Key Benefits of Early Market Access Planning
According to our 2024 State of Patient Access survey, 81% of pharma companies are launching their market access planning much earlier than they did five years ago. By Phase I, one-third of pharma companies are already engaged in market access research, with most pharma companies (54%) engaged by Phase II – III.
What can manufacturers hope to learn about the competitive landscape so far in advance? From identifying a brand’s most valuable differentiators to establishing accurate expectations for launch, early market access research helps pharma companies create and defend a strong position in the market. A solid understanding of the future landscape also helps manufacturers develop targeted approaches with high-value payers.
As this takes time, it’s best to begin as early as possible. Let’s take a look at how early market access planning can help you in six key areas.
1. Anticipate Payer Response
Determining how payers perceive value in a given indication is critical for manufacturers of new brands, especially in highly genericized markets. For example, in the Humira biosimilar space, pharma companies used early research to discover if payers preferred citrate-free formulations and interchangeability status. They asked specific pricing and contracting questions to determine if payers were more interested in high-WAC or low-WAC options. By using Payer Message Monitor to understand the contracts payers were currently considering—and MMIT Indices for a deep dive into the rationale behind contracting and reimbursement preferences—our clients were able to make informed decisions about their own contracting strategies.
In our experience, manufacturers who are launching a novel formulation or mechanism of action (MOA) often expect payers to respond as if the new brand is a novel therapeutic agent. However, in a crowded therapeutic area, payers may not see a product’s differentiators as clinically significant. For example, a manufacturer of a new autoimmune therapy that targets different interleukins from its competitors might believe that its product is guaranteed a spot on payers’ formularies due to its efficacy, superiority, or dose frequency. Instead, payers might view the distinction as interesting, but ultimately unsupported by the evidence—which could lead them to group the therapy in the same basket as competitors with similar targets, or even leave it off formulary altogether.
2. Define Your Value Propositions
Manufacturers need to know what matters to payers in order to craft a compelling value story, which means they must have a thorough understanding of both payer preferences and payer coverage well before launch. By taking a look at payer policies and restrictions in a given indication, trended over time, your team can anticipate how existing coverage will likely evolve between the present day and your launch timeframe. What does the payer landscape look like? What kind of challenges is your brand likely to face?
By doing your research ahead of time, your company can determine the most valuable differentiators for a new brand, depending on the likely landscape at launch. Which factors will be most advantageous for your product? Conducting a simulated P&T session can help manufacturers test and refine their value propositions, as they can get first-hand knowledge of how payers will potentially respond to their drug—and others. For example, after conducting complex research on the ocular space, one manufacturer was able to create an additional value proposition around less frequent dosing, which gave its brand a head start against similar competitors.
3. Mitigate Payer Pushback
Along with payer coverage and preferences, early market access planning also uncovers potential sources of payer pushback. Knowing these pain points in advance can benefit pharma companies in their clinical trial design, as they can modify their inclusion and exclusion criteria to generate the real-world evidence payers want to see. Understanding payer needs months in advance can help manufacturers better refine the final product that is eventually passed on to the market access team at launch.
Early planning also encompasses research into the future market landscape, not just the current one. This information helps pharma companies prioritize their pipeline products to maximize their impact and revenue. For example, some manufacturers have worked with us to understand the shift in utilization happening in the rare disease market, ultimately using that intelligence to decide whether to end-license certain products.
4. Plan for the Unknown
While manufacturers cannot predict market disruptions, early market research gives them the information they need to pivot when the unforeseen occurs. In the biosimilar space, the launch of CVS Health’s Cordavis was an unforeseen event that catapulted Sandoz market share and led to other payers adopting their own manufacturing arms. Manufacturers who had invested in early market research were able to assess and confirm contract agreements and make plans to implement similar strategies in the near future.
To take another example, the COVID pandemic meant payers began preferencing on-body administration of chemotherapy supportive agents, rather than injector pens. Manufacturers launching in this timeframe were able to capitalize on their market access research (via Message Monitor) to highlight their brand’s on-body administration, which helped immunocompromised patients stay out of the doctor’s office during a perilous time.
5. Know Your Timelines
Historical analog analyses can give pharma companies greater visibility into likely payer uptake, anticipated restrictions, and review timelines. Which payers are more likely to have a quick uptake in a specific therapeutic area? Which will take longer to review the drug with their P&T committee? How will payers’ new-to-market policies influence the review timeline, not to mention whether your brand is covered or blocked at launch?
MMIT’s Strategic Launch Report allows pharma companies to see the individual characteristics of each payer, so they know which payer relationships to pursue first—and when. Custom research that combines coverage and claims data can also help manufacturers compare payer policies to what actually occurred at another brand’s launch. Without these insights, your team cannot actually know when payers will approve your brand or place it on their formulary—which could mean a much longer runway to profitability than you initially assumed.
6. Cover Your Bases
Pharma companies are often advised to analyze analogous market scenarios to better predict payer behavior at launch. Unfortunately, many manufacturers forego that work after determining that there is no perfect analog for their brand. While this may be true, conducting multiple historic analogs can show manufacturers what their coverage is likely to be at three, six, or nine months post-launch. Simply put, analog analysis represents a minimal spend that can return maximum gains.
At MMIT, we advise clients to choose at least three analogs in their analysis, so we can account for the nuances of your value propositions and market entry scenario. In one case, for example, we selected six analogs for a client: one to highlight what happens when a brand with subcutaneous administration enters into a majority intravenous or oral market; one to address the scenario of a brand being the first to market within a particular MOA; one to cover pricing strategies in a highly genericized market; and the other three to explore indication-specific concerns, including how prescribers are likely to respond to a market disruptor.
Ultimately, doing your homework on how payer preferences, coverage, and behavior have evolved over time can really pay off at launch. In a complex market, proactive market access planning can help you effectively anticipate both best-case and worst-case scenarios—and be prepared for either. With a comprehensive understanding of the market landscape, your team will be well-positioned to create compelling messaging, engage key payers and providers, and make strategic decisions for your brand’s success.
Learn how our market research solutions can clarify payer, provider and IDN perspectives while our pre-launch solutions help you forecast uptake and ensure access.
