecycle.  It describes how surveyed companies structure, fund and manage critical market access activities.

Quantitative benchmarks include market access team structures, reporting relationships, budgets and staffing, among many other key metrics.  The qualitative data included in the study contains best practices for determining the content of a product value dossier, methods for mitigating major challenges to market access and any changes that are likely to occur in the reimbursement landscape in the next few years.  To round out the data, company profiles also provide examples of successful and unsuccessful market access teams.


Top Reasons to Review This Report

Market Access Budgets Increased from 2011 to 2013:  Though some companies’ market access budgets dipped slightly in 2012, the general trend of increasing budgets continued through 2013.  Allocate budgets more effectively to key market access subfunctions throughout product development.  Track market access budget trends and projections from 2011 to 2014.

Involve HEOR, Government Affairs, and Pricing Early in Product Development: The timing and level of involvement of health economics and outcomes teams, as well as the government affairs function, can be the key to securing reimbursement for pharmaceutical products.  Coordinate various market access groups’ involvement at the most opportune times during product development — and ensure a smooth launch.  Know when and how often to assess your market access strategy — and establish a schedule to do so.

Prioritize Market Access through High-Level Leadership:  Whether companies have dedicated market access teams or address the function on an ad hoc basis, market access teams are most often led by directors or higher positions.  Discover how companies with and without dedicated market access teams meet reimbursement requirements and support diverse portfolios.  Build market access teams to grow alongside developing products to ensure efficiency and adequate resources throughout development and launch.


Key Questions That This Study Answers

  • Which subfunctions should receive the largest portion of the budget?
  • When are market access subfunctions involved in product development and what should their timelines be for communicating with payers?
  • What factors should companies consider when staffing teams?
  • What are the soft metrics that market access teams use to prove success?
  • How early should companies start planning for a value dossier?

Market Access and Reimbursement Metrics


Chapter 1: Fulfilling Market Access Needs Through Structure

Chapter Benefits

  • Design team structure to maximize available resources and drive well-coordinated reimbursement efforts.
  • Build teams to grow alongside developing products to ensure efficiency and adequate resources throughout development and launch.
  • Discover how companies with and without dedicated market access teams meet reimbursement requirements and support diverse portfolios.
  • Improve cross-functional communication among market access groups to better position products for reimbursement.

Chapter Data

37 charts detailing market access team structure and reporting relationships. Data are broken down by company type (Top 10, Top 50, device and small pharma) and by region (US, EU/Canada/Australia and Emerging Markets).
  • Percentage of companies with dedicated market access departments
  • Market access structures
  • Number of distinct market access groups operating within a company
  • Percentage of companies with a separate market access team for emerging markets
  • Function overseeing market access activities at companies with no dedicated department
  • Reporting structure for dedicated market access departments
  • Reporting structure for dedicated market access departments
  • Position heading market access function
  • Number and distribution of FTEs from functions involved with market access teams
  • Number of market access FTEs by region (Top 10, Top 50, device and small companies)

Chapter 2: Increasing Budgets Indicate Promising Future for Market Access Teams

Chapter Benefits

  • Track market access budget trends and projections from 2011 to 2014.
  • Learn how companies pay larger salaries while spending a smaller percentage of their budgets on overhead.
  • Allocate budgets more effectively to key market access subfunctions throughout product development.

Chapter Data

41 charts detailing total market access budgets as well as sub-function budgets. Data are broken down by company type (Top 10, Top 50, small pharma and device) and by region (US, EU/Canada/Australia and Emerging Markets).
  • Average market access budget from 2011 to 2013, with and without salaries and overhead
  • Total market access budget from 2011 to 2013
  • Total market access budget without salaries and overhead from 2011 to 2013
  • Market access budget dedicated to salaries and overhead from 2011 to 2013
  • Percentage of market access budget dedicated to sub-functions by company type
  • Percentage of companies predicting change in sub-function budget allocation from 2013 to 2014
  • Projected change in market access budget from 2013 and 2014 for:
      • General market access activities
      • Government affairs
      • Comparative effectiveness
      • HEOR and HOL activities
      • Managed markets account management and marketing
      • Medical affairs
      • Pricing
      • New product planning

Chapter 3: Implementing Market Access Activities to Achieve Strategic Goals

Chapter Benefits

  • Orchestrate various market access groups’ involvement at the right times of product development — and ensure a smooth launch from the market access perspective.
  • Identify payer requirements early during product development to secure reimbursement.
  • Advise clinical teams early to create a robust product dossier that addresses projected payer demands.
  • Know when and how often to assess your market access strategy — and establish a schedule to do so.
  • Use outsourcing to achieve specialized skillsets and fill in gaps in your market access plan.

