In our first two blogs, we explored challenges related to provider and patient access and how they can influence market access for your brands. In this final blog of the series, we discuss how expert-developed training on payer and reimbursement issues can help your sales team better collaborate with your market access team to expand payer coverage of your brands.
Let’s face it: reimbursement and payer topics often aren’t easy to understand or train in a clear, simple way that doesn’t stress or overburden your sales team. At CMR Institute, we have designed our market access training to break down the essentials so your sales team can support your payer access strategy, whether you are preparing for a launch or engaging in ongoing payer negotiations.
Payer Utilization Management Tools and Their Impact on Access
In our previous blog, we described how prior authorization can affect patient access to your brands. A type of PA called step therapy, which requires patients to “fail” with a less costly medicine like a generic before trying a brand with a higher price, remains popular with many payers. However, differences in the use of step therapy among payers can create variable patient access to your brand.
In today’s cost-conscious environment, step therapy is just one of many payer utilization management tools that your sales team should understand. This is especially important if you sell oncology drugs and other specialty drugs, which plans and pharmacy benefit managers (PBMs) are targeting to reduce costs. But even if you don’t have a specialty brand, understanding how these tools can influence access to your products in your category can help enhance your team’s business planning and account management strategies.
Using Account Management to Enhance Relationships with Payers
Effective account management can help your sales team overcome payer roadblocks to access and set the stage for better long-term partnerships. While a SWOT (strengths, weaknesses, opportunities, threats) analysis can be a good starting point (figure), it is just one piece of the accounting planning process.
Effective account management training outlines the various steps that your team can use to build better relationships with payers and other customers through value-based selling. This process involves crafting value propositions, understanding how your brands affect population health outcomes, and offering resources that resonate with payers. It may also include designing outcomes-based contracts or using other tactics to bring your company’s goals in line with payers’.
Drug-Pricing Pressures from Regulators
While you’re keeping tabs on your commercial payer customers, a new potential threat to access is emerging in the public payer space. A new federal law that could have sweeping impacts on reimbursement and patient access is the The act, which was signed into law in 2022, allows the federal government to negotiate drug prices for the first time for certain brands covered by Medicare. Companies that don’t participate in price negotiations risk losing coverage under Medicare and Medicaid. According to PhRMA, mandating government-set prices could discourage research & development (R&D) and reduce access to innovative drugs.
While many drugs are excluded from these negotiations, it is still vitally important for all sales teams to understand the implications for their brands as the process unfolds amid legal challenges over the next few years. The federal government is the pharmaceutical industry’s most important payer, as Medicare and Medicaid pay for about 45% of US retail prescriptions.
The law also includes other drug pricing provisions that have already taken effect. One requires manufacturers to pay rebates to the federal government for certain drugs paid by Medicare if prices increase faster than inflation.
Market Access Courses Updated Year-Round
To help your team understand how complex payer and reimbursement issues like these affect market access for your brands, we offer more than 50 market access training modules, eBriefs, and other resources specifically designed for pharmaceutical and medical device sales teams.
Unlike many market access training resources available elsewhere, our nationally recognized courses are designed with outside faculty who are industry leaders and experts in provider, patient, and payer access.
Because the payer/reimbursement landscape is constantly changing, we update our learning courses throughout the year. By the end of this year, we will have updated dozens of market access courses to ensure they are accurate and relevant for your sales forces.
Let Us Help You Create Learning Pathways for Your Team
Each role on your commercial team has a distinct purpose to help you expand market access for your brands. That’s why clients ask us to support their market access training with customized learning pathways for each role on their sales team. Many learning pathways only take two hours to complete, so your team can stay engaged with their customers.
In today’s challenging market, your team’s lack of knowledge on payer and reimbursement issues shouldn’t be the reason your market access suffers. Ready to rethink your learning strategy? Understanding the scope of your team’s needs is a good place to start, and this interactive tool can help. Or feel free to send us a note at solutions@cmrinstitute.org to find out what we can do for you.
