The big win-win of HCP personalized market access messaging

The affordability and access crisis in the United States is widespread. In March 2022, the Peterson-KFF Health System Tracker reported that nearly 1 in 10 adults owe significant medical debt, estimated to total at least $195 billion. Approximately 16 million people (6% of adults) owe over $1,000 in medical debt and 3 million people (1% of adults) owe more than $10,000.

When HCPs prescribe products that might not be the most accessible and affordable, it contributes to this growing debt. But too often, HCPs don’t know the market access position and cost of a brand for their patients because most pharma companies aren’t able to give them that information at the HCP or practice level. Instead, pharma companies — typically through sales representatives — provide only general market access information based on the HCP’s geographic location.

This forces the HCP to work from formulary assumptions when prescribing. Without better market access information on which to base decisions, HCPs might not always make the best prescription choices for their patients.

Pharma can help solve this problem by providing targeted, personalized market access messaging to each HCP.

The two-fold case for personalized market access messaging

First, you can help weaken the rampant affordability and accessibility problem.

When HCPs really know how accessible a product is for their patients, they are more capable of making the best prescribing decisions for them.

Second, personalized market access messaging is good for your business.

It’s no secret that market access is critical to a pharma brand’s success and its chances of hitting market share goals. When a brand is affordable, accessible and broadly covered by payers, healthcare providers are more likely to prescribe it to their patients.

Market access challenges are cited as pharma companies’ No. 1 reason they miss performance goals. By giving HCPs practice-level, personalized market access information and delivering it through the channels they prefer, you are more likely to hit performance goals.

Consider that in an analysis of sales for novel drugs in the United States between 2012 and 2017, researchers found wide variability in launch performance. In their first year, 36% failed to meet market expectations, while 26% far exceeded expectations. What separated the high from the low performers? Market access was cited as the top reason for missing expectations.

“Half of the analyzed products that missed first-year forecasts had issues with market access,” the Deloitte Insights analysis reports. “This included unfavorable placement or exclusion from formulary, use of formulary restrictions like step edits, high price and patient cost-sharing, weak health-economic evidence to support the price, or higher than expected expenses on discounts and rebates.”

Targeted messaging through HCP-specific cost and coverage information

You may not be able to determine the formulary position of your brand, but you can remove the friction that prevents HCPs from prescribing and patients from filling prescriptions for your product. One of the most common, avoidable barriers is uncertainty around understanding access, cost and coverage.

HCPs rely on hard efficacy and safety data to evaluate drug therapy options — data that is readily available. What’s been missing is market access data at the HCP level. This information gap leaves HCPs guessing what percentage of their patients will run into access restrictions. In fact, research conducted by an Access Genius client found that when a brand has restrictions, HCPs frequently perceive the restrictions as significantly worse than what they are.

Get Tips on Market Access Perception vs. Reality >>

Through personalized market access messaging, Access Genius gives you the data you need to tell an HCP about your brand’s access for their patients along with the out-of-pocket cost patients will pay across different payers.

Even when the market access status isn’t wholly favorable for your brand, your marketing and sales teams can mitigate negative impacts by at least being able to confidently tell HCPs what to expect — e.g., the percentage of their patients who will be affected and for which payers in their practice. You can even explain what specific restrictions the HCP might expect and perhaps advise on methods to manage this restriction most efficiently when it occurs.

Real-world conversation between a pharma sales representative and HCP

Let’s look at how this specificity plays out in sales conversations between HCPs and sales representatives from different brands. Here you can see how Access Genius personalized market access messaging engages HCPs more effectively and increases clarity around cost and coverage.

REPRESENTATIVE GREG USES GENERAL MESSAGING

Dr. Patrick: What does coverage for Product X look like for my patients?

Greg: We have best-in-class commercial coverage. 80% of commercial lives have access in this area.

Dr. Patrick: Hmm. It certainly doesn’t feel like 80% for my practice. What about for my patients?

Greg: Here are the top plans in the area with formulary coverage for Product X: Plan A, Plan B, Plan C.

Dr. Patrick: I recognize a couple of them, but I don’t see many of those plans in my practice.

Greg: These are typically the plans seen in this area. And as you can see, the coverage is pretty good.

Dr. Patrick: They may be in this area, but I must not see patients with those plans, as it seems like many of my patients can’t get Product X. I know Plan D is restricted because my staff tells me all the time.

Greg: I understand. What plans do you see in your practice? I can get back to you with coverage information.

REPRESENTATIVE STELLA USES ACCESS GENIUS PERSONALIZED MARKET ACCESS MESSAGING

Dr. Patrick: What does coverage for Product Y look like for my patients?

Stella: 85% of your patients have unrestricted access to Product Y and pay $45 or less, including patients with coverage for the following plans in your practice: Plan A, Plan D, Plan E.

Dr. Patrick: This is for my practice?

Stella: Yes, for your patient population. Do you see these plans for patients in your practice?

Dr. Patrick: All these look familiar. Did you check with my staff?

Stella: Yes, and they agree these are the top plans they see most frequently for your patients. Taken collectively, you can write Product Y knowing access and cost will not be a hurdle to therapy.

Dr. Patrick: Good to know! I will keep this in mind for my patients needing Product Y. What about the other 15% without coverage or with restrictions?

Stella: The largest plans in your practice without unrestricted access are Plans B and C, with prior authorizations. Here are the specific PA criteria for both. Given the benefits of Product Y and the few times a PA is necessary, isn’t it worth completing the PA forms so your patients can get Product Y when you think it is the best therapy?

Dr. Patrick: How much would Product Y cost a patient under Plan B?

Stella: Once the PA is approved, you will be happy to know your commercial patients can use our Savings Card to offset their copay obligation and pay as little as $20.

Dr. Patrick: Thank you for the information. It sounds like most of my patients have access to Product Y and a manageable copay. I’ll keep this in mind as I consider the best therapy for my patients.

Stella: Thank you for your time. Here’s a copy of this information for you and your staff for reference. I’ll also update the information if there are changes for your practice.

CONVERSATION ANALYSIS

As you can see, Greg has good general or geographic information about access but is left to hope all HCP patient populations in the area are the same, which is rarely the case. Greg is also challenged to put the restrictions for Plan D in perspective for the HCP’s practice.

In contrast, Stella’s Access Genius personalized market access messaging engages the HCP because the information is specific and relevant to the practice. While Stella had to deliver unfavorable information regarding Plans B and C, she is still able to lean into those conversations with confidence, putting the restrictions into perspective and offering additional options for a patient using a savings card. For patients with access in the HCP’s practice, the HCP begins to consider Brand Y to be a strong option. And for those patients who would face administrative roadblocks, the HCP is prepared to explain the situation up front and avoid giving that patient an incorrect expectation.

With Access Genius, Stella can offer an HCP a market access message personalized for the practice and then punctuate it by sharing relevant plans that are specific to their practice. This powerful combination helps move the needle with any perceptions the HCP has regarding access to the brand.

Fostering a willingness to prescribe

When you deliver personalized market access messages to your HCPs, you empower them to prescribe your brand more often because they can be confident they’re making the best prescribing decisions specific to their patients.

Plus, implementing personalized market access pull-through marketing addresses real problems that pharma can help solve.

Access Genius provides a level of market access detail that pharma marketers have not had before.