Everybody’s talking about market access. But far fewer appear able to define it. In the competitive world of pharmaceutical sales, developing a market access call strategy can pay dividends. But do you know what that means? WG Consulting’s Simon Dawson and Elliot Rosen report.

Throw the phrase ‘market access’ into any discussion you’re having on the challenges of promoting pharmaceuticals to the NHS, and it’s likely that the person you’re talking to will give you a knowing nod that confirms a shared, mutual intelligence. After all, it’s quite simple: if you’re not thinking about market access these days, you’re nowhere. In fact, that prolonged yet knowing silence is quite possibly disguising an inward truth: your colleague knows that market access is extremely important, but, equally, they may not completely understand what it is and how to go about doing it . In the much-vaunted ‘new NHS’, having a market access call strategy is an imperative. The questions remain: what is it and have you got one? It’s widely agreed that a rigid reliance upon the traditional approach to pharmaceutical sales and marketing is a short-cut to product failure. Why? The market isn’t changing: it’s already changed and there’s no turning back. In the past decade, the environment for the pricing and reimbursement of pharmaceuticals has become increasingly challenging. Regulation in these areas has tightened and across Europe a fourth hurdle – cost-effectiveness – has supplemented the established notions of safety, efficacy and manufacturing quality as a further requirement to secure market access. This shift has accelerated the emergence of a key group of influential stakeholders and provided the catalyst for an environment that is increasingly being controlled by payers. Achieving market access in the modern market is as much about understanding the needs of non-clinical stakeholders as it is about influencing the traditional, clinical decision-maker. But, critically, a broadbrush approach will not work. Developing an effective market access strategy requires a more customised and agile approach.

What is market access?

For the benefit of those that nod in silent agreement at the mere mention of market access, some simple definitions of the term would be helpful. There are four basic elements. Essentially, market access is about:
• considering the implications your product may have on the wider healthcare market
• understanding the impact the changing healthcare market will have on your product
• preparing a positive healthcare environment which supports uptake of your product
• communicating the ‘value’ of your product to the range of customers who influence uptake.

Strategically, market access is about packaging data in the right way, for the right customer at the right time. In a changing NHS, aligning your product with a moving target is challenging and only by understanding the needs of all stakeholders involved in the adoption, positioning and funding of your product will you be able to develop messages that improve its chances of success.

Market Access Customers

So who exactly are these new key stakeholders, and can they be defined as ‘market access customers’? Broadly speaking, these customers can be collectively termed as ‘payers’ e.g. national and local decision-makers, policy makers and budget-holders. Their emergence has challenged the industry’s stereotypical KOL mindset – historically, a typical KOL has always been a clinical KOL – but now, the rising influence of health economic, reimbursement and payer KOLs is forcing companies to redefine their sales and marketing operations. “These are very much different to pharma’s traditional clinical customer-base,” says Elliot Rosen, Management Consultant at market access specialists WG Consulting. “Whilst they are not significant in terms of their ability to prescribe a product, they will, however, be making decisions about how the services that use these products are delivered. Some may be responsible for the development or implementation of national/local guidance, and others will be directly responsible for ensuring local funding for new and existing drugs. There is no point in trying to persuade a clinician to prescribe your product if you are not able to persuade the people who hold the purse strings and have the ability to change a service or create the opportunity for your product to be used”.

“In recognition of their growing significance, pharmaceutical companies across the industry now deploy specialist market access field teams to engage directly with payers” says Elliot. “The approach, however, can vary across companies and some have adopted a more account management approach that incorporates sales and market access in one role.”

Whichever strategy is adopted, the most important thing is to ensure that the huge amount of resource being invested in the field force is being converted into valuable interactions with every customer, and every customer group. But engaging with payers in the field requires a completely different approach to more traditional industry methodology. So how do you do it? One answer is to develop a Market Access Call Strategy.

Market Access Call Strategy

Field-based market access is about being able to understand the changing NHS environment and its impact on your customer-base, and being able to adapt your contact or call strategy in response to it. “Companies need to keep on top of change, identify who the key influences are, understand their needs and respond accordingly,” says Simon Dawson, Management Consultant at WG Consulting.

