Payer marketing is nothing new in the pharma sector, but has been playing a significant role in structuring the overall backbone of the industry. Whether it’s about enhancing patient access and its coverage or it's about promoting a drug or service, the calculated approach of payer marketing has proved to be obligatory in the ever-evolving landscape of the healthcare industry.

This blog will delve into the dynamics of payer marketing in pharma, along with the definitions and their significance. It will also shed some light on how access can be enhanced through effective payer marketing. 

Who are the Payers? And what is Their Significance in Pharma? 

Generally, ‘payers’ in this sector are identified as insurance companies, pharma benefit managers (PBMs), or government programs like Medicaid or Medicare. But to ease the identification, they can be classified as:

• Employer-Sponsored Plans- These consider the health expense coverage as offered by the employers. 

• Private Payers- PBMs and health insurance companies fall into this category, which negotiate drug prices and reimbursement rates. 

Now, here are the key dynamics explained, how payers influence pharma-

• Reimbursement Models- The payers decide the extent of coverage and how much the patient’s expenses will be deducted from their bank balance would be. 

• Formulary Decisions- They point out which drugs would get covered under health plans. 

• Patient Access- To decide whether the patient gets access to their respective insurance claims or not. They approve or restrict access to particular treatments based on effectiveness and cost. 

The key payer priorities can be classified as

• Clinical Outcomes- Where drugs must demonstrate real-world effectiveness.

• Cost Effectiveness- Preference for affordable yet effective treatments.

• Budget Impact- Payer assess the financial impact of covering a drug on their healthcare budget.

How to Enhance Access Through Effective Payer Marketing

Virtually, each product’s commercial success or failure relies on sustaining and securing favourable payer access. This is because, according to some reports, more than 80% of prescription drugs are paid for by the government or commercial payers. Access decisions influence physician prescribing patterns, product distribution, profitability, and patients’ direct investment expenses; they have a direct impact on launch success; and they have long-term implications for customers’ cognizance of a brand. Efforts in payer marketing are aimed at conveying product value and securing and maintaining desired access levels. 

The marketing activities need to regard the sophistication of payer customers and deliver texts that speak directly to their business concerns. Payers (and their employer consumers) are concerned about enhancing the quality of the patient experience, ameliorating health outcomes, maintaining sufficient choice, fostering physician relationships, and operating efficiently. Pharma production organizations that develop marketing campaigns that address these core consumer objectives are more likely to be viewed as partners in patient care, and this will help them achieve the desired goal- favourable access for their products. 

With time, the stakes are increasing, and so is the pressure. Pharma enterprises need sophisticated messaging for increasingly high-end purchasers as well as an integrated approach to strategy and execution. Newritics has helped and sis till assisting many big-shot pharma companies to optimize their messaging based on heuristics (behavioural science) and with the world’s largest database of heuristics-based messaging in the pharma industry. Given below is a brief outline regarding some of the key elements of a successful payer marketing approach.

• Classify the consumers- In the earlier section of this article, we have defined how payers can be segmented, and that goes beyond traditional measures of size and control. This enables enterprises to develop and execute tailored strategies for each segment. The goal is to identify payers with similar concerns, management approaches, or philosophies, enabling the development of compelling messages that particularly address those consumers’ needs. Proper segmentation dynamics depend on the brand strategy, product category, and competitive environment, but they may include historic category utilization patterns, observed controls in analog classification, employer and PBM relationships, etc. 

• Upgrade the messages- A gap always happens to be there between a payer’s recognition of value and a manufacturer’s enthusiasm for its product. A vital primary step for a payer marketing team is to comprehend its customers’ perspective, how that perception is likely to impact access, and how that perception differs by segment. This can be achieved through primary research with payer representatives responsible for access decisions. Once the consumer’s perspective is comprehended, there are at least three key marketing activities.

• Mould the market: Market structuring activities might be needed to ensure payer receptivity to the manufacturer’s product-driven texts. For instance, a specific unmet need may not be well comprehended by payers, causing them to undervalue treatments that address the unmet need. 
• Direct the Research: Sometimes developing effective texts needs clinical and outcomes data that takes years or months to form appropriately. Payer marketing team should utilize their understanding of payer consumers to identify the most valuable clinical and health economic arguments, and offer appropriate direction to clinical and health outcomes teams to ensure the base of evidence exists from which to structure impactful marketing messages. 
• Differentiate the Product: Clear articulation from payer marketing teams about their product’s benefits, and also the benefits of offering those advantages to the payer’s membership, is important. 

Differentiation can be showcased along diverse dimensions (efficacy, safety, patient-satisfaction, cost, etc), but to be impactful, it must be a dimension that the payer values and considers in its access decisions. In a particular scenario where efficacy advantages were clear but a price premium caused access hurdles, differentiating the product based on its cost per outcome assisted payers in appreciating the product’s value contrast to competitors. 

• Keep a Robust Accounts Team in Place- A vital step in performing the marketing approach is developing transparent tactics that assist account managers in communicating messages seamlessly, convincingly, and in the appropriate sequence. Moreover, payer marketing teams need to develop tactical plans and train account managers, providing them to profile consumers, assess account needs, deliver key value messages fit for the account, and anticipate and overcome substantial access barriers. This might involve developing and facilitating workshops with the account executives to back up the effective execution of the access strategy and providing them with troubleshooting capabilities to employ when access hurdles inevitably arise. 

• Check the Progress- Most of the time, an element gets overlooked in a holistic payer marketing approach, and that involves monitoring the successes and failures resulting from the execution of the strategy. A structured, scheduled checking session or monitoring program enables enterprises to evaluate failures objectively and thereby intercept organizational chaos over one or more lost accounts; it will also showcase successes and intentionally seek to propagate proven best practices. Making the ground for clear launch progress metrics and tracking processes enables company and payer marketing teams to identify impromptu access challenges, promptly address issues, and ensure the projected launch trajectory is maintained. This can be made possible by compiling self-reported data from account managers, leveraging secondary databases, and executing primary research to structure monitoring tools that offer timely feedback and enable strategy improvements.  

Conclusion

Pharma sales forces are frustrated even to this day due to poor access, and financial performance gets depressed due to overly generous discounts and rebates. All of these can be mitigated through effective payer marketing via effective communication of value, leading to targeted access levels at optimal net prices. 

By collaborating with Newristics, your company can benefit from heuristics-optimized messages. This, in turn, will enhance your brand value by enhancing patient engagement, driven by proper payer and product information, not only to patients but to their respective HCPs and other stakeholders.