How to Overcome Market Access Hurdles for Inpatient Drug Launches

Zachary Elliott, PharmD, MBA

Gaining market access for an inpatient drug requires navigating a uniquely complex healthcare landscape. Success hinges on understanding hospital priorities, creating a solid value narrative, and executing a collaborative commercial strategy. Unlike with outpatient drugs, inpatient access is won hospital by hospital, requiring tailored approaches that balance clinical impact with economic viability. This article outlines strategies to navigate the unique hurdles of inpatient launches and secure favorable access for your drug.

Understanding the Challenges

Inpatient drug launches come with unique market access challenges. Unlike outpatient drugs with revenue potential, inpatient drugs are usually bundled into Diagnosis-Related Group (DRG) payments. This means hospitals take on the financial burden, and drugs become purely a cost rather than revenue generators. The resultant pricing pressures, tighter budgets, and stringent formulary management threaten a hospital’s goals for efficacy and cost control, complicating efforts to gain favorable market access in this space.

Key Barriers to Access

Cost and Pricing Pressure
Inpatient drugs directly impact a hospital’s budget. While outpatient drugs can generate revenue through buy-and-bill models or PBM rebates, the cost for inpatient drugs is absorbed into fixed DRG payments. This places the pharmacy budget squarely in the crosshairs of cost-management efforts.

Complex Stakeholder Dynamics
Adding a drug to formulary involves various stakeholders, including prescribing physicians, pharmacy directors, C-suite executives, and the P&T Committee, each with their own priorities. Striking a balance among them is essential to gaining favorable formulary placement.

Formulary Restrictions
Hospital access isn’t binary; access can range from unrestricted to highly restricted. Hospitals often control costs by setting patient criteria, implementing step edits, or restricting use to specialists, all limiting a drug’s adoption.

Two questions can help determine how challenging access might be; ideally, the drug should stand out for at least one.
1. Does the drug offer meaningful clinical differences from existing options?
2. How does the drug’s price compare to similar therapies?

Best Practices for Securing Inpatient Access

Engage Early With PIE and Market Research
Engaging hospitals early with pre-approval informational exchange (PIE) builds relationships and communicates clinical and financial advantages. Targeted market research provides insight into what each institution values most, enabling a customized approach to access strategy.

Leverage Physician Champions
Most P&T Committees require a formal request to add a drug to formulary, and its timeline can be lengthy. An enthusiastic physician champion can expedite the review process. They should be well-prepped with data on both clinical benefits and cost-effectiveness to confidently support formulary inclusion.

Build a Compelling Value Story
Hospitals need to see beyond the clinical benefits to tangible cost offsets, like reductions in length of stay, ICU admissions, or readmissions. Programs like the New Technology Add-On Payment (NTAP) can help offset costs within the DRG system. Collaborating with Health Economics and Outcomes Research (HEOR) teams to collect real-world evidence (RWE) and create pharmacoeconomic models also strengthens the drug’s value beyond its upfront price.

Post-Launch Pull-Through Strategies
EHR integration and innovative distribution models (e.g., buy-back programs) can help operationally streamline a drug’s access once on formulary.

Evaluate Access Contracts
Contracting can be a plausible lever to pull to gain more favorable formulary positioning. Of course, this is a highly analytical process; perform a pricing-demand analysis to ensure it supports commercial success.

Aligning Market Access With Brand Strategy

Inpatient launches are all about customization; each hospital is effectively its own payer. Unlike with outpatient models, where one national payer might cover millions of lives, inpatient access is won hospital by hospital (or by IDN). This means the sales, market access, and brand teams need to be fully aligned and adaptable.

Customize Brand Messaging
Access varies by institution, and so must your messaging to HCPs. For example, a drug could be readily accessible at one hospital but highly restricted at another, requiring different communication approaches.

Integrate Commercial Strategy
Aligning brand and access strategies ensures a consistent narrative that highlights the drug’s value, builds strong institutional relationships, and encourages product adoption.

Empower the Sales Team
The sales team needs to fully understand inpatient access issues and the unique cost dynamics in hospital settings. It helps them engage meaningfully with the HCPs who inform formulary decisions, supporting the overall brand message.

Final Thoughts

Launching an inpatient drug successfully requires a strategic approach that accounts for hospital priorities, cost dynamics, and varied decision-makers. By proactively addressing challenges, adopting best practices, and aligning commercial and market access strategies, manufacturers can improve their odds of success—ensuring clinical impact while navigating the financial realities of the inpatient landscape.

Zachary Elliott can be reached at zelliott@fingerpaintaccess.com.