Chapter Data

52 charts detailing market access groups’ involvement in product development. Data are broken down by company type (Top 10, Top 50, small pharma and device) and by region (US, EU/Canada/Australia and Emerging Markets).

Market Access Group Involvement:

  • Market access team subfunctions by development phase (preclinical through post-launch)
  • Percentage of companies involving the following groups/areas in each development phase
      •  Dedicated market access teams
      • Comparative effectiveness
      • Government Affairs
      • Regulatory
      • Health economics/outcomes research (HEOR)
      • Patient-reported outcomes (PROs)
      • Health outcomes liaisons (HOLs)
      • Managed markets account management and marketing
      • Medical affairs
      • New product planning (NPP)
      • Pricing

Strategy Evaluation:

  • Reasons to reevaluate market access strategy
  • Scheduled frequency of market access strategy reevaluation
  • Market events that prompt market access strategy reevaluation

Outsourcing:

  • Percentage of market access teams that outsource market access functions
  • Average percentage of market access activity and budget outsourced

Chapter 4: Overcoming Market Access Challenges to Navigate Complex Global Trends

Chapter Benefits

  • Track and prioritize critical operational and market challenges facing market access teams.
  • Actively train market access teams to understand as much as possible about different market facets and skill sets outside their focus areas.
  • Communicate with other internal teams to prevent poor resource allocation and lost endpoints.
  • Learn strategies and best practices for mitigating key market access challenges.
  • Gain insights from leaders industrywide on current and future market trends.
  • Incorporate soft metrics to better communicate market access groups’ value.

Chapter Data

28 charts detailing companies’ assessments of various challenges and market trends and their efforts to measure market access success.  Throughout the chapter, data are broken out by company type (Top 10, Top 50, small pharma and device) and by region (US, EU/Canada/Australia).
  • Perceived significance of specific  challenges to market access, broken down bycompany type (Top 10, Top 50, device and small companies) and region (US, EU/Aus/Can, emerging markets).  Challenges are grouped into these categories:
      • Operational challenges
      • Market trends
      • Emerging market challenges
  • Methods to gauge success of market access efforts (by company type and by region)
  • Perceived effectiveness of market access activities

Chapter 5: Market Access Group Profiles

Chapter Benefits

  • Benchmark your team directly against 10 other groups.
  • Explore market access operations for companies of different sizes and regions.
Chapter Data

Profiles for 10 market access groups broken down into these components:

  • Background and Structure:
      • Company type
      • Region in which market group is active
      • Reporting structure
      • Staffing numbers
      • Percentage of subfunctions outsourced
      • Centralized or decentralized company
  • General Market Access Tasks:
      • Overall market access spending by year
      • Whether budget includes salary and overhead costs
      • Budget split by subfunction, percentage of overall budget and projected change over time
  • 12 activities:
      • General Market Access Tasks
      • Account Management
      • Comparative Effectiveness Research (CER)
      • Government Affairs
      • Health Economics/Outcomes Research (HEOR)
      • Health Outcomes Liaisons (HOLs)
      • Marketing
      • Medical Affairs
      • Patient-Reported Outcomes (PROs)
      • Pricing
      • Regulatory
      • Reimbursement
  • Subfunctions involved in market access activities during different phases
  • Self-assessment rating from 0-10 for  market access team effectiveness

Market Access and Reimbursement Report Sample

  The following excerpt is taken from  the full report's executive summary:

Obtain Highly Skilled Employees with Diverse Talents to Create a Well-Rounded Market Access Team

Market access is a challenging and multifaceted function for any company that demands a well-rounded team to achieve its goals.  Responsibilities for market access require a deep combination of hard and soft skills.  Team members’ tasks are scientific — understanding medicine in order to work with clinical teams for necessary trial endpoints.  But their responsibilities also require economics knowledge and interpersonal skills, as they   need to network with payers and negotiate an optimal, but realistic, reimbursement amount.  Market access activities also require marketing skills and a strong understanding of regulations in any country where the company plans to launch.  The Company H director of market access has trouble finding a full mixture of these skills in potential hires for a team position.   However, finding an ideal match is not entirely necessary if the company is willing to expand the team  to be as effective as possible. Such an expansion is difficult for companies to attempt without certain payout, however.  The director of market access at Company C, a Top 50 company, is currently one of only two people at the company working on market access itself.  Ideally, the director would set up a team with each employee focusing on one of the market access activities:
  • Pricing
  • Pharmacoeconomics
  • Implementation in different countries
  • Value dossier creation