“Building a call strategy is about comprehending what is ostensibly a complicated matrix. It is vital that you understand the different spheres of influence around the customers you are going to be interacting with, and, critically, the best order in which to approach those different customers to maximise those spheres of influence. Having established the best order, you also need to develop specific messages tailored to those customers, so that eventually you have a very unified understanding of your product across all the key people who are going to be making decisions as to whether to fund or use the drug you are promoting.”

“Market access is about packaging data in the right way, for the right customer at the right time”

A market access call strategy should be developed collaboratively, with sales and marketing departments working in tandem. The strategy itself will need to be dynamic enough to be able to respond to market evolution, but sufficiently planned to accommodate all known interactions. This requires an aligned approach whereby the field teams capture the challenges faced in the field and work with marketing, either to understand the materials that exist, or to develop new materials that close information gaps in the marketplace. This all needs to be drawn together into a cohesive strategy that can be understood by the field force and ultimately used to drive product uptake.

The general principle is that there is no one-size-fits-all solution. The challenges you face in your market will change according to your product, therapy area and the setting in which your treatment will be used. Only by understanding where your product fits into the wider NHS can you customise the approaches that will work best. This requires the capture, sharing and interpretation of market intelligence from the field, with garnering information being the responsibility of the market access field force.

“First of all, you need to fully understand your environment,” says Simon. “Map it. Know who your customers are and what their needs are. Talk to them, engage with them and try to build a full understanding of their sphere of influence, how they are involved with certain processes and systems and how they are going to influence prescribing. Only then should you start getting out your materials, to engage with them even more effectively.”

Market challenges

Although the various barriers to market entry will vary from product to product, a number of common general challenges exist. These challenges, which will be indicated through field-based research, will require detailed and customised responses and will drive your market access call strategy. Here are some example scenarios that commonly need addressing and will inform a market access approach:

Scenario planning is a vital aspect of market access call strategy and will play a pivotal part in determining the order in which you engage with the various customers you need to approach. “For example, in one scenario you may primarily need to interact with clinicians to achieve clinical buy-in. Following this you may need to interact with a hospital business manager to understand the impact that using your drug in a hospital will have on a Trust’s income flow. From that point, once you have got the right messages communicated to those two customer groups, you may need to go to a Cancer Network level or PCT level, with the value messages for your product almost being presented by the customers you have already engaged with. This will build a positive wave of understanding amongst your customers, and will demonstrate how understanding the various spheres of influence can work to your advantage,” says Simon.

Despite widespread endorsement of the principles of market access in the modern market, the example above does demonstrate that whilst payers are now widely acknowledged as being highly significant and influential customers for pharma, the traditional prescriber still plays a major role in product uptake. “It is important to note the need for clinical buy-in to drive the need for market access customers to address,” says Simon.

Achieving brand success in the modern NHS requires a thorough understanding of your marketplace; the key stakeholders and influencers, their needs and objectives, knowledge of funding flows and how they work in your disease area and advanced understanding of the likely scenarios and barriers you may encounter when trying to take your product to market. To succeed, you will need a market access call strategy.

Simon Dawson and Elliot Rosen are Management Consultants at WG Consulting. WG provides a range of bespoke services to improve market access opportunities for pharmaceutical companies in the UK. For further details, please contact simond@wg-group.com

Redundancy has sadly become more commonplace within the pharma sales industry as the sector responds to difficult and changing market conditions. The horrors of losing your job are obvious, but is it possible to find positives and emerge stronger from the experience? Pf’s Assistant Editor Diana Spencer spoke to several redundancy survivors to find out.

However unpleasant, redundancy is now a fact of life within many industries. The current economic situation has resulted in higher redundancy figures across the labour market and research by the Chartered Institute of Personnel and Development (CIPD) and KPMG has revealed that more redundancies are on the horizon, with more than a quarter of employers planning further redundancies in the next 12 months.

