Navigating the Future: Key Market Access Trends to Watch in ’24

Kevin Cast
Partner
Archbow Consulting

As we approach 2024, the pharmaceutical industry is poised for transformative changes in market access strategies. From innovative therapy approaches to evolving technological advancements, staying ahead of the curve is crucial for drugmakers aiming to navigate the complex web of market access successfully. Here are a few of the market access trends we’ll be watching closely in the new year.

1. PBMs ARE POISED TO MOVE BEYOND REBATES

Pharmacy benefit managers (PBMs) have traditionally been associated with formulary management and rebate procurement. However, in an era of dynamic healthcare landscapes and evolving patient needs, there’s a growing recognition that PBMs can play a more expansive and collaborative role with pharma companies.

Manufacturers have opportunities to engage deeper with PBMs by embracing outcome-based collaborations and leveraging data to improve medication adherence and identify cost-effective treatment options, prioritize patient-centric solutions, explore innovative pricing models, and optimize contract pull-through.

2. COMPLEX DISTRIBUTION NETWORKS

Emerging pharma companies face a dynamic and complex landscape as they launch drugs into the market. Success in this environment requires a strategic approach to distribution that incorporates technological innovations, regulatory compliance, and a patient-centric focus. By adapting to these trends, companies can position themselves for success in an evolving marketplace.

Manufacturers can collaborate with third-party logistics (3PL) providers to allow trade and commercial teams to focus on core competencies while tapping the capabilities of established distribution partners. Emerging companies must adopt adaptive supply chain strategies that incorporate flexibility and resilience. This might involve dual sourcing, strategic stockpiling, and scenario planning to mitigate potential risks and disruptions in the distribution network.

3. CONTINUED SPECIALTY PHARMACY PRESSURES

Speciality pharmacies (SPs) are experiencing significant margin compression due to rapidly declining PBM reimbursement rates. These rates are often lower than the product’s purchase price, while the expectations for additional services and data insights are increasing. Without additional support from manufacturers, these economic pressures will negatively impact a pharmacy’s ability to provide critical services supporting patients, i.e., pharmacy and medical benefit verification, prior authorizations/appeals, financial assistance, patient education, clinical compliance calls, adverse event reporting, etc. We expect the definition of core and enhanced services to continue to evolve as pharmacies attempt to balance the needs of their key stakeholders—patients, prescribers, and pharma firms—with the economic needs of their businesses.

4. GROWTH OF HCP-ADMINISTERED PRODUCTS

An increasing number of drugs requiring patients to visit an healthcare professional (HCP) for administration are being approved. These products are more likely to be covered under the medical benefit vs. the pharmacy benefit, which creates problems or delays for some SPs. Administration requires additional workload on the prescribing physician and office staff. Therefore, they are looking for alternative sites of care that can dispense and administer the product. Manufacturers may need to look beyond the “traditional” SP network designs to consider alternative/additional sites of care. SPs need to continue to grow their relationships with these sites, and manufacturers need to be prepared to contract with them for access and enhanced services.

5. IMPLEMENTING ALTERNATIVE HUB MODELS

Innovative modeling allows a manufacturer’s hub to remain relevant and create differentiation within the industry, especially with niche patient populations such as cell and gene therapies and rare diseases. Patient support programs (PSPs) can recognize increased efficiencies by focusing on the patient experience, implementing digital solutions, and using data to drive technologies.

A manufacturer’s ability to embrace these trends and challenges will be crucial for success. Companies that navigate these trends strategically and proactively will be well-positioned to secure market access for their patients and contribute to the evolution of a more patient-centered, value-driven healthcare ecosystem.