This blog is the third in a series that shares our vision for a unified access platform. As co-founder and EVP of Product and Strategy for IntegriChain, most of my waking hours — and probably even my sleep — is dedicated to ensuring that IntegriChain delivers value for a market gap. This is where I began to sort out the business dynamics of Market Access as the world moves to specialty and precision medicine.

In this series, I attempt to codify, if you will, the key goals of Market Access teams as they look to the future with the advent of speciality and precision medicine and how achieving these goals has been stymied by siloed data and processes. When a team needs data from across these silos, too often the projects become mired in vendor data requests, manual data wrangling, and other sources of toil and delay. The Market Access function of the future cannot remain handcuffed by siloed data and processes; it must be expansive and integrated. 

In my first two posts, I examined the commercial goals and the financial goals of Market Access; today, we deep dive into the operational goals.

Market Access Operational Goals: Flexible Infrastructure        

If there’s one thing we learned during the 2020 pandemic, businesses must be flexible to survive and thrive. The ongoing business of Market Access is no different. Commercial Operations and Contracting teams need a flexible infrastructure that can support business scale, the changing regulatory environment, business optionality to re-configure product lines and business units — while all cost effectively, of course – and deliver greater productivity through business intelligence and automation.

Operational Productivity

The total cost of ownership (or TCO) of administering government, commercial, channel, and institutional contracts is high. This is partly driven by the overall cost of revenue management systems but also by the weakness of the data management and data access layer of those platforms as well as inefficiencies in their workflows. Moreover, manufacturers of all sizes often have a mix of systems and processes for adjudicating different types of agreements. Larger manufacturers might have multiple revenue management platforms: one for government programs and another for managed care. Small and mid-sized manufacturers might have some processes in house in a revenue management system, some with a managed services vendor, and some in spreadsheets. But the outputs from one Market Access system are often the inputs to another, and without unified systems and improved data management and access, too much time and resources are spent on data “shoe-leather” work–requiring a lot of time and toil. 

Regulatory Adaptability

There are many pending regulatory changes that can impact how government prices are calculated or gross-to-net is forecasted: manufacturers might need to pull co-pay programs into best price calculations; value-based contracts will require price schedule reporting as a part of the government pricing process; Part D benefits might be redesigned, uncapping manufacturer liability in coverage gap; and the Medicaid URA cap has been removed, significantly increasing Medicaid liability once it comes into effect in 2024. 

For many years, the data sets we’ve used in Government Pricing – direct sales, chargebacks, and so on – have remained static. Now, as the government gets more actively involved and wants to benefit from a manufacturer’s drug commercialization, agencies are looking for manufacturers to incorporate more data sources in the calculations such as co-pay program utilization data, Puerto Rico data, and data on new/innovative commercial contracts. If all of the data is available in one system, Government Pricing teams are in a much stronger position to model the impact of the changes that the government is proposing.  

Channel & Revenue Leakage

As patient populations shrink with precision medicine, revenue leakage makes a bigger impact. Higher pricing and resulting rebates for specialty therapies makes leakage far more significant than in the days of primary care medicine. Mind you, revenue leakage is not a new problem to pharmaceutical manufacturers. But traditional revenue management systems solely focused on internal pricing and rebate transactions are too limited in scope. They can’t address difficult challenges such as mixed-use contract pharmacies, stacked discounts paid to commercial payers and covered entities, and diversion detection. Manufacturers lack the forensic tools, benchmark analogs, and unified access data that cross the boundaries of traditional data silos.

Stay tuned. My next and final post of this series will examine how Market Access teams can break down the data silos to achieve next-generation access.