Sadly, the pharmaceutical industry has not been immune to the trend. A move towards smaller sales teams and a reconfiguration of business models means that many sales professionals have recently found themselves in a consultation situation despite their hard work and good sales figures.

The fact that redundancy is so widespread today has led to a considerable shift in attitudes. It is no longer seen as an indication of poor performance, and being made redundant is very unlikely to affect your prospects of securing another job. Indeed, the circumstances could provide a timely opportunity to explore other roles or take time out for travel or further training. Pf spoke to several people who lived through the experience to find out how there really is life after redundancy.

“Things happen for a reason”

For one NHS Liaison representative, redundancy provided a legitimate reason to leave a company where she had been unhappy, as the company’s downsizing meant her entire team was no longer needed. “At the time I was very upset and angry, but it was the best thing that happened to me, as it gave me a valid reason to leave after being there for five years.”

Rather than experiencing any stigma surrounding the redundancy when applying for other jobs, she felt it actually helped to have a valid reason for leaving despite five years of success with the company. Now an occupational hazard of working in most industries, redundancy is no longer associated with an implication of professional failure.

Having successfully secured a position in another company working in a niche market, she is thankful for the chance to explore other opportunities. “I truly believe things happen for a reason and for the better. I am definitely better off now in many aspects, such as work/family balance, income and benefits, though this is an area of the industry I never would have explored had I not been made redundant.”

“My employer asked how I could leave them!”

It seems that even senior roles and those with considerable years’ service with a company are no longer immune to redundancy. One Senior RBM/Project Manager reflected on her feelings at being put into consultation despite ten years’ loyalty and being considered one of the company’s best RBMs: “It was all a bit of a blur. My whole national team were in a consultation position and I was busy managing their expectations, which was bizarre as I was about to be put into the same position.”

Having been told to look outside the company for a role, just in case there wasn’t a suitable alternative to offer, she took stock of her situation. “I was far more relaxed than I ever thought I would be. I have a family and a mortgage so I needed a salary. Fortunately, I had mortgage protection, something I would advise anyone to get. I wondered whether I should do something different or even set up my own business, and registered with a few agencies both within and outside the industry.”

An offer was made of a job she had done six years previously, but grateful to have a position at all, she accepted. However, when an agency contacted her with a position working in facial aesthetics, she realised she was ready for a change. “Now I have the most amazing national team of product specialists with my new company. My consultation process really forced me to look outside my comfort zone, something you don’t get a chance to do when you’re caught in the rat race.

“My consultation process really forced me to look outside my comfort zone, something you don’t get a chance to do when you’re caught in the rat race”

“The irony was that when I handed in my notice, the company asked why and how I could leave them! My response was to thank them for the opportunity to look outside.”

“Thank you for making me redundant!”

In the current industry climate, it is not unusual for people to experience the redundancy process more than once, and though a huge inconvenience, this should not be taken as a negative reflection on your abilities. Indeed, it is not uncommon for sales professionals to face consultation with the same company for the second time.

This was the situation of an employee of one organisation when she was informed that her contract had come to an end for the second time. “I couldn’t believe this was happening again and I was very uncertain as to the future. I ended up securing a position with the same company, but it was a step back and I was merely hanging on in the hope a management position would come up.”

When she was put forward for a job in a company outside mainstream pharmaceuticals, it seemed an ideal opportunity. “All I can say is ‘thank you for making me redundant!’ I wouldn’t have been looking for a job if I hadn’t and would never have had the opportunities that I do now.

Looking back, it was worth all the worry and uncertainty to have what I have now.”

I will survive

Redundancy is never a desirable situation. You might not have to eat live insects and build shelters in trees a la Channel 4’s ‘born survivor’ Bear Grylls, but being made redundant can leave you feeling stranded without much hope.

However, rather than being a turn downwards, with the right approach redundancy can provide real opportunities for development. Being forced to leave your company can help you get out of a rut, consider roles you never would have previously and discover where you can be happiest.

