10 Market Access Trends to Watch for in 2023

As the pharmaceutical industry pivots to an evolved, post-pandemic marketplace in 2023, there are core market access trends that will influence how success is realized. Everything from engaging and communicating with stakeholders to meeting market expectations in ways that drive—rather than deter—access to medications will require new strategies and approaches from market access teams.

The trends highlighted here encompass patients, prescribers, payers, and service delivery partners and shine a light on how market access teams must not only shift their thinking about how products effectively reach patients but also how they can get payers to pay attention (and provide coverage).

Ultimately, manufacturers need to be able to tell a good story to drive utilization and inspire coverage. To do that, they first must develop an amazing product, wrap the right distribution and patient support services around it, craft a story that will resonate with the market, and then use the right channels to tell that story to the right people.

In this article, experts combine their real-world experience with insights from across the industry to help market access teams start thinking about how they can tell their story in the year ahead by preparing thoroughly, thinking differently, engaging in new ways, and tying the story altogether. Those experts include Dina Steinfurth, managing director, Valuate Health Consultancy; Rob Besse, VP, Archbow Consulting; Lane Maloney, SVP, client services director, Entrée Health; Andrew Gottfried, CEO, Entrée Health; Kelly Ratliff, VP, Archbow Consulting; Lori Wood, principal, Valuate Health Consultancy; Jack Timko, principal, market access data science, Valuate Health Consultancy; Paul Smith, EVP, creative director, Entrée Health; Honora Gabriel, VP, Archbow Consulting; and Megan Hall, EVP, executive creative director, Entrée Health.

Featured from left to right: Cora Meese; Andrew Gottfried; Honora Gabriel; Dina Steinfurth; Jack Timko; Lori Wood; Lane Maloney; Kelly Ratliff; Megan Hall; Paul Smith; Rob Besse

What market access trends should companies be on the lookout for in 2023?

Trend #1

Steinfurth (Valuate Health Consultancy): The United States government’s regulations will continue to impact manufacturers’ gross-to-net and profitability in both expected and unexpected ways.

Inevitably, US drug pricing will have (and has had) a starring role in the headlines. If 2022 was any indicator, policy changes in 2023 and beyond will likely keep the industry on our collective toes. While most government initiatives that impact the pharmaceutical industry, such as the Inflation Reduction Act and Medicaid’s average manufacturer’s price rebate cap removal, are designed to increase access and reduce financial burdens—particularly for seniors and low-income beneficiaries—the initiatives have a profound impact on all stakeholders, including manufacturers, healthcare professionals, and payers. For manufacturers, everything from gross-to-net to rebates to product viability and profitability could face significant volatility.

Pharmaceutical companies are wise to anticipate substantial price pressures and market uncertainties with the proposed current legislative changes. They should be prepared to review the viability of in-market and pipeline assets with heightened scrutiny. Manufacturers may wish to commit now to strategically moving away from historically fragmented forecasting methods and instead incorporate policy changes into their modeling assumptions to ensure dynamic and accurate forecasting. New software and data-driven approaches to global pricing, forecasting, gross-to-net modeling, discounting, contracting, and sequencing can be significant differentiators for market access teams when embraced and deployed in this complex regulatory environment.

Trend #2

Besse (Archbow Consulting): Increased cost pressures will amplify tensions between distributors and manufacturers.

Negotiations between distributors/wholesalers and manufacturers are rarely simple, given the need for each entity to decrease costs—typically at the expense of the other party. This has never been truer than it is today, as inflation is driving overall pharmaceutical supply chain and materials costs to increase at a time when wholesaler competition for new hospital and pharmacy business has never been fiercer. Each party needs the other to deliver pharmaceuticals to patients efficiently. As such, how will these companies share costs without causing negative consequences for all involved?

In most negotiations, the party with greater leverage gains the financial advantage. Small-to-medium–sized manufacturers start with a weaker negotiating position and, therefore, typically pay higher distribution rates compared to large manufacturers. Meanwhile, all manufacturers are experiencing gross-to-net challenges at a time when all wholesalers are experiencing increased buy-side and sell-side pressures.

Small-to-medium manufacturers can no longer be expected to absorb ever-increasing distribution fees any more than distributors can continually be expected to “trim more fat” from an already overly lean distribution system. Manufacturers will need to seek common ground or alternate distribution systems to maintain economic viability for all parties in the foreseeable future.

Trend #3

Maloney (Entrée Health): Payers are human and, therefore, consumers, too. Using an omnichannel approach to communication is more critical than ever.

