Meet Your Launch Goals with Payer and HCP Insights
The weeks preceding a pharma product’s launch date are a critical window for market access teams. The ability to pivot and adjust to last-minute shifts can make all the difference between a successful first year and a disappointing launch trajectory. While much of your market access research may have already been completed by the time you go to market, there are several ways your team can continue impacting coverage and utilization.
Our first post in this series discussed the benefits of early market access planning in Phase II-III, while the second post shared six essential steps to complete in the year before approval. In this post, we’ll discuss how post-launch market research on payer and HCP behavior can enable optimal performance for your brand.
Payer Engagement and Label Changes
In the hectic pre-launch window, your market access team will likely be working alongside project managers, brand teams, patient support and clinical development on various workstreams. Once you receive label confirmation from the FDA, your team will be busy updating a range of marketing documents, from the press release to formulary kits, working with your legal and regulatory teams to get them approved.
In addition, your team will likely be finalizing a payer target list based on the current market dynamics within your therapeutic area. By launch time, most of our clients have already conducted historic analog analyses on therapies with a similar market context to level-set coverage expectations and guide their payer strategy. Our Strategic Launch Report also analyzes coverage and claims updates for selected analogs to help manufacturers better understand the relationship between coverage and sales.
As payers typically review brands on their own internal cadence, it’s tremendously helpful to know when each payer is set to review your brand’s therapeutic area. Many payers also have automatic new-to-market blocks in place. Our New to Market report highlights which organizations will be early and late restrictors and adopters, which can help you strategize when to approach each payer. If your approval date comes earlier or later than expected, your team may need to reprioritize your payer targeting to adjust to the new timeframe.
Label changes are another last-minute shift that could impact your launch. Your product’s actual label may be broader or narrower than expected, depending on the FDA’s review. Even a minute verbiage change can impact your product’s positioning within a market basket. To investigate what payers are thinking and uncover any new opportunities, your team might need to consider conducting fast market research.
Conversely, if the FDA limits your product’s approval, your team will need to adjust your payer strategy based on the label’s language. If the FDA has cited a lack of clinical evidence or efficacy data, you might also need to run damage control to address payer concerns. When faced with this scenario, several of our clients have managed to secure payer coverage that is less restrictive than the label, although in some cases, this coverage included unanticipated restrictions.
Account Targeting and Payer Feedback
Executing your payer plan of attack requires a great deal of collaboration. Ideally, your account directors will be properly trained and have all the materials ready to deliver to payers in their meetings. Make sure to get feedback from your account directors about how these meetings are going, as making a strong first impression on payers is crucial for your brand.
Typically, the market access team will also need to establish processes to track and communicate coverage wins internally, especially to senior leadership. It’s important to be strategic about how you collect your coverage uptake, as you’ll need to show how your coverage is trending from launch onward. Our Analytics PAR Insights report and Launch Coverage Analytics solution showcase weekly policy changes to help your team better understand new opportunities and access challenges.
In addition to this quantitative information, you’ll also need qualitative payer insights. Double-blinded custom market research allows your team to ask specific questions, which illuminates the rationale behind P&T decisions and provides crucial feedback on the comparative value of your brand. For example, one of our clients launched right after a competitor released a novel molecule for the indication. The client used MMIT’s payer panel research to determine how the competition fit into therapeutic guidelines, and then crafted their messaging around their product’s superior reliability.
Another option is non-prompted research that monitors payer feedback on manufacturer meetings, which can show you what topics are bubbling to the surface. This can be especially powerful in determining payers’ response to a market event, such as a competitor with a newly expanded label or dosing change. Our Message Monitor solution provides a fly-on-the-wall perspective on these payer discussions, and can even provide direct feedback from payers who’ve recently connected with your sales team.
Prescribing Barriers and Physician Messaging
Although market access teams are not responsible for marketing to HCPs, close collaboration with brand teams can ultimately benefit everyone. For example, cross-functional messaging helps HCPs understand the value of the brand and how it’s covered for their specific patient population, increasing pull-through. If HCPs erroneously believe that prescribing your drug will require complex prior authorization, or they don’t understand which tests to order to determine eligibility, your utilization will suffer.
For market access teams, it’s essential to consider the prescriber journey as well as the patient journey. What hurdles are HCPs experiencing when they’re trying to prescribe your brand? Are there any issues with reimbursement? Lab and claims data will not only reveal these barriers, but will also help you circle back to payers and build a case for looser restrictions. For example, a client who knows that a significant percentage of physicians are requesting medical exceptions for their brand now has qualifying evidence to use in their payer discussions.
Along with lab and claims data, physician market research can help your team identify potential HCP messaging gaps. Open-ended promotional effectiveness tracking reveals which elements of your messaging are resonating with HCPs as compared to your competitors’ messaging. Do HCPs understand, remember and attribute your main differentiators to your brand? Which data points are the most impactful in terms of changing HCP prescribing behavior?
In some cases, a pharma company might uncover an easily remedied HCP education issue, like a frequently missing diagnosis code that results in claim denials. By uncovering the specific roadblocks faced by your target HCPs, your market access team can have a tremendous impact on utilization rates.
Product Performance and Market Maintenance
If your brand’s coverage uptake isn’t meeting expectations after the first six months, it’s time to diagnose any potential problems. Are payers actively making decisions to not cover your brand, or are they just not making decisions yet? Is there an opportunity to gain further traction with payers through contracting, or do you simply need to wait for new-to-market blocks to lift?
Secondly, what’s the quality of access? Even though your brand may be covered, patients might still not be able to access it. Alternatively, patients may be accessing your brand through medical exceptions, despite the lack of coverage. Additional payer research can shed light on these dynamics and reveal the reasoning behind payer policies and restrictions. Perhaps your brand needs to develop new documents based on additional unmet needs, or to run new financial proof points.
Most importantly, it’s critical to continue tracking coverage dynamics, as policies, plans and payer hierarchies are always evolving. In pharma, there’s no such thing as the status quo, even if your brand has been out for a few years! By monitoring market changes, your team can discover new opportunities to improve utilization or overall coverage. With a strong, data-driven strategy, your team will be able to overcome any roadblocks to maximize patient access to your brand.
Learn how MMIT’s payer and provider insights solutions can help your team improve patient access to your brand.
