Unlocking the Key to Successful Medicines Access: Understanding Payer Insights for Pharmaceutical Value
Susan Hogue
When it comes to developing new medicines, the journey from the laboratory to the pharmacy shelf is both exciting and complex. Biopharmaceutical companies put in extensive efforts to develop drugs that can make a real difference in people’s lives. But there’s more to it than just the science – understanding what payers value is a crucial piece of the puzzle.
Who Are Payers and Why Do They Matter?
Payers are the ones who foot the bill for medications. They could be insurance companies, government healthcare programs, or even individuals paying out of their pockets. Essentially, payers are the gatekeepers who decide whether a new medicine is worth the cost or if it meets the proposed value propostion. This is where the concept of “pharmaceutical value” comes into play.
Cracking the Code: Pharmaceutical Value Insights
Creating a new medicine is a massive investment of time, money, and effort. To make this investment worthwhile, biopharmaceutical companies need to ensure that their products align with what payers consider valuable. This is where gaining payer insights comes in.
Understanding What Matters:
Payers have their own criteria for determining the value of a medicine. It’s not just about whether it works and is safe, that is a given but – it’s also about whether it’s more effective than existing treatments, if it improves patients’ daily functioning and quality of life, and if it reduces overall healthcare costs in the long run.
Tailoring Medicines to Payer Needs:
Gaining insights into what payers value allows biopharmaceutical companies to tailor their development programs accordingly. This might involve tweaking the patient centered outcomes assessments in the development program or collecting different burden and cost of illness data alongside the trials program, or even exploring alternative pricing strategies that align with what payers are willing to reimburse.
Enhancing Market Access:
Even if a medicine is groundbreaking, it won’t make an impact if payers don’t cover it or heavily manage. By understanding payer preferences, companies can make strategic decisions that enhance the chances of their medicines gaining approval for coverage, thus ensuring patients can actually access them.
Building Collaborative Relationships:
It’s not a one-sided game. Biopharmaceutical companies and payers can work together to find common ground. By engaging in open dialogues and sharing insights, both parties can co-create solutions that benefit patients, payers, and the pharmaceutical industry as a whole.
The Path Forward: A Win-Win Situation
In essence, gaining payer insights for pharmaceutical value is a win-win situation. Biopharmaceutical companies win by creating medicines that resonate with payers, leading to increased market access. Payers win by gaining access to treatments that align with their goals of improving healthcare outcomes and managing costs. And, most importantly, patients win by receiving treatments that are not only safe and effective but also financially accessible.
As we navigate the ever-evolving landscape of healthcare, it’s clear that collaboration between biopharmaceutical companies and payers is essential. By understanding what payers value, we can pave the way for a healthier, more affordable, and more innovative future for medicine.
HOW AESARA Can Help
AESARA is:
An industry leader in strategic HEOR and market access consulting and delivering impactful tools for our partners and we pride ourselves on the craft of HEOR evidence storytelling and communications
AESAEA Team includes:
Industry veterans with decades of experience, at multiple biopharmaceutical and medical device/diagnostic companies, successfully navigating price, reimbursement and access processes and engaging with payers across the US health system
AESARA Provides:
Rich, up-to-date project expertise in developing value, access and reimbursement strategies for novel technologies across multiple indications and settings
AESARA Utilizes:
The AESARA Payer Center of Excellence where, we effectively and efficiently gain insights from current C-Suite decision-makers and HTA Advisors, enabling our clients to optimize their payer strategies and elevate product uptake
References:
Zhu L, Brogan AP, Patel CK, Reinsch TK, Gratie D, Wu KWK, Hogue SL. Value Communications With US Payers: Can Digital Solutions Help Improve Patient Access? Poster presented at the 24th Annual International Meeting of the International Society for Pharmacoeconomics and Outcomes Research; May 18-20, 2020. Virtual ISPOR.
Hogue, SL, Patel C, Brogan AP. Unmet needs exist in payer communications – are digital solutions the answer? Poster presented at the 23rd Annual International Meeting of the International Society for Pharmacoeconomics and Outcomes Research; May 18-22, 2019. New Orleans, LA.
Reinsch TK , Mader G , Manuel FM , Patel CK, Hogue SL. The wave of the future? Alternative digital value communication solutions to enhance engagements between US payers and MSLs. Poster presented at the 24th Annual International Meeting of the International Society for Pharmacoeconomics and Outcomes Research; May 7-10, 2023. Boston, MA.