Anyone forced to cope in harsh conditions will tell you that survival is about positivity and being able to adapt to your environment. It’s important to sit back, take stock of your situation and consider where you are heading. A new direction could be exactly what you need, and it might be the threat of redundancy that provides the momentum to make that change.

The third Annual Health Check from the Healthcare Commission has now been published. Alan Jones provides a round-up of the most significant results. Have you accounted for these in your local plans?

The Healthcare Commission as an independent body has gone and is now part of the Care Quality Commission, officially live in April 2009. For its swansong, it published the latest results of the Annual Health Check for England’s 319 NHS Trusts. As companies re-invent account management for the NHS and dive deeper into customer-centric working and enhanced customer focus to achieve deep customer insight, these results provide one with a fabulously rich vein of NHS gold for local account management purposes.

What is the Annual Health Check?

Over the last 10 years or so, the NHS in England has been subject to very close scrutiny over its performance. Once upon a time we had star ratings, but these were ditched as being too narrowly focused. Then Standards for Better Health, published in 2004, went to the other end of the performance management spectrum with a vast array of 24 core standards (with 44 components) and 33 national targets. One such standard, just for interest, is the implementation of NICE technology appraisals. All NHS Trusts are asked to make self declarations as to whether they are achieving all of this (or not), the Healthcare Commission makes some spot checks and then, voila, each Trust gets a rating on a fourpoint scale ranging from excellent to weak on both quality of services and use of resources (financial management). But these are only the headline stories and so much more information is available to you.

How did the NHS do in 2007/08?

The Commission found that overall NHS Trusts had improved over previous years. In terms of quality, the Commission judged 100 NHS Trusts (26%) to be excellent, 139 (36%) good, 132 (34%) fair and 20 (5%) weak. For their use of resources, this year 94 Trusts (24%) were excellent, 145 (37%) were good, 132 (34%) were fair and 20 (5%) were weak. Overall, 42 Trusts were excellent on both measures (mostly NHS Foundation Trusts), compared with two in the first annual health check in 2005-6, while the number scoring weak on both measures has fallen from 25 to six.

One hundred and sixty-nine Acute and Specialist Trusts were the most dramatically improved, whilst PCTs’ performance disappointed overall, with only 33% rated excellent or good on quality of services, although this year Salford PCT became the first ever double-excellent PCT. Brent, Great Yarmouth & Waveney and North Yorkshire & York PCTs were all rated ‘double-weak’. And just to give you a flavour of some of the individual standards being measured: a core standard with one of the highest rates of compliance was C22b (99.3%), about requiring organisations to use annual public health reports to inform policies and practices. Knowledge of what is in these reports is also critically important for you in terms of PCT account management.

Regionally, NHS North East performed the best and NHS London the worst. In fact, London SHA was the only area of the country where performance for quality of services had declined and, for the first time, there seems to be a gap opening up with the rest of England – not surprising really since London’s small PCTs were ‘unreconfigured’ in the last re-organisation and remain weak.

Action to address these issues will likely focus on encouraging PCTs to work together to commission services and future reconfiguration of London PCTs is not out of the question. So those working the London Health Economy need to note that already a London Clinical & Business Support Agency is being formed, responsible for sharing the skills and knowledge that will enable London’s 31 PCTs to become world class commissioners – a possible new Regional Influencing Centre?

So why is all this important to me?

Well, if you are an account manager, it would make sense to know how your organisational accounts are performing and what they are being measured on. The individual Trust Annual Health Check results are vitally important to know and need to be added to any ‘sophistication indices’ you might be using. We have seen that there are 42 organisations at the top of this excellence tree (including one PCT) and six organisations at the bottom (including 3 PCTs). Now, let’s say you are calling on these organisations, surely this kind of knowledge might change the very nature of your account management strategy for a particular organisation? For instance, as far as joint working approaches to those at the top of the tree were concerned, your approach might be centred more around their innovativeness and their moving even further forward in terms of delivering improved outcomes for their patients. With those at the bottom, your approach might be more measured and possibly about helping them out of the deep black hole they are in! And a thorough analysis of the detailed results would also be needed. For instance, they might not be implementing NICE guidance and you might be able to be of some assistance here. It will be very useful for local Acute Trust, Mental Health Trust and PCT account managers to know the individual detailed results of their accounts and these can all be found on the Healthcare Commission’s website. Please see www.healthcarecommission.org.uk.

