Unprecedented Times for Market Access: Amy Mahery

Amy Mahery began her career in field sales at Johnson & Johnson, before joining EMD Serono (which is the healthcare business of Merck KGaA, Darmstadt, Germany in the US) in 2004. At EMD Serono, she held various positions in marketing and, later, market access, in the oncology and neurology/immunology therapy areas before being appointed Global Head of Market Access and Pricing of the healthcare business of Merck KGaA, Darmstadt, Germany, in November 2019. 

Pharm Exec caught up with Amy just two weeks into her new job to discuss her key priorities and how she will draw on her multi-faceted industry experience to approach the challenges and opportunities of global market access in a changing industry landscape.

Pharm Exec: Following several years in marketing, what led you to make the switch to market access?

Amy Mahery

Amy Mahery: I've been really fortunate that in my career I’ve had the opportunity to weave in and out of different functions in therapeutic areas and even between affiliates and global. I’ve navigated my career based on learning and gaining depth and breadth in different areas, in order to make myself versatile. That's how I ended up in market access. One of my friends, a trusted colleague, told me that although I’d held multiple commercial positions, I was really only operating at the tip of the iceberg. In seeing the market access lines on the P&L, I knew he was right and that there was a lot more that I needed to know and understand about the business of biopharma. With that, I took the step that really opened my eyes to the business of this industry and its totality, and since then I've rotated in and out of market access and pricing. The strategic business implications and the dynamic environment keep me coming back!

What are your first priorities as global head of market access and pricing of the healthcare business of Merck KGaA, Darmstadt, Germany?

I think the market access environment is always changing, but we’re at a really unique point because we’re on the precipice of potentially significant change in some of our major markets, particularly the US and China. Predicting events and the implications on our portfolio is complicated and highly interconnected work, which we do with our cross-functional colleagues. Comprehensive and cross-functional scenario planning and market shaping is a constant critical priority, so I’d say that that’s the first one.

Related to that, we’re working to establish a consistent and systematic integration of global market access and pricing into the R&D process. While market access integration into R&D is occurring within our company, it’s currently intermittent. We have some program teams where this is working incredibly well and others where there is room for improvement. I think that's the same for other companies. Standardizing the role of market access and pricing in clinical development is not only a priority for me, but also for the company, and I think for the industry at large.

Another constant priority is talent management and engagement. The war for talent, particularly in market access as a highly specialized field, is raging on. So, retaining a highly engaged team, especially during periods of change management, is critically important.

How has spending time in market access in different therapy areas helped to prepare you for your new role?

I spent a good deal of time in the US market access affiliate, about three years doing payer marketing and contracting strategy for our  multiple sclerosis medication, Rebif, in the US. I think that that really laid my foundation. Of course, there’s the rest of the world to learn about. After a couple of bouts back in marketing, I came into an oncology role in the global market access organization that was exclusively focused on pipeline management. In doing that, I not only built upon my oncology portfolio, but also realized the importance of appropriately integrating market access perspective in our clinical development programs to guide decision making. That’s a critical enabler of our success organizationally. It gave me a lot of visibility into the strategic work that we're doing and gave me an elevated opportunity to participate. That led me to leading the neurology and immunology team here and into a VP role in global neurology and immunology market access. So, I was very familiar with the products and that made the transition very easy. As you can imagine, between oncology-a highly dynamic field that changes day-to-day-and more specialized illnesses like multiple sclerosis and lupus requiring daily management, I gained a really broad view of the global market access environment and how to navigate that with highly selective orphan drugs andsome of our core specialty medicines across a spectrum of therapeutic areas and value propositions.

What would you say are the key market access barriers facing the industry at this time?

I think we’re in an unprecedented time; we are, as an industry, driving innovation at a rate that’s outpacing the market’s ability to fund it. Payers are responding with delayed or reduced reimbursement and cost containment strategies that are spreading across the globe. The wealth of innovation over the last 10 or so years has really reduced the payers’ perceived unmet need across the spectrum, whether in highly specialized areas or primary-care areas such as diabetes. That means that we’re looking to partner with payers on access and potentially innovative agreements. But they have the least amount of incentive to say yes, compared to the past. That’s a major barrier we're facing right now. The environment has changed and a new baseline has been set.

There’s also the constant barrier of technology. We’re close to flipping the switch and enabling so much opportunity in terms of market access and patient-care delivery, but we're just not there yet. There's broad agreement that value-based access and pricing arrangements are the ideal, but they require data. We need interconnected quality, longitudinal, and timely data. We're not yet able to fully optimize it. But I strongly believe we’ll get there; we'll hit a turning point where technology will enable the industry to customize ways of measuring and recognizing value. 

Is the technological evolution in market access something that you can drive, to some extent, or does it require a wholesale change in company culture?

I think it’s more industry-related, because the health system needs to have interconnected data that's patient specific and longitudinal so we can track patients and outcomes over time. A lot of the time, even in systems that have those data, they only contract in yearly cycles. The benefit of a long-term effect of an innovative therapy can't be recognized when you've got that mismatch of technology versus system, which can be frustrating. Then you have situations like in the US, where we don't have one set of data. Countries such as Italy are set up to do these types of things, not that they’re enabling them to the fullest extent yet. But in the US it's more complicated, with so many different payers and so many different electronic health records. We really need a unified way of examining population health. This will help us not only extrapolate insights that could speed drug development and indication expansion, but also enable the type of optimized value-based contracts that we would love to put in place.

Assuming we get to this point, will it affect how you shape and manage the market access teams?

We already have a number of people who work on value-based contracting, whether that’s in global market access or in our global evidence-generation team. We've put some value-based contracts into place but they’re quite cumbersome to execute-and this speaks to the point I made earlier. We've heard from some smaller countries that some of the value-based or innovative contracts we've put in place have become so laborious that they need extra reources to be able to monitor the data and report and calculate what that means in terms of value. So, I think that the skill sets required to pull this off already reside within the company, and we’ll continue to leverage as technology improves and value-based contracts become more prominent. Will we need to shift a little bit? Maybe, but I think that this is something that we're well prepared to handle, as we’re taking advantage of these contracts now and realizing how they can be optimized. 

Do you see a shortage of upcoming market access talent?

Yes and no. I think that historically there's been a shortage of not just market access talent, but a certain type of talent, because market access competencies need to come from all aspects of the business. It’'s not enough anymore to keep market access contained as a functional expertise silo.

What we need from talent is broader perspective, not only within our function. When we’re pulling in talent, ideally, they will have some commercial experience, some experience in R&D or in evidence generation and health economics. We’re looking for a broad base of experience so they can understand the context and the implications of market access. And, vice versa, those commercial leaders and medical and R&D leaders who are best equipped to deal with the future are going to be those that have the market access competencies. How we look at talent is just a bit different from how it’s been in the past. We were looking for highly focused, functional expertise in market access. Now we need a broader view, both inside and outside our function.

What kind of opportunities do you see in the next 12 months? What do you feel positive about?

I think that a lot of the barriers we’ve discussed are opportunities in waiting. Data and systems, for example, there are great examples of these. We’re primed, we’re ready, and we’re really waiting to flip the switch on some of this innovation and expand it outside the pilots that are being executed now. I think that that’s a major opportunity for us as an industry. Then, as innovation becomes more advanced in terms of cell-based therapies, there are opportunities for us to review the model of healthcare delivery and partner with a system to come up with solutions that best serve patients-while also understanding the budget constraints. As I’ve mentioned before, we’re in an unprecedented time of innovation, and as some of these changes start to unfold, we’re ready to capitalize to deliver for patients in need.