Work performed by Clarion, now part of Lumanity
Challenge
Our client, an established specialty pharmaceutical company, was preparing for the launch of a novel, branded ophthalmic product into a market with rapidly evolving competitive dynamics. With an entrenched market leader, a promising new entrant, and the potential entry of generic alternatives, our client recognized the importance of a robust pricing and market access strategy. We were selected based on our expertise in both ophthalmology and market access to develop a clear and actionable strategy that would optimize access, product adoption, and overall profitability while supporting the product’s overall commercialization strategy.
Solution
To develop a robust market access strategy, we synthesized insights from primary research and data analysis to establish a comprehensive fact base of the market. We conducted qualitative and quantitative primary research with payers, eye care providers, and patients to gather insights into coverage, prescribing behavior, and price sensitivity. Additionally, we conducted in-depth data analyses of prescribing and formulary coverage data for marketed products to quantify the effect of coverage on utilization, further assess price sensitivity, and segment payers based on coverage patterns. Combining primary research insights with these analyses, we segmented payers and developed a model to evaluate trade-offs between price, rebates, uptake, and profitability across segments. By evaluating trade-offs and synthesizing these findings, we developed a pricing and contracting strategy recommendation to optimize access and adoption and support commercial success of the product.
Market Access Landscape Assessment and Implications
- Managed care landscape to establish a fact-based view of the current and future market dynamics
- Analysis of external pricing and reimbursement trends, including evolving payer policies (e.g. new-to-market blocks)
Primary Research Perspectives
- In-depth interviews with national and regional payers/PBMs with ~160M covered lives across channels to identify drivers of formulary management decisions, perspectives on our client’s target product profile, and feedback on pricing options and resulting coverage
- Quantitative survey involving high-prescribing eye care providers to obtain feedback on the product profile and quantify the impact of coverage on prescribing habits
- Quantitative survey involving target patients to evaluate out-of-pocket price sensitivity and impact on prescription discontinuation
Payer Segmentation and Prioritization
- Data-driven segmentation and prioritization of payers based on coverage of existing products, ability to restrict access, influence on prescribing decisions, and other measures of reach
Pricing and Contracting Strategy Recommendation
- Recommended list price and implications for formulary position
- Contracting strategy across payer segments and engagement objectives (including target rebate levels)
- Anticipated coverage across payer channels and identified segments
- High-level recommendations for payer messaging and patient support programs
- Impact of product and market scenarios on key components of the pricing and market access strategy
Impact
Our recommendations helped the client develop a clear and actionable strategy anchored in a rigorous fact base of the current and future market. By synthesizing insights from primary research and data analysis and critically evaluating the changing market dynamics, we helped to set clear expectations and goals for product access across channels and identify opportunities to maximize the value of the product. These helped to inform overall commercialization strategy. When the product was launched, the list price was in line with our recommendation and the real-life commercial coverage of the product closely mirrored our projections.
Expertise utilized
Collaborative approach: We consistently engage key stakeholders across the client team, ensuring that primary research efforts are targeted toward producing critical insights, and that the client’s unique situation is considered in crafting a practical, feasible strategy.
Unique expertise: We provide a deep knowledge-base and seasoned expertise in market access, driven by an in-depth understanding of the principles and evolving trends of managed care.
Products & markets: Our deep experience and expertise across therapeutic areas like ophthalmology ensure strategies and recommendations reflect nuances of the relevant market.
“[The team] worked with our cross-functional team to incorporate perspectives and ensure buy-in throughout the process which helped to garner broad organizational support for the ultimate recommendation.”
Senior Director of Pricing Strategy
