Panel Discussion: Industry update on market access for 2023 and beyond - Responding to policy shifts and affordability pressures:
John Baker, independent expert, Rosalind Davis, Director of Government Pricing and Contracts at CSL Vifor, Brandon Rawdin, Finance Director of Market Access at AstraZeneca Edward McAdam, Director of Government Pricing, Contract Operations and Analytics at Indivior.
Vanessa Mirsky, Advisor at PharmaCCX, moderated a panel discussion at the Pharma/Biotech GTN Summit in November 2023 in Philadelphia, Pennsylvania. The panel included industry thought leaders; John Baker, independent expert, Rosalind Davis, Director of Government Pricing and Contracts at CSL Vifor, Brandon Rawdin, Finance Director of Market Access at AstraZeneca and Edward McAdam, Director of Government Pricing, Contract Operations and Analytics at Indivior.
Led by questions from Vanessa, the discussion explored how pharmaceutical companies should navigate ensuring affordable access for patients, whilst protecting profit margins for manufacturers.
Manufacturer Challenges
The session began by addressing the strategies and contingencies organisations are implementing to navigate current regulatory and macroeconomic challenges. John stated that its essential for employees to understand that every piece of their company’s portfolio contributes, either positively or negatively, to their bottom line. Working from a channel level, rather than brand, can help mitigate both regulatory and economic difficulties. He explained that this helps build an understanding of how manufacturers can boost profitability whilst maintaining accessibility for patients, although this differs from channel to channel. Another method is to look at individual drugs in the channel, suggested by Rosalind. Modelling is a key strategy, as it allows organisations to pressure test and prepare for all possible situations. Edward said that organisations must analyse channels in respect to gross to net (GTN) and adapt accordingly. The evolution of the healthcare system is changing how manufacturers operate, and therefore pre-existing models must change. Removing entities e.g., wholesalers, between an organisation and the patient will benefit the bottom line, agreeing with John.
It was highlighted that it is also important to protect profit margins for manufacturers, whilst ensuring affordable access for patients, so that they can continue to supply product. The speakers suggested ways in which this can be executed. John said that manufacturers must prioritize profitability, otherwise the business can’t run, and patients lose access regardless. “Examine the entirety of the channel as a holistic unit” – he explained that if an organisation decides to exit from a portfolio, e.g., Medicaid, they must have a clear understanding of the impact across multiple business levels. For many Medicaid applicants, individual retirement accounts (IRAs) are their main asset, with Brandon forecasting they will have the largest impact on patient affordability. Patient ‘out of pocket costs’ will be capped at $3300 in 2024, decreasing to $2000 in 2025. Having costs spread out over the course of a year will make medicines significantly more affordable for patients. Considering manufacturers, Brandon stated that reevaluating patient affordability programmes and free drug eligibility will help ensure that return in dollarized sales occurs.
The Future of Industry Dynamics
Looking ahead to the next five years, the panellists predicted a transformation in dynamics among manufacturers, pharmacy benefit managers (PBMs), providers, and patients. Brandon didn’t have any specific predictions, attributed to the current questions that the industry is trying to navigate due to regulatory changes. However, he reaffirmed, “one certainty is that there is going to be a lot of change, specifically with who we pay and contact.” John believes the industry will shift to dealing with patient access through other channels, for example greater spends on patient assistance programs (PAPs). He also predicted that there will be an increase in patients going directly to the manufacturer to receive treatment, which will affect how companies deal with GTN challenges as well as maintaining market access for patients. Edward echoed this prediction, envisioning the removal of intermediaries between organisations and patient by exploring alternatives in the speciality drugs marketplace. Additionally, there could be more opportunities to engage and have discussions with states, to figure out new collaborative ways to tackle major healthcare issues in the US, such as opioid and substance abuse.
Another change that all speakers agreed will happen is the function of market access teams within organizations. At Indivior, the market access team is very specialised, with different representatives for different states as needs vary across the county. The function of market access has bled into sales, showcasing cross functional collaboration. Edward made a point; “the influence has changed… who is really going to make that decision on the placement of your product?” Rosalind agreed, sharing that organisations should become more financially versed and integrate better with market access. “Pricing teams should be central”, highlighted by John, which involves sales, finance, marketing, legal and compliance teams who must all be prepared to assist deals for the success of their company.
Overall, the panel discussion provided a detailed insight into the careful balancing act of ensuring affordable access for patients whilst maintaining profit margins for manufacturers. It is important for individuals in the industry to be able to understand and navigate the complex network of pharma companies, payors, PBMs, healthcare providers and patients.