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Elevating Market Access Intelligence

Updated: Apr 10, 2018

The Impact on Training Customer-Facing Teams and Managers

Recent trends in access and reimbursement have resulted in a complex environment in which to discuss and promote pharma and biotech products. And the trends we learned five years ago are different from the trends that are impacting the market today. Pharma and biotech companies have recognized that this complex market requires more than just basic training on market access for customer-facing resources. It requires new roles or changes to the responsibilities of existing roles to take an account-focused approach to customers.

But how do these roles need to approach their customers? And, importantly for training professionals, what’s the best way to prepare them for successful customer engagement?

Future of the Healthcare Market

Several important trends are shaping the future healthcare market and having an impact on the customer-facing resources who must navigate that market:

  • Centers for Medicare and Medicaid Services and Triple Aim: The Triple Aim approach looks at reducing the per capita cost of healthcare, improving the patient experience, and improving overall population health. The goal is to make treating chronic diseases (e.g., diabetes, cardiovascular disease) more efficient and effective by evolving the healthcare system.

  • Backlash Over High Prices: Many insurance plans are being pressured to contain prescription drug spending. However, current laws limit the ability of plans or the government to control costs.

  • National MCO Mergers: Completion of the proposed Anthem-Cigna and Aetna-Humana mergers would result in the top five US payers directly or indirectly influencing the majority of commercial and Medicare Part D lives. These mergers are likely to result in lower margins for pharma/biotech companies, especially in commoditized drug classes.

  • Unfriendly Reimbursement Environment for Newly Launched Products: Payers are beginning to not cover, or even exclude, new medications at launch. Manufacturers are answering this challenge with programs to assist patients with access and reimbursement.

  • Value-Based Care Becoming the New Norm: CMS is working to tie nearly all Medicare payments to value in the next few years. And large MCOs like United Healthcare, Anthem, and Aetna are following suit. Initiatives to promote value-based access and care delivery are being developed across the entire spectrum of healthcare stakeholders, including managed care organizations and policy-making authorities.

  • Use of Extrapolation for Biosimilar Approval: The recent FDA Advisory Committee review of the Celltrion biosimilar to Remicade was the first direct test of extrapolation, a key feature of the new regulatory pathway designed to speed introduction of biosimilars to the US. Clinical trials for the biosimilar were not required for each of the approved indications of the branded biologic, and we expect this to continue going forward.

  • The Heterogeneous Nature of ACOs: ACO penetration across states varies and is dependent on the managed care history of the state and ACO size. ACOs consist of small physician groups, hospitals, or a combination of both. There is a high degree of variability in how the ACO channel is operated and incentivized, with the trend moving toward arrangements imposing a heavier risk burden on the ACOs.

  • More IDNs Including an Insurance Component: As provider and payer organizations merge their market access and rep access, decisions become centralized, and the impact of losing access becomes more severe. IDNs are applying to be insurers in growing numbers.

The Challenge

As the healthcare marketplace has evolved, so have the fundamental factors that define the success of customer-facing resources. The type of “sell” is moving from one focused on a single provider to one focused on a full account. In provider-based selling product/industry knowledge, selling skills, relationship management, and basic business acumen were sufficient for customer-facing resources to be successful.

However, more and more companies have recognized the need for account-manager-type roles for this environment. The success factors needed for these account managers (or for traditional selling resources taking over account management responsibilities) are different, and training professionals must ask some key questions to develop effective training:

  • Business of Medicine: How does the overall business of medicine, including the value that customers, patients, and society as a whole place on pharmaceutical and biotech products, impact the role?

  • Strategic Planning: What type of strategic planning is needed for this role? Are they building their own strategic plans or pulling through an existing strategy?

  • Customized Value-Based Messaging: How can the role define value from the perspective of the customer?

  • Customer Motivations and Influences: How can the role identify a customer’s motivations and influences, and how does that impact the interaction?

  • Account Dynamics: Why is it important to understand the differences in the geography, and how do team members use that information?

The Solution

In the face of the above challenge, the request for “market access” or “managed markets” training is a common one and is seen as a need across all customer-facing roles. Training professionals can choose to approach this challenge by simply finding market access training courses and deploying them to their team. Or, they can take a more sophisticated approach that recognizes that current market access training needs go beyond “knowledge” training. The new account management roles and responsibilities that companies have created make this type of approach even more important.


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