A Framework for Future: Strengthening Market Access Competencies

Access has become the front and center topic for the pharmaceutical industry. The majority of pharma companies now have explicit goals and commitments related to patient access at the executive level and in their mission statements. “Access” is now on the agenda of multiple functions and the role of the market access function, which traditionally focused on technical issues like health economics models, evidence synthesis, and pricing research, is rapidly evolving to become that of an orchestrator of access and product availability across the organization.

The evolving role of access highlights key access competencies required for success. This article proposes an updated view of the access competencies framework published in 2016. We tackle this in three themes:

• How is the role of access evolving? Lay out key trends tha affect the role of access as a function and prompting an update of access competencies.
• What are new access competencies? Describe new competencies relevant for practitioners and leaders in addition to the five core competencies.
• How can development of new access competencies be supported? Articulate methods/initiatives on how new access competencies can be developed.

In this article, we consistently use the term “market access” when we refer to the function, and the term “access” when we more broadly describe the ambition to reach as many patients as fast as possible in a sustainable way.

Convening power

The BCG Market Access Roundtable is a forum that brings together senior market access leaders and serves as a platform for interactive discussion on industry-level topics. Roundtable members collectively select topics that are relevant but not handled in other forums, and which can have either near- or long-term relevance. Members work in smaller working groups on specific topics to develop thought pieces, relevant frameworks, or policy-related publications, which are collectively ratified by the Roundtable on a biannual basis. The Boston Consulting Group (BCG) hosts the Roundtable and facilitates these forums and the working groups. As of this year, 23 companies are full-time members of the BCG Market Access Roundtable.

Role of access continues to evolve

In “Access in the New World,”¹ we summarized key developments within and beyond the healthcare system that impact patient access and the role of market access functions in biopharma companies. Traditionally, working in the market access function required technical expertise in areas like evidence generation, evidence synthesis, pricing, and health policy. Access leaders and experts also needed to be able to provide an outside-in perspective on reimbursement and procurement decision processes, relevant stakeholders such as health technology assessment (HTA) agencies and payer organizations—their interests and needs—and translate these into market access strategies. These are the competencies that we described in the original access competencies framework.² The BCG Market Access Benchmark³ confirmed that leading pharma companies are increasingly organizing their market access functions along these lines.

With the growing commitment to achieving patient access around the world, market access functions are expected to provide broader stewardship on access to the organization, ensuring that access is considered throughout the product life cycle, from early research and development to commercialization, growth, and loss of exclusivity. Access leaders are core members of global development and commercial teams, collaborating across global functions that share the overall access goals and coordinate access activities at a product and portfolio level. They collaborate with their counterparts in country organizations for strategy development and implementation, ensuring that evolving evidence requirements of HTA organizations and financial constraints of health systems are well understood by the global organization. Access leaders also have a critical role in leveraging insights and experience with innovative value solutions at the global level to achieve rapid, broad, and sustainable patient access.

In light of an ever-increasing influence that payer organizations have on the relationship of the prescriber with the patient, we concluded that the role of the market access function is likely going to expand further, and market access may in the future drive strategic trade-offs at the portfolio and brand level to achieve corporate access goals.

New competencies required

With the changes in the roles of the market access function, additional core and advanced access competencies are required to win in the new world. Traditional core competencies are still relevant for developing access strategies that coordinate evidence generation, evidence synthesis, pricing, and health policy. However, as additional core competencies, access leaders will need to be able to provide a system-wide perspective, understanding, and interpreting of key macroeconomic trends and the resulting policy implications, to adjust internal priorities and position the access efforts of the company within the broader healthcare ecosystem context. They have an opportunity to leverage the increasing digitalization in healthcare, which has been further accelerated by the COVID-19 pandemic, and new advanced analytics and machine learning capabilities to focus healthcare delivery on outcomes that matter to patients while reducing unnecessary procedures and services.

