This blog is the first in a series that shares our vision for a unified access platform. As co-founder and EVP of Product and Strategy for IntegriChain, most of my waking hours — and probably even my sleep — is dedicated to ensuring that IntegriChain delivers value and fills a market gap. This is where I began to sort out the business dynamics of Market Access as the world moves to specialty and precision medicine.

There’s more innovation in disease treatment and prevention today than maybe at any time in human history. As Life Sciences continues to evolve to next-generation specialty and precision medicine, the technology supporting Market Access business processes and decisioning has not kept pace. 

Too often, manufacturers rely on legacy applications and siloed datasets to support individual access functions. Contracts and Pricing teams conduct most of their work within revenue management systems that do not extend beyond Contracts and Pricing data and business processes. Finance teams responsible for critical gross-to-net processes are, for the most part, limited to spreadsheets. Account Management, Payer Marketing, and other commercial functions work primarily with reporting that is generated by a commercial data warehouse or by the manufacturer’s data aggregator. All three functions become effective data silos. When a team needs data from across these silos, too often the projects become mired in vendor data requests, manual data wrangling, and other sources of toil and delay.

The goal of Market Access is simple: accelerate commercialization and get patients access to therapy faster. The function of Market Access is highly complex and impactful on the success of not only new innovative brands but on the overall success of the manufacturer. Market Access casts a wide net, encompassing the creation of payer and channel strategies that ensure patients will have access to therapy, the development and management of patient support services, the management of complex financial relationships with the government and private insurance companies, and the ability to accurately forecast and report on the impact of access strategy on the P&L.

We’ve spent many hours talking to hundreds of Life Sciences manufacturers of all sizes and complexity about their commercial, financial, and operational goals for access-related functions over the next one to three years. The common theme we have heard with each of these objectives is that the goals are stymied by the data and application silos that exist within Market Access today. We at IntegriChain are passionate believers that Market Access requires a truly unified data and application platform to future-proof its essential functions.

We’ll start this series of posts by level-setting on the nine goals we identified. Today, we take a deep dive on the commercial goals of Market Access, examining how today’s data silos challenge each objective. In future posts, we’ll examine the financial and operational goals as well as share more about the data and technology capabilities we believe Market Access teams need to accomplish all of the goals they communicated. Keep in mind, an individual manufacturer’s Market Access goals will likely be a subset of these depending on the business, the brands, and the patients.

Market Access Commercial Goals: Removing Access Barriers 

Specialty medicines face high access barriers including complex logistics, payer policy restrictions and coverage restrictions, and significant patient out-of-pocket costs. Moreover, increasing competition in many specialty categories – and even rare disease – drives the need for commercial contracting. To address the evolution towards specialty and precision medicine, we see three key commercial goals for Market Access. 

Innovative Contracting

For today’s medicines, removing access barriers requires innovative approaches to contracting. Fierce competition in larger-population specialty categories and emerging competition for small-population indications has created a resurgence of interest in value- or outcomes-based contracting. But the industry has found it nearly impossible to implement these contracts. Oftentimes, payers and manufacturers can align on the clinical endpoints for the agreement but not on how to measure the endpoint. Market Access leaders are still hesitant though even when there is conceptual alignment on the endpoints and measurements because their existing systems and processes were not built to support value- or outcomes-based contracts. 

Access Barrier Insights

Market Access teams invest mightily in field reimbursement teams and hub reimbursement support programs that are designed to triage therapy initiation and adherence barriers on a patient-by-patient basis. They invest in extensive co-pay assistance programs designed to offset prohibitive patient out-of-pocket responsibilities. But the loop between payer account management, payer contracting, and the broader landscape of patient support services remains unclosed at best. How does the Market Access team know which investments are most effective in resolving access barriers and for which patient cohorts? Where is there duplication of investment? Where are the gaps in unsupported patient cohorts? To answer these questions, Market Access teams need better connectivity and better understanding between the world of payer contracts, policy restriction, and formulary design with the world of specialty pharmacy patient status reporting, co-pay program utilization, and hub reimbursement support.

Channel Agility

Government pricing and gross-to-net are critical operational processes, but these operational processes should not dictate commercialization strategy. Market Access teams are seeking new channel designs that optimize distribution cost and access for smaller patient populations. In areas such as cell and gene therapy, Market Access is exploring models that introduce completely new roles and distribution models for channel stakeholders. But these channel designs and contracts have implications for government pricing and gross-to-net. Manufacturers need platforms that can operationalize these new agreements: integrating non-traditional fee structures with government price calculations, seamlessly sourcing contract terms into best price estimates, and flowing through new transaction types for relevant gross-to-net line items. And all must be achieved without the overhead of building custom adapters or the pain of manually wrangling data into government pricing and gross-to-net applications.

Stay tuned. There’s much more to share on the financial goals of Market Access in my next post.

 

About the Author

Josh Halpern

Josh Halpern

Co-Founder & Executive Vice President, Product & Strategy

Josh Halpern drives IntegriChain’s product vision and go-to-market strategy. In the early years, Josh led the development of IntegriChain’s market leading channel and patient data aggregation solutions. Josh evolved IntegriChain into a drug commercialization services company and technology platform uniquely focused on Market Access, growing the company to more than 500 team members and 250 customers.