The Hardest Job in Biopharma? The Vice President of Market Access

Pete Vaccaro
Partner
Formulary Insights

It’s 11 AM and a large insurer is threatening to walk away early from a three-year contract for your most profitable drug unless you agree to significant new concessions. Meanwhile, the next round of negotiations with the largest US Medicare plan for your newly launched drug awaits you after lunch. But at this moment, you’re on a call with your CEO’s chief of staff who is asking you to investigate ways to bypass pharmaceutical benefit managers and go straight to employers—or even patients—potentially risking key relationships for uncertain gain. Meanwhile, without serious intervention, your colleagues are planning a new formulation that will surely antagonize payers more than appeal to them. And don't forget, you still have to interview three candidates for your vacant VP of Trade position before the end of the week. All that, and the new administration has thrown the future of federal drug policies into all-out upheaval, making it even more challenging to predict and plan. And did we mention it’s only Tuesday?

Welcome to the tumultuous life of the vice president of market access––undoubtedly the hardest job in biopharma.

Market access is a unique balancing act. It’s not just about ensuring product access is optimized for profitability, it’s about navigating a web of complex decisions by PBMs, health plans, health systems, wholesalers, policymakers, and internal stakeholders. In short, it’s about aligning internal strategies with external realities—external realities that often change without warning and at a frequency likely not experienced by other biopharma executive roles.

Amy Heath
Partner
Formulary Insights

“Next to delivering a medicine of true value, market access is the most critical function in ensuring a biopharma company’s commercial success and long-term viability,” says Dave Moules, a seasoned leader whose career includes pivotal roles at both GSK and Pfizer. Over the years, Moules earned respect across the payer and manufacturer landscape for his strategic insights and integrity. “Given what’s at stake, market access leaders operate under immense pressure to secure quality access for their products,” he continued. “Leading this function in today’s environment is not for the faint of heart.”

Every day brings competing pressures. On one hand are the internal demands from multiple brand marketing teams, finance, legal, various sales leaders, and other departments, all of whom expect—and need—your team to make their priorities your own. And, let's be honest, many of these internal folks are naively confident they could do the job better than those with decades of relevant experience. On the other hand, there are external pressures from payers, policymakers, and the public that complicate decision-making. One wrong move can collapse a partnership, put your product out of reach for patients, or, in some cases, even sink your stock price. Few jobs across the entire economy, never mind biopharma, require so many touchpoints with so many stakeholders across more domains of knowledge and expertise, all while carrying such a high risk of consequence.

Bearer of bad news

Market access is a balance of strategic planning and immediate crisis management. Negotiations with payers over drug coverage take months and are built on a holistic understanding of the marketplace, company needs, product demand, the regulatory environment, and more. So when a large payer suddenly threatens to walk away from an existing contract unless a company significantly hikes its rebate rates, the risk of a major financial blow could have far-reaching consequences. These moments are inevitable and demand that the VP of market access shift to an entirely different skill set in order to lead his company through such a high-pressure challenge.

Biopharma CEOs don’t think like payers, and understandably, they are often frustrated when a critical revenue stream is put at risk by them. The VP of market access must serve as a go-between, fluent in the language of both, but they can easily get caught in the crossfire. This can be a thankless job: no company wants to cough up more than originally expected, and to the CEO and the rest of the C-suite, the idea that some revenue is better than none at all is often cold comfort. The market access team is at high risk of being scapegoated for not anticipating the challenge, even though external market forces are the true cause. In these stressful circumstances, even positive outcomes are often met with minimal acknowledgment and maximum scrutiny.

Chief diplomat/chief negotiator

The market access VP is both the chief diplomat and chief negotiator, constantly juggling the interests of payers, patients, and the company. Succeeding in this role requires an ability to think like a payer, and that mindset can’t be conjured out of thin air. It takes cultivating and maintaining personal connections with people at dozens of different payer organizations. What’s more, each payer has its own rules, strategy, and idiosyncrasies at the organizational level.

The payoff of building and managing these relationships is immense. Rather than being the last to hear about a potential change from payers, market access VPs can be the first if they’ve built trusting relationships. These are some of the most important and valuable external relationships a biopharma company can have, but they take immense patience and years of work. The payoff comes in the form of a competitive advantage in time and space that permits frank, internal discussions about what is required in the moment.

Renaissance leader

While market access is about mastering the external world, the VP also needs to be a versatile leader internally. This role demands fluency across a wide range of departments including marketing, legal, R&D, sales, finance, and government affairs. Each department has its own language and priorities, and the VP must be adept at translating across them. For example, research is rightfully focused on scientific innovation, but the market access VP must ensure that clinical evidence is positioned in a way that makes sense to both payers and regulators, balancing scientific potential with practical business concerns.

In addition to technical knowledge, the VP must also be a skilled communicator, able to collaborate with legal and finance on compliance and pricing matters, as well as with government affairs to navigate shifting policy landscapes and synthesize all of this into one coherent strategy. That’s to say nothing of management responsibilities over a team that often includes hundreds of individuals.

D.C. decoder

Additional challenges come not only from outside the walls of the company but from beyond the industry itself. In such a highly regulated industry, the market access VP must be astute in both public policy and politics––and especially so at this particularly volatile political moment. In just 2022, the Inflation Reduction Act reshaped drug pricing negotiations, altering the calculus for market access teams. And with a new administration in office that ran on repealing the law, the game could be upended all over again. Meanwhile, leadership changes at HHS bring even more uncertainty for pharmaceuticals. That’s to say nothing of state-level policies. These days, market access leaders aren’t just monitoring policy changes or speculating with government affairs colleagues. They’re in war rooms, mapping out every potential scenario, anticipating ripple effects, and preparing contingency plans before new rules can even take shape.

Policy is yet another layer of uncertainty for market access leaders to grapple with. VPs need to synthesize regulatory updates in real time, translate legal jargon into actionable strategy, and ensure their company isn’t caught flat-footed when policies change. And the work doesn’t stop when the policies take hold. The VP must shape internal pricing strategies to stay compliant, adjust negotiating stances to reflect the new realities, and help the C-suite understand the potential implications of new regulations––all while staying vigilant for the next round of regulatory upheaval.

What every market access VP needs: alignment on expectations

For all this complexity and all the high stakes, market access teams and leaders too often go overlooked as expectations are imposed on these teams rather than built with them. But success isn’t about pushing for a preferred outcome—it’s about aligning expectations with the realities of the healthcare landscape and optimizing the results. Leaders across an organization––from the C-suite to brand marketing teams, sales, and government affairs––must collaborate early with the market access VP to ensure their strategies account for payer needs and other potential challenges.

Market access will always be a complicated mix of strategy, diplomacy, and crisis management. Even with the right alignment, companies still won’t be able to perfectly forecast every market shift. But they will be better prepared for how quickly the forecast can change, how to pivot when it does, and how central the VP of market access is in making those adjustments. And if the entire team shares that outlook, they might even give the VP a rare and precious gift: a moment here and there to breathe.