Other questions are: Why have NHS Foundation Trusts done so well? What is it about this future NHS hospital model that is so different to the non- Foundation Trust? And why are PCTs doing so poorly? Also, how will this relate to PCTs moving towards becoming ‘world class commissioners’? This is particularly relevant as from this autumn, PCTs will be assessed against a whole range of new competencies. The results will eventually be made public and here too will be another rich vein of information for local account management. Finally, the Audit Commission too is an excellent source of local information, and those who want to dig more deeply into the finance side can see their recent Health Briefing Auditors Local Evaluation 2007/8 at www.audit-commission.gov.uk, where, in Appendix 2, you will find each NHS Trust’s scores in terms of financial management and value for money. For instance, Bromley PCT scores very highly here and Ashton, Leigh and Wigan PCT are mentioned in despatches for their approach to tackling health inequalities.

Deep customer intelligence has to be the way forward for account management and the ‘truth’ is indeed out there…

Which company benefit drives us?

As the cost of living continues to escalate at an alarming rate, employee perks, such as a company car, can make all the difference. Interestingly, respondents to this year’s Pf Company Perception, Motivation and Satisfaction Survey voted company car policy as one of their top ten motivations, though only 45% were satisfied with this aspect of their remuneration. Paul Harrop, Sales & Marketing Director, Daimler Fleet Management, looks at how cost-cutting and environmental pressures are forcing companies to change their policies.

When changes to company car Benefit in Kind (BIK) taxation were introduced in 2002, many companies took the opportunity to review the value of the company car as an employee benefit. The reforms were fundamental, with a change from taxing engine size to taxing CO2 emissions and removing preferential treatment for those who drove high business mileage.

Employees who were financially penalised were attracted towards cash for car options to reduce their BIK tax burden. Employers also saw advantages in a salary alternative, such as potentially reduced administration from ceasing to manage a company fleet, removal of Class 1A National Insurance paid on the benefit the driver receives, and a drive to diversify their employee benefits packages.

While predictions about the decline of the company car proved to be unfounded, there have been changes and a diversification in the funding and composition of corporate fleets:
• There is a greater use of personal finance and employee car ownership schemes.
• Diesel derivative vehicles, because of their comparatively low CO2 emissions, have expanded in number within company fleets.
• Car provision is a choice within a wider and more sophisticated range of employee benefits.
• Duty of care issues are increasing the focus of attention at board level on building safety into fleet vehicle policies.

Duty of care responsibility falls to the organisation as a whole, with the directors being most at risk for legislative breaches. Although the law won’t blame individual managers for accidents, it could impose unlimited fines for a company “if the way in which any of its activities managed or organised by its senior managers causes a person’s death and amounts to a gross breach of relevant duty of care owed by the organisation to the deceased”.

An integral part of the Health & Safety at Work Act, Duty of Care requires an employer to be responsible for employee health and safety while at their place of work. Any vehicle used by an employee during the course of their work is defined as a ‘place of work’.

Assessing the options

Cash for car calculations are complex and to ensure employees taking the salary alternative are treated fairly, employers need to consider the cash allowance from the employer in lieu of company car, any BIK tax saving and the business mileage reimbursement.

Given the choice between cash or car, an employee needs to calculate cash received in lieu of a car and payments (including tax) for both scenarios, as well as the servicing, maintenance and running costs of a vehicle. A fleet management supplier will use a discounted cash flow (DCF) module to help companies to analyse whether a company car or a cash alternative is the best option.

Company involvement in assisting staff to acquire vehicles through private finance arrangements has to be handled carefully because poorly-established schemes may fail to remove BIK liability from the employee. HM Revenue & Customs (HMRC) offers the following advice to a company: “In order to review a scheme, you will need to see all the documentation which could include:
• A document or brochure outlining the scheme
• Scheme rules
• Agreements between employee and employer
• Agreements between employee and finance provider
• Agreements between employee and car provider
• Correspondence and agreements between the employer and any third parties involved, such as the finance provider and/or the car provider
• Instructions to managers about the operation of the scheme.”

