Historically, obtaining reimbursement was viewed as the last step in a regulatory process which was closely scrutinized by general managers of pharma company affiliates. Nowadays however, due to the complexity of funding in terms of number of stakeholders, number of steps, different types of funding strategies (build market, build share,…), pharma executives must manage the Road to Funding as a process which involves many functional areas within the company.
| 1. |
Identify & understand the Road to Funding for the country / region and the disease area |
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In many markets, funding is not a one-off decision. For example, payers may need to fund a diagnostic for the patient to be diagnosed in an early stage with a certain disease. Then the drug needs to be approved for reimbursement at a national level by a reimbursement committee in the Ministry of Health. And finally, extra money needs to be placed at the hospital pharmacist’s disposal so that the hospital can physically pay for the drug. If in addition the drug is delivered in an IV infusion (or if its side effects management are labor intensive), availability of human resources may also constitute a bottleneck to a therapy being delivered. |
| 2. |
Identify stakeholders who channel funding |
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Key Account Management efforts will help identifying the stakeholders who will decide on reimbursement of the diagnostic, of the drug and who will make the drug available. Typically, KAM processes distinguish between gatekeepers, influencers, deciders,…. The role of the stakeholders must be identified in each step of the Road to Funding. For example, physicians may play a different role in influencing national reimbursement decisions versus hospital budget allocations. |
| 3. |
Define the stakeholder’s beliefs that should lead them to channel the funding appropriately |
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For each stakeholder, we need to define their current beliefs as well as the beliefs we want them to have. This is important because most (mentally fit) people act according to their beliefs. We need to identify these beliefs that will drive the stakeholder to act in such a way that the funding will be channeled to the drug. |
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| 4. |
Prioritise stakeholders according to channeling power and ability to impact beliefs – define Key Funding Drivers |
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It is currently a common trend to see pharma companies trying to drive funding through patient related activities. Whereas it is overly clear that HIV patient organizations have been instrumental in putting pressure on payers to make funding widely available in HIV – it is not so clear whether and how patient organizations in areas such as lung cancer (where patient survival is usually short and hence patient organizations are not very strong – or even not existing). Local Product Marketing Plans often list stakeholders, but fail to identify the relative importance of stakeholders explicitly. This often leads to patient activities being implemented regardless of their influence. |
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Develop value messages based on supporting data sets to ensure appropriate stakeholder beliefs are impacted |
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Pharma companies increasingly design their product positioning strategies on a globally enforced basis. Messages about customer benefits are then defined on the basis of clinical data from globally run clinical trials. The challenge with this approach is that health economic analyses use outcomes data that are usually found in pre-existing clinical data sets. At the same time, however, value messages should be locally defined, depending on local healthcare structures, stakeholders etc. A prime example of this issue relates to the emergence of a number of oral drugs used in oncology indications. Healthcare administrators need to believe that these drugs can be cost-effective even if they are not infusional. In many countries, however, drug purchase costs are not being compared to human resource costs which are required to manage infusions. It gets even more different when one looks at physicians. In some countries (with tax based HC systems) physicians are civil servants on fixed pay. They like oral drugs as it reduces their workload. In other countries (social security systems), physicians do not appreciate oral drugs as they lose the infusion fee they get when they prescribe infusional products for their patients. These sorts of differences often come up through statements as “oooh that product will never work in our country”, but rarely result in fundamentally different strategies and tactics. |
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Coordinate delivery of messages and cross-functional activities targeted at stakeholders |
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Funding is very often driven by simultaneous application of Push and Pull funding strategies. It does not work to pressure opinion leaders to exert advocacy to the payers during one quarter, then to discontinue this work and then work on the payers the next quarter. These actions need to be planned synergistically. As payers become more important, the industry will most likely end up publishing health economic studies together with payer opinion leaders, similarly to the way that the industry currently supports clinical trial publications of scientific opinion leaders. |
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Monitor implementation of activities and evolution of the prioritised stakeholders’ beliefs |
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Key performance indicators that reflect payer beliefs and behaviors are rather difficult to measure. Interviewing a payer whether he/she is willing to make funds available for the use of a product in a patient population will probably yield answers of a dualistic Yes/No nature, which is not very discriminating to measure our performance in achieving willingness to pay. This does not mean there should be no performance measures whatsoever. If payer meetings are being held, activity based parameters such as number of meetings, number of attendants, ... by date XYZ can be assessed |
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