Beyond these core competencies, we identified new, advanced competencies to drive enterprise-wide access leadership, specifically in the areas of access communication and internal and external co-creation. We recognize that access is a complex systemic issue that cannot be solved by any one function or organization alone. It requires an agile approach to defining and refining hypotheses and solutions rapidly and balancing needs and concerns across stakeholders. Simpler and more effective communication around access, including sensitive topics like pricing and profitability, is critical in order to gain support and increase trust.

Not all core and advanced competencies are equally relevant for all roles within the market access function. Clearly there is a continued requirement for technical excellence across the traditional core competencies. Access team members who master the competencies of the Access Competency Framework 1.0 and advance to leadership roles within and beyond the access function would be candidates for additional core and advanced competencies.

Additional core competencies

Macroeconomic and policy understanding

Access is complex. And it is much more than just about pricing. With increasingly sophisticated healthcare technologies, access leaders need to engage with a broad set of external stakeholders to increase disease awareness, strengthen health systems and their capacity for diagnosis and treatment, and find new, sustainable financing solutions. This requires a deep understanding of the macroeconomic situation within countries, and how to facilitate the necessary policy changes.

Understanding macroeconomic environment and apply to access context

• Understanding global macroeconomic drivers and how they impact healthcare/access for patients in a sustainable manner.
• Understanding and leveraging macroeconomic drivers to inform access strategies, communication with payers, etc.

Understanding impact of solutions on healthcare systems as a basis for strategic thinking and non-price access hurdles

• Be able to leverage healthcare/access system opportunities.
• Be able to anticipate and address system-related hurdles (beyond pricing) that impact access; understand second-order implications of solutions on the healthcare system and on funding and stakeholder positions.
• Be able to analyze trends and patient behaviors and understand drivers.

Understanding how healthcare policy is developed and applying knowledge to engagement with policymakers to participate in the process of optimizing access

• Understand how policy is formed and prioritize and evaluate the impact of policy initiatives (and assess ability to participate in making them).
• Master engagement with policymakers with respect to regulatory and payer integration; “internationalization” of policy-making, e.g., spillover between geographies on pricing, impact of politics on policies.

Digital, data, and analytics in access

COVID-19 has greatly accelerated the trend toward new digital tools, real-world data (RWD) sources, and advanced analytics in healthcare. Clinical science and practice are increasingly complementing each other and providing insights into ways to optimize health systems and delivery of care along the patient journey, resulting in improved outcomes. They also allow for the identification of opportunities to optimize resource use, avoid duplication, and reduce waste, which will create savings that can be invested back into the health system.

Leveraging digital as an accelerator of existing opportunities and as an enabler of new opportunities

• Be able to leverage digital tools for access, e.g., future patient journeys.
• Understand how digital solutions are valued by stakeholders and which access paths exist for digital solutions.
• Understand how digital tools can create opportunities to enhance diagnoses and linkage to care for patients in a more timely manner.

Analyzing and leveraging novel data sources, e.g., RWD, to generate evidence and distill insights

• Grasp concept of “democratization” of data, i.e., most of the data is no longer directly collected or owned by pharma companies.
• Be able to identify potential data sources and curate data.
• Be able to discriminate quality of data and identify how to leverage for access and generate evidence from data.
• Understand what data other stakeholders use, e.g., for basis of value demonstration, reimbursement/pricing decisions.
• Apply advanced analytics to derive insights, e.g., on pricing, epidemiological data.

Advanced competencies

Enterprise-wide access leadership

With access as a corporate goal that extends beyond the market access function, fostering the development of an access mindset and creating the ability to effectively collaborate and lead across global functions and country organizations is an increasingly prominent responsibility and, therefore, a critical competency for access leaders. These individuals need to understand the full pharma business model and the contribution of different functions to find solutions that balance access goals with financial constraints and risk tolerance. While, in the past, decisions have been driven by return on investment of the portfolio, the focus on sustainable patient access and health equity will require new tools to monitor and evaluate access, and for us to strike a balance between shareholder and societal responsibilities.

