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Market access in the biotech and pharmaceutical industry is focused on ensuring patients can get the medications they need at a price they can afford. As the healthcare landscape changes and more targeted and tailored treatments hit the market, access has become increasingly complicated and important.
Insurance companies, prescribers, and regulators require evidence that new treatments are effective and worth their costs. Without a comprehensive market access strategy, therapies might not reach the people who need them most.
This guide provides a roadmap exploring the key challenges a pharma market access team must overcome to be successful. From navigating reimbursement barriers to improving affordability, a well-executed, agile market access strategy is critical to achieving optimal patient outcomes and commercial milestones.
Market access in biopharma is a complex, integral function that is responsible for ensuring that new specialty therapies are approved, affordable, reimbursed, and accessible to patients. It’s the what, the where, the how, the when, the ‘at what cost’, and ‘under what coverage criteria’ that bring a new product from concept and pre-launch planning to execution.
Bringing a drug to market involves much more than regulatory approval, market access professionals must work with insurers, policymakers, prescribers, and internal teams to establish a pricing strategy, secure coverage, and navigate pharma reimbursement policies. Without a strong market access foundation, even the most innovative treatments may face insurmountable barriers.
A successful market access approach not only helps guarantee that treatments reach the right patients but also accounts for pull-through and persistence rates. Leading pharmaceutical manufacturers today aren’t just concerned with getting patients onto therapy; they want patients to stay on therapy to achieve their desired health outcomes. Market access today is more than demonstrating a drug’s value to payers and streamlining distribution; its access and affordability programs, education, and ongoing support services to ensure that game-changing therapies are available to those who need them.
Still, the rise of specialty drugs has made market access much more complex. Traditional access strategies may no longer be enough, making it vital that biopharma companies take an innovative approach to market shaping and overall access. More often than not, this requires manufacturers to differentiate—and win—on the overall treatment experience, which is no small feat in today’s evolving healthcare landscape.
Pharma market access teams frequently encounter the following challenges in securing treatment coverage, managing costs, and streamlining the patient journey to access and initiate treatment.
Roughly 30% of the global data volume generated today comes from healthcare, but despite being data-rich, most biopharma companies struggle to connect this data and unlock insights at scale. Disparate data systems and varying criteria make it challenging for healthcare decision-makers to coordinate across payers, regions, and regulatory bodies.
Field reimbursement professionals require industry expertise and excellent communication skills to navigate these complexities. Without the right tech and data infrastructure, market access teams struggle to operate efficiently or effectively.
High therapy costs and inconsistent reimbursement policies present significant barriers to patient access. Approximately 30% of Americans have reported not taking their medications as prescribed due to high drug prices, leading to worse health outcomes and increased hospitalizations.
Studies have shown that a 10% increase in patient cost-sharing can decrease medication adherence by 5.4% to 6.2%, depending on the medication class. This non-adherence contributes to disease progression, complications, and higher healthcare costs.
Market access teams must navigate these financial challenges to ensure patients can afford their prescribed treatments. Implementing strategies to reduce out-of-pocket expenses and streamline pricing and reimbursement processes is crucial to improving patient outcomes and reducing overall healthcare expenditures.
Another challenge in biopharma market access is siloed patient data. Without centralized data into where patients stand (across prescribers, SPs, HUBs, copay systems, etc. – just think of the number of stakeholders involved in the process!), market access teams will struggle to track and understand what is needed to efficiently and effectively move patients towards their next milestone.
In addition, a lack of data integration can make it difficult for teams to provide clear evidence of a therapy’s value to support reimbursement strategies and negotiations. In such cases, running a health technology assessment (HTA) and using health economics can help assess the cost-effectiveness of treatments; however, without unified data, this process remains fragmented and risks being less effective.
Treatment adherence issues arise when patients and providers are not properly engaged, educated, and supported. All of this understandably impacts therapy success rates, so a market access director and their team must work closely with HCPs to ensure regular, relevant provider education, outreach, and engagement often impact therapy effectiveness.
Best-in-class biopharma teams are using innovative strategies like those below to overcome barriers and redefine market access.
Specialized technology solutions, like Courier Health’s patient CRM built specifically for biopharma field access, can streamline operations and supercharge your team to be more efficient and strategic in their day-to-day.
Currently, many teams juggle five or more disparate systems, leading to inefficiencies, data silos, and increased administrative burden. In contrast, a purpose-built tech solution can provide a unified platform that enhances productivity, improves data accuracy, and allows teams to focus on high-value strategic activities.
