This article by Beverly Barr was originally published in Pharmafocus.
For the UK pharmaceutical industry, biotech or devices firms, any discussion around market access tends to be synonymous with ‘hurdles’ or ‘barriers’ to a new product being introduced to the ever-changing National Health Service.
But opening up the conversation to find a definition of market access leads to a far more interesting debate. This is because there are multiple stakeholders involved in the market access process and each defines it from their own perspective. It is these different perspectives that make market access complex and so difficult to address through a single solution or skillset.
No more talk of 'hurdles' and 'obstacles'
At a recent meeting run by the PM Society and Wellards, views on the future of market access were explored from a pharma, payer and patient perspective. One of the most striking ideas to emerge was that the industry needs to stop identifying market access stakeholders as ‘barriers’ or ‘hurdles’, but rather to truly understand them as customers.
From an industry viewpoint, there are many roles and competencies involved in market access which include health economics, pricing and reimbursement, government affairs/policy, NHS liaison and communications. Each has their own definition of market access according to the role they play in the process (see different perspectives below), or whether they view UK country specific market access from a European or Global remit.
Ask the other, non-industry, stakeholders involved to define market access and the situation becomes even more complex. The drive for cost-containment, and with it the need for proof of cost and clinical effectiveness for any new product or device, has resulted in a new array of non-clinical stakeholders - NICE being the most obvious of these.
Patient organisations and patients are also increasing important, as are a raft of NHS contacts including commissioners, chief pharmacists, NICE implementation leads and hospital business and service managers.
The situation is further complicated when taking account of the complexities and challenges faced by these stakeholders within particular therapy areas. Suddenly, it is not surprising that there is no single definition for market access and no ‘one size fits all’ winning strategy to ensure market access success.

National and local decision-makers

At a national market access level for health technology assessments, the industry has grown much more experienced over the last ten years. However, it has become clear that local market access is at least as important as the national level. The value message that works nationally does not always work at a local level, and a positive NICE appraisal does not automatically gain product adoption at a local level.
The most successful companies are the ones who took the time to understand needs of the various local stakeholders. From April 2013, NICE’s role will include the assessment of high cost drugs for people who suffer with rare conditions.
Add to this the expected introduction of Value-Based Pricing, individual patient budgets and Health and Wellbeing Boards - whose importance must not be underestimated - and we see many new factors to take into consideration. 
So what is the answer? The role of pharma, biotech and devices in delivering market access has always been about securing the right product, for the right patient, in the right place at the right price. This fundamental objective stands. However, to achieve it, industry must also provide the right data, to the right stakeholders with the right message, communicated in the right language and at the right time.
The most successful companies are the ones who took the time to understand needs of the various local stakeholders.
These are easy words to say but the solution is by no means easy to achieve. At the PM Society and Wellards Future of Market Access meeting it was surprising to learn, that even ten years after the introduction of NICE many companies do not take full advantage of the consultancy advice it offers, and many do not use PharmaScan to inform NICE of new technologies as soon as possible. Early and effective engagement and dialogue with NICE must be a key element in any market access strategy.
A regional and local focus which will largely be defined by clinical commissioning groups (CCGs), will be also critical to success. Understanding the patient populations within the geographical area covered by the CCG is vital.
Similarly, understanding the role of Commissioning Support Units, the Local Area Teams, Health and Wellbeing Boards and acute trusts will all play a part in a successful market access strategy. This means that it will be vital to develop an in-depth knowledge of the local population and healthcare priorities as well as an ability to understand their challenges, whether they are clinical, economic or a mixture of both.
In so doing, it will be possible to develop value propositions, communications, services and partnership programmes tailored to their individual needs. David Thorne, chief executive, Newcastle West CCG, suggested that the QOFs, quality and productivity, collaborations between primary and secondary care and knowledge transfer in areas such as training and management, were all areas of opportunity for industry in the NHS.

Patient power

Over the years, patients and patient organisations have become much more knowledgeable about market access. The requirements of patients in a particular therapy area will of course vary and there is also variation between individual patients. Some choose to be fully involved in the decision-making process, while others are content to defer to clinicians.
Nevertheless, with healthcare providers and payers encouraging people to play a more active role in managing their own health, particularly for chronic conditions, the role of individual choice must be recognised as a factor in market access, especially in terms of the personal health budgets.
Patient engagement has never been more important. Patient organisations have become highly influential players in raising policy-maker and public awareness about specific diseases and their burden on society.
They also play an important intermediary role between all stakeholders and help express the patient voice. The mission of any patient organisation is to listen to the needs of their patient members and to develop projects based on these needs.
Regardless of personal definition of market access, everyone in pharma, biotech and devices is likely to agree that the common goal is to ensure that patients have access to the most appropriate products and services when they need them.
Early engagement with patient organisations, transparency in interactions and demonstration of long-term commitment to the disease area is necessary in the development of a market access strategy in its widest sense. However, a word of warning: if industry cannot focus on achieving a short-term gain through these partnerships - there must be clear parameters and any relationship must be sustainable and not reliant on budgets tied to a product lifecycle.
Regardless of role or personal definition of market access, everyone in pharma, biotech and devices is likely to  agree that the common goal is to ensure that patients have access to the most appropriate products and services when they need them.
For industry the new changes in the NHS present challenges, and only these companies who take the time to understand how the changing healthcare environment impacts on each of their clinical and non-clinical stakeholders will be able to fully embrace the change.
In so doing, industry will be able to plan the impact that each stakeholder may have on a product throughout its lifecycle and then to devise value propositions, communications, services and partnership programmes that are truly meaningful at a local level.
In a sea change, it may require industry to adapt by perhaps redesigning ‘products’ to incorporate services that consider the entire care pathway; by revising or restructuring teams to provide more extensive skills and experience; or by giving more flexibility to the local implementation/field team to allow them to offer new services tailored to address the actual challenges of a specific area.
These are exciting times! The new NHS environment can and should be viewed as a significant opportunity to develop not only innovative programmes, but meaningful market access solutions tailored for a spectrum of stakeholders, ultimately targeting improved patient outcomes together.

Tips for industry

  • Present data about your product in a balanced way to outline its value to a range of stakeholders at the most appropriate time, using the most appropriate communication vehicle or format
  • Consider the implications your product may have on the wider healthcare market                         
  • Understand how changing healthcare environment may affect your product
  • Identify and remove all barriers to prescribing, ensuring a rapid uptake of a new product at an optimum price.

Tips for patient organisations and NHS

  • Align your resources and processes with the key priorities of the NHS to allow you to implement appropriate healthcare provision
  • Ensure the right group of patients has access to the right treatments at a fair price in the shortest time possible.
Dr Beverly Barr leads the Market Access Interest Group and is vice chair of the PM Society, she is also director at Zaicom International.