Consumers can be overwhelmed by the sheer amount of information available at their fingertips, making it hard to know where to start and what to believe when learning about new products and services. It’s the same for payers in the market access space. That gives manufacturers a unique opportunity to frame and deliver a story that reaches payers in ways that resonate with them as individuals. That’s the crux of omnichannel marketing: understanding and delivering bite-sized content your target customers want to digest through the most effective channels.

When done right, omnichannel is a proven way to reach customers successfully, but it’s not a one-size-fits-all approach. Thanks to market research, we know that payers are looking for a way to consume manufacturer-provided information with and without the presence of an account manager. By supplementing account manager touchpoints, omnichannel allows the conversation to continue, all while collecting meaningful insights to continuously refine messaging.

Manufacturers can prepare for and start to embrace omnichannel marketing by conducting primary and secondary market research to learn about topics that interest payers. How do they prefer to receive information? What types of information are they looking for from manufacturers? Those insights, teamed with account manager knowledge and housed in a central data location, strengthen learnings and establish a continuous feedback loop that allows manufacturers to consistently improve how they communicate with payers.

Trend #4

Gottfried (Entrée Health): Ensuring global access in an uncertain economy will require telling a compelling clinical and economic story.

As fears of a global recession loom, pharmaceutical companies face new concerns over access to their life-changing/saving products. Around the world, stakeholders are balancing population health concerns with cost tradeoffs, making awareness and value demonstration more important than ever. Government and commercial payers alike are seeking more details on disease prevalence by market, economic impact models, and standardized clinical benefits that can inform formulary and access decisions.

When manufacturers embrace awareness and value demonstration up front, they influence global stakeholder decisions and can inform better commercialization strategies across their distribution, pharmacy, and patient affordability planning. The right clinical and economic story guides everything from how and when HCPs should prescribe, site of care and administration, which patients are likely to need financial and psychosocial support, and the distribution and dispensing models that make the most sense. Market access teams who commit to telling the best story are likely to build the most successful global commercialization models and help more patients access their medication.

Trend #5

Ratliff (Archbow Consulting): Post-pandemic healthcare consumer expectations will drive manufacturer innovation in the site of care and method of administration determinations.

Throughout history, pandemics and global health crises have sparked life-changing innovations. We have the Black Death, 1918 Spanish Flu, and yellow fever epidemic to thank for improvements in public health, patient care, and disease control. COVID-19 likely changed much of how people live and view healthcare today, including where, when, and how patients want to receive care in the future. A new expectation has been set for care to be delivered in the most convenient location and method for patients, requiring a new way of thinking for manufacturers going forward.

To keep pace and meet expectations, market access teams must challenge themselves to rethink therapeutic delivery. Can traditionally HCP-administered products now be self-administered by collaborating with technology-driven partners? How can telehealth, apps, avatars, mobile infusion clinics, health-focused ride shares, community pharmacies, drive-thru clinics, and other alternative care options be integrated into market access strategies to meet patients where they are and work toward eliminating health inequities? With such rapid evolution, market access teams may need to plan for more systematic research with stakeholders and partners to understand and incorporate preferences and emerging technology into commercialization strategies.

Trend #6

Wood (Valuate Health Consultancy): Evolutions across the healthcare industry will accelerate the acceptance of digital therapeutics as a viable treatment option.

Digital therapeutics garner both excitement and skepticism within the market access ecosystem. Whereas some organizations with sophisticated capabilities and resources are more willing to invest in prescription digital therapeutics (PDTs) and remote monitoring, others are still contemplating the overall clinical and economic effectiveness. These organizations seek real-world evidence (RWE) to justify the necessary investments in new technology. Regardless, many stakeholders are banking on digital therapeutics as concerns about staffing shortages, rising healthcare costs, and the overall effectiveness of today’s treatment pathways increase.

Remote monitoring has already realized some early success in various chronic disease areas, such as diabetes and heart disease, while PDTs have had similar success in behavioral health. Digital therapeutics that can integrate with electronic health records allow for better overall patient management for healthcare professionals and better overall acceptance. However, questions remain around monitoring responsibility, reimbursement, place in therapy, and magnitude of outcomes.

Embracing digital therapeutics comes at a cost, as manufacturers must prove value and operational efficiency for patients, healthcare professionals, and payers. This can happen by educating stakeholders and expanding utilization to allow data generation to support the demand for RWE. Innovative market access teams who see digital therapeutics as a great opportunity will need to identify partners willing to work together to prove their overall value and place in disease management.

Trend #7

Timko (Valuate Health Consultancy): Customer relationship management will be the key to igniting a data revolution in market access.