The Courier Health Platform unifies patient, provider, and healthcare organization (HCO) information and communications, improving digital data flow and streamlining overall coordination. In addition, intelligent next-best-action recommendations help access and reimbursement teams prioritize tasks and HCP account engagement, optimizing their global market access outreach.
Market access teams sit central to the commercial org, interfacing with internal patient services, sales, external HUBs, distribution, copay systems, and more. A single system for logging all interactions, including calls, emails, and faxes eliminates the need for internal and external teams to switch between platforms to understand what is happening with patients and who has communicated what. In addition to saving them precious time, it also gives them the patient’s full history and context before reaching out. This helps drive higher-quality patient and provider interactions.
Innovative and strategic tech investments empower market access managers and their teams with real-time, actionable insights, enabling them to take the necessary steps to move patients toward the next milestone. With streamlined reporting and analytics, teams can unlock the holistic market research and performance insights needed to understand macro and micro trends, track SOP effectiveness, and adjust strategies as needed.
Advanced data analysis capabilities not only enhance decision-making but also help teams establish a baseline standard for continuous performance improvement.
Additionally, as market access teams work to overcome barriers, outcomes research becomes even more powerful. A comprehensive view of therapies' real-world effectiveness can support payer negotiations, improve access, and ensure treatments meet patient needs.
Courier Health’s patient CRM platform was designed to meet the unique needs of biopharma field access and patient services, with patient data and the patient journey at the core of features and functionality. With capabilities designed to streamline their daily work, it helps simplify patient, provider, and HCO management and optimize access and reimbursement pathways. By centralizing patient journey data into a single command center, the CRM helps biopharma commercial teams more easily understand and optimize program performance.
The solution is also highly configurable, allowing for quicker implementation and time-to-value.
In addition, dynamic workflow automation boosts efficiency by reducing manual tasks and increasing visibility into the various journeys patients and providers take, from initial awareness and activation through therapy initiation and adherence.
The Courier Health Platform surfaces real-time insights that enable a pharma company client to unlock more informed, data-driven decision-making. This includes tracking SOPs effectiveness and using data to understand individual and team performance and workload distribution.
Some additional strategies that biopharma companies can take include the following.
It’s vital that life sciences organizations give market access and patient services leadership a seat at the executive leadership table. When these teams are involved early in pre-launch planning and program setup, they can provide valuable patient and provider journey-related insights that increase overall program effectiveness. They have a valuable POV and voice that should be included at every stage to drive better patient and business outcomes.
Once the end-to-end patient journey is mapped, cross-functional teams must collaborate to define key touchpoints, from initial outreach and treatment education to ongoing support. Aligning on clear success metrics—such as patient engagement, adherence, and health outcomes—allows teams to measure and refine their strategies effectively.
By fostering alignment across departments, organizations can create a unified, patient-centric approach. This ensures patients receive timely, relevant information that is tailored to them. Strategic coordination empowers teams to make data-driven decisions that enhance both patient experiences and overall healthcare impact.
With the rise of field reimbursement, commercial leaders must evaluate their existing processes and systems and consider strategic technology investments to upgrade their operations. Leading-edge technology platforms will empower market access teams and field reimbursement managers (FRMs) by providing them with improved data visibility, advanced automation, and proactive insights to ensure faster and more efficient access to therapies.
Finally, biopharma commercial teams should future-proof their investments by focusing on flexible technology that is able to easily scale up or down. A flexible infrastructure designed specifically for life sciences makes it easier to adapt to changes, whether adding new indications, launching additional therapies, or configuring a system to meet your needs.
Gaining more control over the patient experience does not mean asking internal consultants (at great time and expense) to make a change. Scalable solutions empower manufacturers with the internal data and capabilities to optimize resource allocation and program performance.
Market access is integral to bringing innovative treatments to the patients who need them, ultimately increasing the likelihood of product and business success. In the fragmented U.S. healthcare landscape, biopharma companies need a skilled—and empowered—market access team to creatively tackle access, affordability, and engagement barriers.
Equipping these teams with the right tools – connected systems, AI-powered workflow automation, and advanced analytics – allows them to perform at the highest possible level.
Innovative solutions like Courier Health’s patient CRM help simplify this, making it easier for biopharma companies to remove access barriers, quickly adjust to changing market dynamics, and support patients throughout the process.
To stay competitive, biopharma organizations must embrace innovative digital solutions. Courier Health gives market access and FRM teams the tools they need to succeed. Get in touch with our team today to learn how our purpose-built approach can support your market access initiatives.
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