Can Market Access Training Boost Sales?

Market access training can address provider objections and remove barriers.

Feature Story – By Don Benson

As a life sciences field trainer, you are constantly holding your training solutions against the gold standard: “What will the team do differently to increase their sales after this training?” You may hear this question
from your department head, or even the head of sales. So, it’s fair to ask, “Can market access training increase sales?”

The answer is a clear yes. The market access (MA) environment has a direct influence on the prescribing environment. This article shares examples that can be
used to convince internal stakeholders that MA training can address prescriber objections and remove barriers to use.

Here is an easy one: “I can’t write your drug for my Medicare patients. They can’t afford to pay their share of costs, especially when they’re in the Part D donut hole.”
Your curriculum should teach key points about Part D that can address this objection.

Here is an example of key insights on Part D:Payers who sell Part D plans do not have to follow the standard Part D benefit. In fact, most do not.
The original “donut hole” no longer exists. The standard Part D benefit has reduced the patient’s share of cost to 25% (from an original 100%).

With effective MA training, your sales team should be comfortable enough to address Part D objections. For instance: “Doctor, don’t assume the patient has a 25% cost share in Part D. Many plans have placed our product on a formulary tier that in some cases offers a lower share of cost. Please write the prescription and see what the patient’s benefits are. Give them a chance for access to the best therapeutic option.”

Access Restrictions

Market access is a broad term that encompasses many concepts. It pulls in the evolution of payers as they respond to healthcare reform and also considers how hospitals banding together to form Integrated Delivery Networks (IDNs) represent another potential restriction point for product access. And field teams need to understand every restriction to product access that may create hidden objections from the physician.

Pressure from the payer is an example of how the evolving payer business model has crafted new ways to restrict product access. The first segment describes how payers are changing their business models:

Payers, pharmacy benefit managers (PBMs) and specialty pharmacies are merging into larger enterprises. UnitedHealthcare (UHC), OptumRx and Briova are examples of this vertical integration between a payer, a PBM and a specialty pharmacy.
In the traditional environment, the PBM strategy was to reduce pharmacy benefit costs. Put simply, lower drug spend meant higher profits to the PBM. This drove their product access decisions.
The new relationship between payers and PBMs means they will work together with the goal of reducing overall costs, not just pharmacy benefit costs.
This dynamic is leading to the cross-management of medical and pharmacy benefits. Using our example, UHC would coordinate with Optum and Briova to reduce overall costs, not just pharmacy costs.

The next segment reveals how those changes may impact the sales effort. A change in strategy that stresses lowering overall costs rather than just pharmacy costs is a significant shift from the stakeholder that holds so much influence on access to your product. MA training would help your reps understand the entirely new competitive environment this vertical integration creates:

Formularies and treatment protocols published by payers may incorporate both categories of drugs.
New competition from medical benefit drugs may impact sales of pharmacy benefit drugs. Of course, the converse is also true: Pharmacy benefit drugs may now impact sales of medical benefit drugs.
Step edits may be defined for drugs that used to have no competition in their medical/pharmacy benefit space.

Here is how this evolving market access environment might look to a salesperson in the field (assume they are selling an oral medication for this scenario):

UHC and OptumRx merged their formulary decisions for 2021.
OptumRx published a comprehensive formulary that added an infusible treatment as a first-line step edit, moving the salesperson’s drug to second line.
The sales team now must answer objections based on an infusible competitor, which introduces these considerations for the first time:
- Patient convenience — does the patient want an infusible therapy?
- Buy and bill risk — does the prescriber prefer the no-risk scenario of writing a prescription rather than submitting claims for drug reimbursement?
- When does the clinician call the infusible treatment a failure and move on to prescribing the second-line therapy?

An effective MA training program could help the team understand when the competitive environment has changed so they can adapt their messaging appropriately.

IDNs Now Matter in the Market Access Space

So far, we’ve described MA pressures being exerted at the payer level. However, the new MA environment has placed IDNs in a position to restrict product access as well. There are two key points for reps to consider in this regard: why an IDN would restrict access to a drug, and how an IDN implements that restriction.

Here’s why IDNs restrict product access:

IDNs are accepting financial risk through contracts with payers. Accountable Care Organization (ACO) contracts are an example of this.
When an IDN has enough skin in the game, meaning they are holding enough financial risk for the cost of care, they will change their own formularies to drive use of the drugs they want prescribed (not the drugs the payers want prescribed).

Recognizing why an IDN may restrict access to drugs will help the sales team recognize which of their customers are actively doing so.

In this environment, your prescribing customers are being told what to prescribe by their employer or business partner. This can be a far stronger influence than any payer formulary. You can teach field teams to first understand the “why” as we just described, then understand “how” product access is restricted:

An IDN may create a new outpatient formulary that does not reflect any single local payer formulary.
The IDN may also implement a treatment protocol for many conditions, not just for chronic diseases.
The IDN may apply a control mechanism that is far stronger than any payer tool: the electronic health record (EHR) with e-prescribing capabilities.

It is fair to say this new IDN dynamic impacts the sales environment for everyone in the field, not just hospital teams. A sales rep walking into a physician’s practice must know if that practice is part of or even owned by an IDN. This could mean that the hospital’s EHR is waiting outside every exam room, guiding physicians to make the prescribing decisions preferred by the pharmacy and therapeutic and medical policy committees at the IDN’s headquarters.

If your product is in that EHR, the sales team has a strong pull-through opportunity. If the product is not, then the combined efforts of the full matrix team could be deployed to remove that access restriction.

Conclusion

Your MA curriculum should be broad enough to consider new payer business structures while capturing the powerful ways IDNs have created another restriction on product access. Each facet of the MA environment that impacts product access and the competitive environment is important. When a direct line is drawn between MA pressures and the sales effort, the argument for implementing a full market access curriculum becomes easy to make.

Don Benson is managing partner of ProFusion. Email Don at db@fusiontrain.com.