By divesting itself of its car fleet, a company does not entirely drop its administrative responsibilities for work-related driving. As the HMRC guidance implies, schemes have to be rigorously structured and monitored for effects brought about by any new tax changes. This may cause particular pressures on those tasked with fleet administration when it is not their primary job function. Fleet management suppliers have the expertise to assist companies in negotiations with their local tax office, and their support can be invaluable.

Other points to consider include:
• Fuel benefit is offered by the employer is taxable as BIK based on CO2 emissions. If a pay and reclaim system is in operation, then keeping within the HMRC’s Approved Mileage Allowance Payments (AMAP) when reimbursing the employee for using a private vehicle for business purposes ensures the employee will not have a tax liability. Tax-free fuel reimbursement levels are a cause of current controversy. Unlike the Advisory Fuel Rates (AFR) for company cars, which have risen since 1 July 2008, reflecting the rise in fuel prices, the Approved Mileage Allowance Payments (AMAP) for business mileage in private vehicles have remained unchanged at 40p per mile for the first 10,000 miles and 25p per mile thereafter.
• Any cash for car scheme with employees using their own funds to acquire the vehicle means that they will incur an extra debt they wouldn’t have had with a company car. This can be an issue if they already have outstanding loans, and may bring the employer into contentious areas such as determining employee credit worthiness for the benefit of the finance provider.
• Personal finance schemes may not be suitable for companies with a high staff turnover, where leavers find themselves responsible under contract for a vehicle they may not require.
• In addition to the financial factors, it is worth considering the value of a company car from an HR perspective as a motivational HR tool. A company car, typically a prestige model, attracts high quality candidates and retains specialist and highly skilled employees. The benefit provides hassle free motoring for the employee, with servicing, maintenance, insurance, road tax and other issues being handled by the employer.

Finally, turning to operational issues, duty of care and a vehicle’s fitness for purpose are critical areas to evaluate.

Duty of care

Most companies need employees to drive for business requirements, including sales and technical support visits to customers. Employers have a duty of care for all employees driving on company business, regardless of whether they use a company car or a privately owned vehicle. Vehicles must be roadworthy, insured for business purposes and legal in every respect.

It is generally accepted that it is easier to achieve higher levels of control with company cars, particularly over the crucial area of servicing and maintenance. Failure to adequately monitor vehicles and work-related driving policies can leave companies vulnerable to prosecution under Health & Safety legislation, including the Corporate Manslaughter Act in the case of accident fatalities.

Fitness for purpose also covers many other aspects:
• Is the vehicle fit to perform the job for which it is intended?
• Does it have adequate storage and load capacity?
• Is there a requirement to carry client passengers?
• Is the vehicle suitable for the average business mileage it will cover?
• Does the vehicle fit in with the company image and environmental policy?

Duty of care issues have made many employers reconsider their policies in favour of retaining the company car. At the same time, there have been a number of developments that have changed negative perceptions about the restrictiveness of company car policies geared towards low CO2 emission vehicles:
• Manufacturers are producing an expanding range of low CO2 emission vehicles that is becoming increasingly attractive to businesses and their employees.
• Volatile fuel prices are focusing attention on fuel efficiency of greener vehicles.
• There is an increasing acceptance of the need to reduce the environmental impact of motor transport.

Daimler Fleet Management UK Limited (DFM) currently operates a UK fleet of over 58,000 vehicles, which forms part of a pan- European fleet approaching 470,000 vehicles. DFM is 8th in the Fleet News FN50 league of the UK’s contract hire providers – see www.daimlerfleetmanagement.co.uk. For media enquiries, please contact: Ronnie Gunn, MPS & BBI International Ltd, tel.  01494 452600  01494 452600 , email ronnie.gunn@mpsuk.co.uk.