It’s a wild understatement to say there’s plenty of noise around market access right now. But as pharma companies and their agency and vendor partners rush to fill the void, it’s worth remembering not all access programs are created equal.

Given all the turmoil in the healthcare world, especially around access-related issues, it behooves the creators of access programs to get them right straight out of the gate. “A lot of the key stakeholders are changing and evolving, and there’s been a lot of M&A activity,” explains Scott Dulitz, SVP of corporate strategy and strategic business development at TrialCard. “There’s been talk about moving to a world without rebates. There are a lot of things going on that may have longer term impact on market access.”

So how does one go about creating an effective market access program in the current healthcare environment? MM&M informally polled a host of access experts and determined the most successful programs follow these seven commandments.

1. Have consistent messaging

While this may seem like common sense, it is often overlooked in multifaceted programs. “It’s imperative not to position a product in one light to a provider and another to a payer,” says Seth Gordon, managing partner at TAG MM, a division of The Access Group. “A program must represent appropriate use across the board.”

Marketers must also consider that most everyone in the supply chain is focused on value-based care and outcomes. As recently as a decade ago, the main themes in access programs were efficacy, outcome, and cost. And while that information clearly remains essential, overall value and outcomes have become the twin cornerstones.

2. Integrate support

When patients are diagnosed, they face what Kristin Phillips, managing director of content and strategy for the Patient Experience Project, calls “a plague of support.” They receive calls from their HCPs, pharmacy access managers, specialty pharmacy staffers, and insurance providers, among others. “These patients haven’t even taken the drug yet, and they are inundated by a carousel of calls and messages,” Phillips notes.

In many cases, the avalanche of information can lead to problems down the road, given that patients might not be able to take in all the data presented to them or ask the right questions. “If you can provide a single point of contact, whether that’s one rep from the hub or one person from the pharma company, it’s much more effective,” she adds.

AbbVie’s Humira Complete hub serves as a prime example of this trend toward consolidating support, which prompts Prescient Healthcare Group principal Ben Druck to dub it the gold standard of market access programs. “Humira Complete fully integrates clinical, financial, and patient support,” he explains. “They have people on call for the providers to help with documentation, proactively support the patient with visiting nurses, and follow up for maintenance. It’s important because you can’t just sell the pill or injection. You have to support everyone so you can get one step closer to the outcome.”

3. Choose the right focus

Access programs can’t go light on the messaging about which stakeholders, such as physicians, care most. For instance, in a program aiming to portray the benefits and side effects of a pain medicine, focusing on pain-management properties will resonate more than information about opioid-induced constipation, Gordon notes.

For patients, the focus should extend beyond cost and condition, Phillips says. “Patients are often overwhelmed dealing with diagnosis or an escalation of a condition. You’ve got to understand how they feel emotionally about their diagnosis and address that, too,” she continues.

4. Use social media

Co-pay and hub programs are merging, so one of the most effective ways to disseminate information and create demand is by doubling down on social media.

According to Dulitz, TrialCard used Facebook, home to numerous patient communities, to promote a recent co-pay program. “We gave [patients] an opportunity to sign up and get a co-pay card. It worked really well,” he says.

5. Consider persistency

When planning a market access program, among the first questions that should be asked is about the overall persistency of a medication over the course of a 12-month program, according to Dr. Paul Harney, president, North America for Prescient Healthcare Group. A low persistency rate signals there could be issues around message communication, whether it’s information overload or a focus on the wrong data. Some market access programs automatically track persistence data, but far more do not.

Once you know a patient has discontinued taking a drug, you can begin to determine whether it was due to side effects, cost, or lack of information. “There are a lot of different ways information can be delivered — via per diem nurses, educational videos, FaceTime, or Skype,” Dulitz explains. “If you get patients connected to these things, persistency will go up.”

6. Bring teams together

Taking a drug to market takes a lot of planning and work, and much of that work is still completed in silos. This results in market access programs that are isolated — which, in turn, leads to suboptimal results for patients, payers, and providers alike. When programs are planned across audiences and at the same time, their messaging tends to come across more authoritatively.

“[The idea is to] put together a cogent value story that is customizable for different stakeholders,” Gordon says.

This process should be performed on a digital platform that works in conjunction with EHRs and can be embedded into provider and payer workflow, Dulitz adds. “A lot of these programs have been promotional in nature — pushing messages. All we can hope is that we get to the holy grail where market access programs have the ability to go onto the e-prescription, scrape off a lot of the core information, and auto-populate the enrollment form.”

7. Ask instead of assuming

Nothing frustrates payers more than when a drug is prescribed and patients don’t use it. Phillips says one of the easiest things a marketer can do is ask patients and HCPs what they need, then figure out a way to satisfy those needs while hitting business goals. “[You need to] understand who the patient, caregiver, and provider are, what their needs are, and how to provide value for them,” she notes.

Payers weigh in

In late summer, Red Team Associates managing partner Harris Kaplan sat down with four payer-side executives — two who work for PBMs and two pharmacy directors at health plans — to gauge their opinions about patient access programs. What criteria do they use to evaluate the programs? Which organizations have created the most effective programs? Here are some of his quick-hit findings, with relevant quotes.

Payers aren’t happy when pharma companies use patient access programs as a means of gaining market traction for non-preferred or non-formulary product vehicles (coupons, co-pay cards). In effect, they believe such tactics circumvent formulary guidelines.

“They are just ways to get a patient onto a drug when their payer has made the decision not to pay for them.” Among large payers, the current trend is to have patient access program payments not count toward a patient’s deductible — and smaller payers are following the strategies of larger ones.

Among large payers, the current trend is to have patient access program payments not count toward a patient’s deductible — and smaller payers are following the strategies of larger ones.

“Products need to remain affordable, and patient access programs take that away.”

Payers don’t really conduct detailed evaluations of patient access programs.

“We just monitor the utilization of our preferred brands and products. As long as it’s within the range of our predictive modeling, we’re fine. If not, then we will take specific action to restrict that product, and refer or step through the preferred product.”

The companies most often mentioned as effective creators of patient access programs are Amgen, Regeneron, and Sanofi — though in general, patient access programs are considered more or less the same.

“It’s standard business practice for the pharma companies. There’s nothing novel or new about it. Nobody stands out. It’s a generic-type situation. Each plan is different, but they mostly have the same objective.”

Some companies have recently started using debit cards — in lieu of coupons — and there is some confusion on the payer side about how they work.

Spreading the word about patient access programs is largely seen as the physician’s responsibility.