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The Formulary Speaks for Itself, or Does It?

The Formulary Speaks for Itself, or Does It?

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There are many factors that need to be taken into consideration when optimizing and accelerating market access. One of the first items that should be on your checklist is honing in on a strong messaging and engagement strategy when targeting payers. In understanding what messaging most resonates with payers, market access, commercial, and marketing teams can gauge where value is perceived according to each payer. 

Formulary positioning

Formulary positioning and communicating value are key to driving interest and having quality engagements with payers. In addition to formulary positioning, other market dynamics to consider include enrollment mix of medical and Rx lives as well as therapeutic area or disease state. In order to drive impactful conversations with payers, market dynamics capabilities and digital tools are needed to aid in targeting and messaging to gain a competitive edge in the marketplace and establish strong relationships for future contracting decisions.  

No More Tiers

Preferential formulary positioning helps measure the success of market access strategies. For those organizations’ drugs that are on higher tiers, it makes communicating value and finalizing contracts that much easier. When engaging with payers, market access teams should take into consideration where their products are positioned on the formularies. From there they can build a strong messaging and targeting strategy.

On the other hand, it’s also important to note that favorable formulary positioning doesn’t necessarily mean a drug has favorable performance and profitability. A healthy mix of rebating, value-based contracting (VBC), and patient services should also be taken into consideration. Positioning your messaging and highlighting these different perspectives around your drug will help target a variety of payers with different value propositions, increasing the likelihood of accelerating your market access strategy. Instead of solely relying on formulary position, market access teams can communicate value by differentiating on clinical outcomes using real world evidence (RWE) or by emphasizing patient preference and convenience regarding the product.

Communicating Value

According to IQVIA, the implementation of value-based payment models will continue increasing through 2027. When it comes to communicating value, there is no one specific model that needs to be used. It is up to the discretion of each pharma company to decide the cost-value mix for each of their drugs. 

Therefore, market access teams need to analyze what payers, like Managed Care Organizations (MCOs) and Pharmacy Benefits Managers (PBMs), perceive as most valuable and what drugs provide maximum outcomes for the patient. Knowing where to assign value and being able to communicate it as early as possible will help drive market access strategy efforts. This is where market dynamics capabilities come into play.

Market Dynamics Capabilities

The market dynamics that are impacting the pharmaceutical industry have to be addressed and woven into the market access targeting strategy. Especially when your drug has less favorable formulary positioning, extra steps need to occur before deciding what messaging strategy to use. Market access leaders need sophisticated analytics capabilities to help them track market dynamics to help them decide what strategies to invest in.

TikaMobile’s capabilities pull in market dynamics data so that market access leaders have a well-rounded understanding of the market to decide what messaging strategies will help communicate value for drugs while also giving them a competitive advantage. To better target payers, TikaMarketAccess enables market access teams to explore and analyze the enrollment mix of medical lives, as well as Rx lives to have a stronger engagement strategy with key decision makers. More specifically, the Payer Detail Module provides market access teams with actionable information concerning payers such as attributes, plan profiles, and contract developments, enabling teams to disseminate information and break down silos.

Citations

https://www.iqvia.com/-/media/iqvia/pdfs/library/presentations/7-market-access-trends-for-2027.pdf

https://www2.deloitte.com/us/en/insights/industry/life-sciences/pharmaceutical-pricing-market-access.html

https://www.zs.com/insights/accelerating-market-access-three-trends-shaping-pharmas-future