After spending a week at the Asembia 2022 Specialty Pharmacy Summit, it became clear that new approaches are needed to address key fundamental challenges to our healthcare system. Here are four common issues that remain to be solved and are critical for pharma success and improved patient outcomes.
Issue 1: Technology will continue to play an increasing role.
Healthcare stakeholders across the spectrum are looking toward digital solutions to solve for inefficiencies and friction points in their current workflows.
Health systems are searching for ways to attenuate their labor deficits, increase efficiencies, standardize care, and improve patient outcomes.
Prescribers are looking for ways to improve their clinical workflows and juggle growing administrative burdens without sacrificing patient satisfaction.
Patients are demanding enhanced convenience, transparency, and collaboration with their healthcare providers.
The industry has identified that digital and technological solutions can help satisfy these needs with a growing focus on health information technology and electronic health record solutions.
However, in some cases, the juice isn’t worth the squeeze. Some digital solutions may be missing the mark due to challenges around scalability, flexibility, regulatory hurdles, high costs, and a lack of enhanced workflow.
It is very clear—proven offerings with supportive data that overcome these barriers are needed to break through and satisfy the market need today.
Issue 2: Complexity and influence in healthcare are increasing … and fast.
What worked in a fragmented market in years prior may no longer translate to commercial success in this now highly consolidated, vertically integrated market. This ever-narrowing customer base has put the pressure on Pharma to adapt or face commercial failures.
Take, for example, the following:
Centralized formulary restrictions
Increasing cost pressures
Changes to benefit design that push costs to patients
Complexities within our healthcare system are being driven from individual entities repositioning, evolving, and growing their business model and footprint. These adjustments can be both reactive and proactive to market dynamics to improve their financial position or reduce risk.
Greater focus is being directed to population health as the customers’ patient base is growing.
The need for Pharma to adapt their commercial strategies is paramount, or there is a good chance these headwinds will be too much to overcome. Your commercial strategies may need to be aligned and re-visioned to address the new market dynamics.
Issue 3: Market Access—the “ball rolls downhill.”
Perhaps the most high-profile challenge to the healthcare system is the desire to provide access to novel specialty medications (often with a high cost) while continuing to balance affordable coverage to the overall market.
Pharmacy benefit managers and payers are working on models to prepare for the wave of high-dollar medicines and curative therapies that are in the pipeline. This includes immediate strategies such as increased utilization management on current therapies, co-pay card maximizers/accumulators, and exclusion lists.
A consequence is that the cost of care shifts to the self-insured employer and patients in the form of out-of-pocket costs, increased premiums, and more restrictive plan designs. Pharma and patients are searching for various market access strategies to overcome these challenges. Currently, it appears the solution(s) is/are still elusive.
Two things seem certain: 1. Pharma will need to thread the needle on their go-to-market plan including value proposition, health economics and outcomes research, pricing, rebate strategies, and patient support programs. 2. A collaborative effort is necessary from all key stakeholders to ensure that the patient does not get lost throughout the process.
Issue 4: Barriers to a successful product launch are increasing.
Long gone are the days of launching with an automatic six months of payer coverage that then rolls into continued broad access.
Now, products approved via accelerated approval pathways are no longer guaranteed broad access. These immense payer pressures combined with the growing complexity in health systems have created a market that can be segmented, narrowed, and specific.
The first 12 months of a launch can be a battle of attrition. Recent IQVIA data now show only 25% of all new-to-brand prescriptions are successfully getting filled and less than 50% of brands are achieving their year 1 budget goals. These conditions demand innovative strategies, strong cross-functional execution, and unwavering focus on helping improve patient outcomes.
Coming shortly, we will break down and share how industry leaders are leveraging new resources and novel approaches to overcome these four challenges.
To learn how we can help, please reach out to:
Dan Newman, VP, Business Development, 15+ years in the pharmaceutical industry, including sales leadership, managed markets, trade, alternative channel design, training, and patient access, at dan.newman@aventriahealth.com.
Ryan Nitzel, VP, Sales, 20+ years of experience in sales leadership, commercial contracting, national account management, and market access with portfolios including pharmaceuticals, medical equipment, software, and services, at ryan.nitzel@aventriahealth.com. Making a difference in patient care by helping patients, providers, and payers collaborate on shared priorities