There is a wealth of syndicated data that manufacturers can leverage to understand better and predict how the decisions of healthcare organizations affect individual patients and providers. While robust and continuously improving, these data do not paint a complete picture. The series of events leading up to any organizational decision is absent—and, with them, any hope of decoding the complex decision-making dynamics that lie at the heart of market access.

However, first-party data can shed some light on these decision-making dynamics, provided manufacturers fully commit to formal customer relationship management and closed-loop marketing for their account managers and payer customers. This requires thinking about the individual stakeholders within payer organizations as the customers rather than just the organizations themselves. Manufacturers must provide account managers with insights and resources powered by the data they help generate through customer interactions. These data should ultimately contribute to a data warehouse that is built to reflect the complexities of market access customers. Manufacturers who can successfully generate and activate their own first-party data can receive a more complete understanding of their payer customers, enabling more targeted and effective communication.

Trend #8

Smith (Entrée Health): Creativity will be a force for access.

Navigating access to healthcare can be overwhelming and complicated. Finding a successful path forward to help patients get access to the healthcare they deserve requires a specialized communication approach that educates, informs, and breaks down the walls of a hard-to-navigate system. Access is one of the pieces of the healthcare puzzle that benefits significantly from creativity—from developing innovative solutions to problems that capture the hearts and minds of everyone involved to helping patients obtain the right healthcare while navigating availability and affordability.

Manufacturers must get creative to solve big-picture problems, such as tackling inequity in access to care. And we need creativity in how we talk, visualize, inform, educate, stimulate, and connect the dots with meaningful interactions that deliver this critical information. With regular changes to policy, increasing competition, and new products and services, we must think about problems and issues affecting access in new ways. This starts by treating communication touchpoints—everything from value propositions to enrollment forms—as more than just straight facts but experiences that offer customized tools, interactive engagements, video, immersive data, and artificial intelligence that get stakeholders all on a path to making access more meaningful.

Trend #9

Gabriel (Archbow Consulting): The right patient support solution will be about putting the right support in the right place at the right time.

Launching new medicines is more complex than ever. This is in part due to the focus on small patient populations, including patients with rare cancers and orphan diseases. These medicines often require specialized manufacturing, distribution, and administration, leading to unique patient treatment journeys and driving the need for more intentional patient support solutions.

Employing a one-size-fits-all approach to a patient support solution launch or replaying tactics that have worked before rarely equals launch success. Instead, manufacturers should thoughtfully consider their product’s differentiating features and work to understand product-specific barriers and challenges to develop optimal patient experiences.

Pharmaceutical manufacturers should engage cross-functional stakeholders in collaborative design sessions to be in alignment with product-specific patient support solutions. These stakeholders are immersed in the details of specific disease states, patient experiences, and product access channels and are uniquely qualified to help map the end-to-end patient journey. This approach, when managed correctly, enables integration across a treatment ecosystem and pushes partnership planning—ultimately creating an integrated launch where the right service is available at the right time for the right stakeholder.

Trend #10

Hall (Entrée Health): Ensuring equity in access will drive improved health outcomes for patients and business outcomes for manufacturers.

Social determinants of health, by definition, impact health outcomes for patients. In recent years, manufacturers have paid increasing attention to enhancing inclusivity in clinical trials (e.g., 2020 PhRMA guidelines1), developing treatments for historically underserved populations, and encouraging decision-makers to consider race, gender, ethnicity, and other factors that contribute to health disparities.

Manufacturer decisions that account for the myriad factors that influence individual access to healthcare will enhance clinical outcomes and product success. For example, a patient who must take three buses to see a physician or receive an infusion may be covered, but the patient certainly doesn’t have access to the healthcare they need. When market access teams start integrating health equity considerations into their strategic decision-making—across distribution, pharmacy, patient support, payer engagement, and regulatory and global planning—market access teams will be able to address the other trends in this article with heightened confidence and speed.

Addressing the needs of our example patient is relatively easy: appropriate patient support in this instance might include transportation subsidies, such as a rideshare voucher. Other examples can present much larger challenges, but all support that drives access is more than a moral victory for manufacturers. Equitable access—one that accounts for economic, environmental, linguistic, cultural, and physical barriers to healthcare—will continue to greatly influence business success.

Reference

1. PhRMA, “PhRMA Announces First-Ever, Industry-Wide Principles on Clinical Trial Diversity” (Nov. 17, 2020). https://www.phrma.org/equity

About the contributors

Article contributors are employed by Archbow Consulting, Entrée Health, and Valuate Health Consultancy, which are all members of the Entrée Health network and the value and access division of Omnicom Health Group.