Creating a company-wide access mindset both within the market access function and other functions as well

• Be able to tailor communication to specific functions, e.g., use appropriate language that helps other functions understand access issues.
• Know how to build access competencies across organization in other functions.
• Strengthen partnerships with other internal teams (medical, public affairs, corporate communications, regulatory affairs, etc.).

Shaping company strategies with an access perspective

• Integrate access considerations into other functions’ strategies and/or overall company/portfolio/brand/asset strategy.
• Be able to articulate trade-offs and second-order implications of access opportunities at company level.

Internal and external co-creation

Access is a systemic issue that cannot be managed by any one party alone. Innovators in the biopharma industry are excited by the opportunities that our rapidly progressing understanding of biology and pharmacology provides, but they also need to understand that the resulting technologies will require significant changes in the healthcare system, which will take time and potentially large investment. As we develop treatments and sometimes even cures for previously untreatable diseases, healthcare decision-makers will ask questions about their long-term effects. As we develop new sophisticated molecular diagnostic and high-resolution imaging solutions, they will ask about the clinical utility for patients and health systems.

Access leaders will need to engage across the whole spectrum of stakeholders and use new approaches to articulating critical hypotheses and testing nascent solutions (minimum viable products) that can be deployed and improved rapidly. They will need to be able to balance the various interests and accept that they will not always be in control of the process and the outcome.

Internally focused: Being able to balance different/ competing stakeholder interests and integrating across functions

• Understand breadth of internal stakeholders and impact on access and work in collaboration with them to develop integrated strategies rather than individual siloed strategies at a product or portfolio level.
• Understand stakeholder needs/interests and know-how to integrate these.

Externally focused: Knowing how to build and maintain a network of external partners across a common goal

• Understand breadth of external stakeholders and impact on access.
• Understand stakeholder needs and be able to respond to these in order to enable co-creation.
• Identify opportunities for partnerships and effectively drive collaboration, offering constructive solutions toward the shared goal of enabling access for patients.

Access communication

Access is relevant for all stakeholders from industry to healthcare decision-makers and ultimately patients and their families. But it is complicated, requires a long-term perspective, depends on the context, and leads to difficult decisions, which are often hard to fully grasp and accept when we as individuals are impacted. The biopharma industry has not consistently done a good job at synthesizing and articulating the important requirements and outcomes of access in terms that resonate across all affected and interested people.

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Access communication needs to be specific, it needs to address conflicting interests, and explain difficult issues such as affordability and price in a transparent and relatable way. As stakeholders across society and patients have different value perspectives and requirements, communication needs to be tailored and considered in evidence-generation decisions based on trade-offs with regard to risk and cost. Understanding the differences in requirements for each stakeholder and making the trade-off decision is key to delivering clear and responsible communication. This will foster trust across those affected, which is the basis for effective and sustainable solutions.

Internally and externally focused: Translating complex or detailed access topics into clear messages and stories for non-access experts

• Be able to synthesize content rather than abbreviate.
• Be able to translate content into appropriate language/powerful messages that resonate with audience, including a potentially broader, non-technical audience (may differ by audience).
• Be able to combine key messages into compelling and concise stories to articulate the value of a product, a company, and the
• innovative pharma industry at large.

Externally focused: Considering needs and values of different stakeholders in evidence-generation decisions

• Understand communication needs and values of different stakeholders and how these can be supported through evidence generation.
• Be able to articulate evidence-generation trade-offs based on risk and cost and strategic implications.
• To effectively engage stakeholders and ultimately enable patient access in the future, access leaders and practitioners need to demonstrate this expanded skill set by building the additional core and/or advanced access competencies.

References

1. https://www.pharmexec.com/view/access-in-the-new-world
2. https://www.pharmexec.com/view/building-market-access-competencies-future
3. https://www.pharmexec.com/view/market-access-being-becoming