Market Access: From Being to Becoming

Examining the key learnings from BCG’s 2019 benchmark study-and the capabilities uncovered that will be critical to future performance

Since 2013, The Boston Consulting Group (BCG) Market Access Roundtable has been conducting a comprehensive benchmark of market access-related activities every three years. In 2019, we conducted our third benchmark, which covered the “traditional” market access (MA) activities, e.g., pricing, health economics  and outcomes research (HEOR), and also activities that interface with other functions, namely health policy and real-world evidence (RWE).

The 2019 benchmark is based on quantitative data from the 14 participating companies and 100-plus interviews conducted with market access, public policy, and RWE leaders from across global, regional, and nine local markets: US, EU5, China, Brazil, and Japan. In addition, we ran a structured survey with over 40 questions and synthesized the response of about 400 participants. The detailed results, containing 40-plus analyses, are documented in five chapters: Key insights, Organization, Resourcing, Governance, and Capabilities, and shared with the participating companies.

Working Group Members; click to enlarge

In this report, we highlight key observations from the 2019 benchmark, which includes 10 industry-level insights; deep dives on five hot topics identified, and 10 capabilities that were seen to be critical for the future success of the market access function.

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.

10 industry-level insights

1. Access function across organizations seem to be in a state of flux, with most companies in the benchmark having changed their leadership in the last three years.

2. Many companies are “experimenting” with alternate models for market access (e.g., BU structures, Agile), based on the approaches the rest of the organization is taking.

3. Overall anchoring of market access functions is still typically between commercial and R&D teams, with some shifting in between the two.

4. 2019 shows fluctuations in resourcing across global, regional, and top markets, in contrast to the general overall growth trend observed in 2016.

5. Role of global vs. regional vs. local is still largely unresolved, with all possible models still in play, and logic deeply embedded in overall organizational anchoring.

6. Role of health policy (separate from public policy) has increased across most organizations, with many splitting it explicitly from public policy and in some cases integrating it within the access function.

7. Multiple models co-exist for organizing the RWE function (centralized group, center of excellence [CoE], or decentralized setup), with no clear preferences and continuing shifts.

8. Importance of integrated evidence planning (IEP) is driving for greater collaboration of medical affairs and access functions and of global and local, with its associated growing pains (e.g., anchoring, local support, funding).

9. New technologies (e.g., cell and gene therapies), how to compete in a “data-rich world,” and “new ways of working” were identified as three trends that would further impact the role of access as a function.

10. “Understanding of stakeholders that impact MA,” “Effective coordination and decision-support within [and beyond] MA functions,” and “Ability to optimize strategic pricing objectives” were the top-ranked capabilities.

Deep Dive 1: Market access priorities

In distilling the various interviews and survey results, we found that a key priority that cuts across all leadership (market access, public policy, and RWE) groups we talked to was sourcing, developing, and retaining market access talent and capabilities.

The BCG Market Access Roundtable had already identified talent and capability development as a key priority in its first benchmark in 2013 and, based on that work, had developed a comprehensive framework on market access competencies.

Subsequently, we also pioneered the set-up of an executive training course in collaboration with the London School of Economics (currently in its third year of delivery). Given the fact that this has been highlighted again as a key priority and recognizing that a lot has changed in the last decade, the BCG Market Access Roundtable has launched a new working group to tackle the topic and will provide recommendations by the end of 2020.

Aside from highlighting the need to improve the collaboration across these three sub-functions, six other priorities that fall in the cross-over between the functions were also highlighted (see Figure 1).

Deep Dive 2: Organizational anchoring

For our benchmark, we focus on seven key MA activities, five of which are typically within the core of MAs functions, such as pricing, health technology assessment (HTA), HEOR, and health policy, and the two closely-related activities of public policy and government affairs (PPGA) and RWE.

Comparing how the seven MA activities are anchored across the different companies, we identified five key trends that are worth noting.

• Traditional activities: pricing, HTA, and HEOR are primarily anchored in commercial, while PPGA is primarily anchored in corporate affairs.

• Many of the benchmark companies have started to split out HEOR functions and, in many of these cases, they are moved to R&D and located/combined with RWE group.

• Many companies have started to split out health policy as a specific sub-function from public policy and moved it in with other traditional MA activities.

• For RWE, while primarily anchored in the R&D/medical group in most companies, we are seeing a growing trend to split it and have some capacity/capability also in commercial.

• Most global MA heads sit at CEO-2 level, often reporting into a head of marketing/strategy/chief commercial officer.

