PRMA’s Nathan White: Why Understanding Payer Archetypes is Key to U.S. Market Access

Via PRMA Consulting

Until recently, pharma’s biggest market access challenge in the U.S. has been learning to navigate “known unknowns.” Suddenly, however, long-standing unknowns – like the future of the Affordable Care Act, the nature of pricing reforms, or the influence of the Institute for Clinical and Economic Review (ICER) – are being set in a whole new context. COVID-19 has reshaped the narrative, adding another tier of uncertainty to an already complex marketplace.

As the economic implications of the pandemic redefine the parameters of payer decision-making, the need for agile strategic insight – and greater collaboration – has only intensified. Pharma finds itself at the brink of great change. But in a U.S. market increasingly driven by extreme unknowns, one thing has become crystal clear: deep understanding of diverse payer archetypes has never been more important.

Navigating complexity

The U.S. healthcare system is known for its fragmentation and market orientation. The inherent complexities mean that the world’s largest market is also one of the hardest to navigate – posing unique market access challenges that demand detailed customer insight and robust processes for sharing information. Market access teams are working diligently to find their way through, but opportunities to transform the process – and enhance customer engagement – are there for the taking.

But first, let’s examine the environment. At the macro level, securing patient access to life-changing treatments is becoming ever more complex. As the cost of healthcare increases, payers are squeezing their drug budgets in search of savings – and pharma companies need to align and fine-tune their value stories if their medicines are to avoid the cull. Meanwhile, the continued absence of a formal health technology assessment (HTA) process has led to calls for greater control over the cost of medicines and renewed pressure to overhaul pricing systems. Most intriguingly of all, payers are starting to re-evaluate the evidence they require when they review new medicines, with cost-effectiveness – a major focus in European markets but rarely a factor in the U.S. – quietly emerging as a potential consideration. The future promises to be fascinating.

Click here to read the full write up by Nathan White on PRMA’s website.