Market Access & Pricing
While innovation in healthcare is skyrocketing, payers (health insurers, PBMs, employers, national health systems, and facility administrators) are more pressured than ever to save costs. These constraints are leading to increasing scrutiny on evidence and value, introduction of new cost containment measures and pricing policies, and evolving reimbursement pathways and payment models.
Strategic considerations for pricing, value, access, and evidence generation need to be integrated early and throughout product lifecycle from early development to post-marketing, to avoid significant loss of commercial potential.
How We Help
Health Advances supports clients in developing value-creating strategies to enable patient access to innovative therapies, diagnostics, devices, and digital health technologies and to optimize coverage, coding, pricing, and reimbursement that reflects the product’s value proposition and rewards innovations.
Biotech & Pharmaceuticals Strategy Competencies
- Opportunity Assessment and Revenue Proposition
- Product and Development Strategy
- Strategic Pricing and Access
- Global Launch Prioritization and Go-to-Market Strategy
- Life Cycle Management, Indication Prioritization and Strategic Pricing Across Opportunities
- Policy and Advocacy
Diagnostics, MedTech, and Digital Health Strategy Competencies
- Market Access Landscape Assessment
- Value Story Development
- Global Pricing Strategy
- Coding, Coverage, Reimbursement, and Revenue Generation Strategy
- Evidence Generation Strategy
- Health Economic Modeling
- Global Market Access Launch Prioritization
A clear and concise market access strategy is critical to ensure the successful commercialization of all products. At Health Advances we leverage our decades of experience in market access, both in consulting and in industry roles to create a holistic approach that incorporates evidence, payer, policy, regulatory and clinical considerations to generate an actionable strategy.
- Market access considerations are at the cornerstone of our work across all sectors. It is embedded in every project and a key piece of every client head’s knowledge base
- Our cross-sector collaborations bring deep expertise across healthcare settings and in areas of convergence such as precision medicine, connected devices, companion diagnostics, drug delivery, digital therapeutics, and many others.
- Our proprietary payer panel and access to real world data sets (including claims data) provide richer insights on the drivers of price potential, uptake and access, and the strategies that will ensure your innovation makes it to patients.
Strategic Market access coding, coverage, pricing, and reimbursement are a core part of our strategy consulting offerings to optimize commercial potential. In addition to our strategic insights and excellence, our partnership allows us to provide you with end-to-end solutions from product concept to payer marketing and health technology assessments.
Guided a biopharmaceutical company on how to prepare for commercialization of their lead product in 7 markets, through product value proposition (PVP) development, value-based pricing determination, launch sequence strategy incorporating commercial build out considerations and market access roadmap.
Deeply considering the payer mix, quantification of the product value by assessing the cost and clinical profiles of existing therapeutic alternatives, coding and evaluating potential tools payers could use to negotiate pricing and restrict access for a therapy delivered in the hospital, the team recommended price points that would maximize access and reflect value.
Gained internal alignment on pricing for a novel molecular diagnostic system in the US and seven EU countries to determine current estimated costs, expert views of the novel system, value of savings associated with system adoption, acceptable costs, and impact of future changes in regulation and reimbursement.
A leading molecular diagnostics company engaged our team to help understand best practices to embrace and pitfalls to avoid when building a successful market access organization and optimize adoption of its diagnostics portfolio. Synthesis of deep industry and analog insights was used to inform strategic recommendations to support the client's market access org strategy as its portfolio expands in the future.
Health Advances worked with a leading diagnostics company to develop a strategy for managing market access for novel assays culminating in the development of an interactive Excel based tool that leverages answers to a set of key questions to recommend a test specific strategy. To glean the insights to develop the tool, the team completed both an extensive primary research program with a global panel of clinicians, laboratorians, and payers, and developed detailed case studies of several past examples of diagnostic test market access strategies, both successes and failures. Ultimately, the client was able to use the tool to understand which investments would optimize the value of the Company's lead pipeline asset and planned to leverage the tool for future product launches as well.
Health Advances was engaged by a life science company to evaluate the cost benefits of different mRNA capping approaches in the bioproduction process. Our team interviewed industry experts to understand the cost drivers associated with each mRNA capping approach. Additionally, the team built a dynamic cost benefit tool to compare the economics between mRNA capping approaches and highlighted cost savings associated with the most favorable approach.
Health Advances developed a system economics model and payer strategy for a molecular diagnostics company developing novel prognostic and predictive tests for cancer. One such test helps physicians determine the optimal treatment strategy for patients with early-stage breast cancer. The team developed a system economics model based on the unique aspects of the test’s value proposition which helped differentiate the test from others in the space. Health Advances incorporated the system economic justification into a broader payer strategy based on conversations with payers and an analysis of analog diagnostics.
Prioritized global expansion opportunities for a client’s drug delivery device. Systemically ranked and narrowed 60+ countries based on a multitude of factors, including size of patient population and impact of market access and pricing considerations on likelihood of success in each market.
Evaluated the impact of Medicare reimbursement changes would have to the client’s positioning, and segmented wound care practices to identify features correlated with lower barriers to using the new product. As a result, our client was able to develop targeted marketing messages and secure a partner with proper capabilities to maximize access.
For a digital health innovation team developing a novel stroke monitoring solution, our team provided critical support for the market access roadmap, evidence generation plan, and overall commercial strategy in the US. Through in-depth assessments of pathways for analogous solutions and discussions with a range of US stakeholder, our team outlined the payment models and prospects for direct contracting or traditional coverage and reimbursement. The team collaborated with the client to define the optimal pathway based on evidence requirements, feasibility, implications for uptake, and risks.
Our team helped validate and refine the digital health strategy for a large diagnostics client, with a focus on using wearable devices and other digital technologies to improve screening, diagnosis, and disease management. Based on deep market and stakeholder insights, the team prioritized opportunities for the client and recommended a strategy for competing in these markets, including evaluation of relative attractiveness of the targeted use cases, estimated total addressable market by country, and key success factors (value propositions, key features, evidence requirements, market access, and potential partners).
An early-stage digital behavioral health company enlisted Health Advances to help categorize/stratify the payer landscape to identify which payer types are most likely to purchase their product and what operational configurations and evidence these payer segments would require. Our team examined commercial payer coverage and budget pathways as well as requirements for coverage decisions within each pathway. Interviews with executives at commercial payer organizations and other digital health companies elucidated reimbursement challenges and requirements. Armed with strong market insights we constructed a roadmap outlining the steps towards payer coverage over time.
Health Advances was hired by a biopharma industry advocacy organization to draft a white paper mapping the current landscape of initiatives related to a regulatory policy issue and providing recommendations to the FDA for future policy.
Health Advances worked with two patient advocacy organizations to develop a white paper advocating for and providing tactical recommendations for greater inclusion of the patient voice in value assessment of cell and gene therapies.
- Biotech & Pharmaceuticals
- Diagnostics, Research Tools, & Precision Medicine
- Digital Health & Enterprise HIT
Capital Equipment, Consumables, Instruments & Supplies, DME & Consumer Devices, Drug Delivery Devices
Digital Therapeutics, Drug Delivery Devices, Employer Health, Real-World Data & Analytics, Remote Patient Monitoring & Connected Devices, Tech-Enabled Services, Virtual Care, Women's Health