Deep Dive 3: Organizational set-up

We do not observe a dominant organizational design for traditional MA activities (e.g. pricing, HEOR), and activities at interface with other functions, namely health policy and RWE. Having said that, we found it helpful to look at two dimensions along which companies have made trade-off choices:

1. Degree of centralization vs de-centralization. There is a large spread in the level of centralization vs. decentralization (~1.26x above and below the average), driven by the overall context of the company (e.g., portfolio mix, commercial structures, strategic focus). However, there are two general trends we can observe: a) there is overall tendency to reduce regional/global resourcing in favor of local; and b) increasing resources in China.

2. Functional set-up vs. anchoring by therapeutic areas (TA). There is an even higher variation along this dimension, driven by distinct choices made by each company to address its specific current challenges. Interviewed MA leaders also made it clear that there was a general expectation that more changes are to come as strategic focus and portfolio/TA mix evolves. In addition, we found that while there is a large spread in how functional resources are deployed (~1.44x above and below the average), there was a slight overall shift in the functional focus-with increased resources in customer-facing activities, in particular those that are local, and gaining efficiency in backend activities like HE/HTA modeling.

Deep Dive 4: Resourcing (global/regional/local)

In the 2016 benchmark, virtually all companies increased their resourcing across the board. In 2019, the picture is more nuanced, with some companies continuing to increase their resources (either started later or from a lower base) while others are optimizing existing resources through differentiated deployment. For example, the regional layer is losing favor at about a third of companies. Others are exploring “agile or “new ways of working,” allowing for greater flexibility of resource deployment, which generally also result in fewer regional alignment roles.

As in the other years, we also looked at the overall resourcing of the MA function across global, regional, and local deployment and found two distinct scaling factors at play:

• The launch needs, expressed by the number of mid-to-late-stage products a company currently has in their pipeline. As MA activity tends to be most pronounced in the lead up to and at launch, the number of mid-to-late-stage products in the pipeline seem to be a good indicator for the MA resource need.

• The overall company size, expressed by the sales of their current products. The value generated from currently marketed products enables companies to hire MA resources, and larger companies by sales can afford to staff greater teams.

The scaling by launch needs and sales also allows to control for the differences in TA focus, portfolio, size, and other factors. The close alignment to the regression outlines the validity of the two scaling factors.

Deep Dive 5: Integrated evidence planning

As has been noted in the previous benchmark and continued discussions at the BCG Market Access Roundtable, IEP has emerged as a key joint process to align evidence-generation activities across MA, medical, development, RWE, and regulatory early and encompassing the product life cycle.

Integrating the evidence-generation activities ensures the right evidence package is built for a product accounting for all stakeholders in the most effective/efficient way. This requires driving alignment on aspects of target product profile and trial design between functions to ensure the right choices are made across functions vs. within a function only.

Most organizations have deployed one form or another of IEP, although they are at differing levels of integration, sophistication, and maturity. At earlier stages of integration, companies still develop functional evidence-generation plans bottom-up, and bring those plans together into an “integrated” plan later. While this is a good starting basis, it does not allow for the most efficient use of resources. In addition, we notice that involvement of countries (timing and number) varies across the companies  and is less systematic in terms of the involvement of smaller yet progressive countries (see Figure 2).

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10 top capabilities to ensure future success

Close to 400 MA colleagues from global and regional markets and the nine largest countries outlined what they perceive to be the key capabilities for future success. Ten capabilities stood out, covering traditional aspects of MA such as health policy, evidence generation and synthesis, and pricing, as well as broader themes such as organizational effectiveness (see Figure 3).

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Looking across the top 10 capabilities, two themes emerge as key: evidence generation and synthesis, and collaboration/co-creation.

More than half of the capabilities relate to collaborating and co-creating with internal and external stakeholders. As MA is becoming even more of a cross-functional endeavor, more MA objectives can only be achieved through support and collaboration from other functions. Consequently, the ability to steer the whole organization toward achieving MA goals becomes more complex. Hence, more capabilities in this regard are required.

Outlook

With access becoming the front and center issue for pharma companies, “access” is part of the agenda of multiple different functions, and the role of the MA function is evolving rapidly.

With the increased importance comes a greater need to more closely collaborate with other functions, and drive the larger organization toward achieving the company’s access objectives. At the same time, other functions are building their access focus and capabilities. Hence, access activities are no longer limited to the MA function only, and while the reach of access is increasing, the remit of the MA activity is blurring.

The MA function within companies will need to refine its focus and rethink the way it interacts with internal and external counterparts and stakeholders.