Pharma marketers need to know the different areas of access to best benefit their brand.
The number one goal of pharma marketers is to maximize sales of their products. But this is challenging because many factors, including sales force time and attention, promotional budget, key opinion leader support, and product access, contribute to success. The last of these, access, adds another layer of complexity because it has several meanings, each representing a specific strategic choice for brand champions. Marketers need to know the different definitions of access and how to use each type to their brand’s benefit.
Access Is More Than Formulary Position
Many marketers think of access as preferred positioning on health plan formularies and automatically assume that this should be the goal for their brands. Typically, preferred products have the lowest co-pays among branded products. Low co-pays mean that patients are less likely to complain to physicians about cost and more likely to comply with treatment. Fewer patient complaints mean physicians are more likely to prescribe those brands.
Access also refers to the ease with which physicians can prescribe a brand. For example, health plans may require physicians to obtain prior authorization before prescribing a product. Or they may impose generic step-edits, which require that a patient fail therapy with a generic product before they will reimburse a branded agent. Pharmacy controls like these disrupt physicians’ treatment process by adding paperwork or denying payment when patients try to fill a prescription. If physicians can prescribe products that are free of these “hassles,” they will.
Finally, access can refer to patients’ willingness and ability to pay for a product. Patients’ price sensitivity has many contributors, some of which have nothing to do with the actual products or the patients’ pharmacy benefits. Patients’ perception of a condition’s severity is one major factor. For example, patients with type 2 diabetes tend to be less sensitive to out-of-pocket costs than patients who take anti-allergy products or oral contraceptives. In addition, health plans aim to get patients (and physicians) more engaged with the cost of their treatments by creating multitier formularies.
Some real-world examples will illustrate how these considerations vary from drug to drug and how various levers can be used to increase product access (Figure 1).
Treatment Guidelines and Physician Perceptions of Product
Novo Nordisk launched its once-a-day GLP-1, Victoza, in late 2010 with few, if any, contracts for preferred access.1 Its only competitor was Amylin’s Byetta, which had a five-year2 head start and good formulary access but requires BID (twice daily) injections. Victoza eclipsed Byetta in share of the GLP-1 category in less than two years without, according to Health Strategies Group research, offering contracts to health plans.3
This strategy worked for several reasons. First, health plans have historically applied few management controls to the diabetes category. In addition, Victoza had a superior product profile and offered patient coupons. Finally, diabetic patients believe in their physicians’ treatment recommendations and are reluctant to reject prescriptions due to out-of-pocket cost.
Market Share and Plans’ Ability to Manage a Category
The autoimmune category is one of the most crowded and complex biologic drug classes. Ten competitors differ in route of administration as well as approved indications. However, payers see only slight clinical differences among these agents; therefore, when they make access decisions, net price is their key consideration. As a result, access strategies in the category reflect two primary factors: health plans’ ability to manage use and brands’ market shares.
Enbrel and Humira have been able to leverage their high market shares and plans’ management systems to obtain pharmacy benefits that work to their advantage. More than one-third of plans have agreed to include one of these brands on their second formulary tier in exchange for rebates.4 High-market shares, like those of Enbrel and Humira, make this strategy feasible because health plans have difficulty shifting use away from market leaders, but they can use co-pay differentials to encourage physicians and patients to use preferred agents first.
Payer Perception of Disease and Product Attributes
Historically, drug treatments for multiple sclerosis (MS) have had few barriers to access. The severity of the condition, combined with the wide variation in patients’ response to therapy, has discouraged plans from managing access to MS products tightly. These factors have enabled many brands to adopt narrowly focused access strategies, contracting only with the few plans that have managed product use and reimbursement.
Aggressive price increases for category products have prompted health plans to begin erecting barriers to access. For example, plans are beginning to require that patients fail on certain interferon products prior to receiving others on the same formulary tier. Going forward, brand teams will need to broaden their access strategies to compete more intensely with the many other category brands for preferred formulary positions, or to convince plans not to apply management tactics such as step-edits and prior authorizations.
The reimbursement and access landscape will become more complicated as brand use shifts toward the specialty market. Ideally, new brands would have sufficient clinical and economic differentiation so that health plans would grant them unfettered access without price concessions. However, few brands will achieve this ideal. For most, teams will need to develop a brand access strategy that reflects category competition, distribution of category market share, the positioning of new products in accepted treatment standards, and patients’ perceptions of their disease.
1. Source: MCC-Hypoglycemics, 2011
2. Source: Amylin 10K filing for the fiscal year ended December 31, 2004
3. Source: MCC-Hypoglycemics, 2011
4. Source: MCC-Autoimmune, 2012