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Why on-demand insight is key to successful payer submissions

Jan McKendrick | 9/17/2023

In the digital age, on-demand innovation is changing the way we live—redefining everything from how we watch TV to how we pay our bills. It’s also setting new expectations in the workplace, transforming the way we access and share data, and helping organizations collaborate and make better-informed decisions. With “anytime, anywhere” access to the best information, businesses can identify trends, track change, and develop agile, evidence-based strategies.

This capability is particularly important in the development and launch of new medicines, where real-time insight is key to determining the right strategy and the right evidence to support crucial payer submissions. Without it there’s the risk that evidence packages won’t align with payer needs, undermining submissions and potentially restricting market access. With so much at stake, visibility of key information—wherever and whenever it’s needed—is paramount. Yet in some companies, disparate systems and ageing processes mean vital information can sometimes fall through the cracks, compromising the ability to make fully informed strategic decisions. Perhaps it’s time to bring capabilities into the on-demand era.

 

The theory of evolution

The environment for your product is always changing. Optimal market access therefore requires understanding—and adapting to—evolving treatment landscapes and diverse payer requirements. As we all know, the requirements of national HTA bodies, payer organizations and advisory agencies differ from country to country, with further nuances around disease and indication. What’s more, as science evolves, evidence requirements—and payers’ thinking—evolves with it. Being alert to that change, and understanding the implications for your brand, is crucial. It requires an ‘always on’ approach, and organizational agility to ensure global strategies respond to evolving thinking.

The challenges are significant. Global teams working across multiple markets often need to consider thousands of pieces of evidence collectively required by individual submissions templates. Defining the right global strategy ultimately depends on finding the commonality in payer needs, without losing the specificity of each market’s needs. But how can you do that when you’re faced with such a mountain of requirements? One approach is to break things down into themes—like comparators, efficacy, or budget impact—and then have structured, collaborative conversations across markets to identify needs, challenges and gaps in evidence in those domains of evidence. But it isn’t easy. To ensure your global evidence strategy is focused on the right areas, you need:

  • Tools of collaboration to capture and share intelligence and drive joined-up thinking
  • Anytime, anywhere visibility of real-time information
  • A systematic process to guide your thinking
  • Agile methodology to ensure you respond to change in an appropriate, timely manner

Without these attributes, it’s almost impossible to be certain that your global strategy is aligned for success.

 

Next generation solutions

So how do you do it? The best solutions rely on a combination of great tech and expert insight. Cloud technology is inspiring the next generation of access solutions, powering digital tools that provide a consistent framework for real-time decision-making across global organizations. At Avalere Health we’ve leveraged our deep understanding and global network of payer communities to develop the PRMA Healthcheck®, a cloud-based application that drives readiness for HTA and payer submissions.

The PRMA Healthcheck® gives market access teams greater visibility of current payer thinking in a structure that aligns with the very latest evidence requirements. The application supports strategic decision-making, helping companies better understand the payer landscape to ensure they’re generating evidence that best demonstrates the value of their products. The benefits can be felt across and beyond the market access function:

  • Global teams know that their access strategies are grounded in a fundamental understanding of what payers need.
  • Affiliates know that global is working in payer-relevant terms that resonate with customers. They can be confident that evidence generation plans are rooted in common payer needs, but won’t overlook critical aspects that are relevant in their markets.

 

The PRMA Healthcheck® application guides global teams through four key steps required to develop an optimal global strategy.

Jan McKendrick

Executive Director and Practice Lead, Global HEOR

avatar for Jan McKendrick - Executive Director and Practice Lead, Global HEOR

 

Four steps to optimal evidence generation

The PRMA Healthcheck® application provides a framework for evidence generation that—in tandem with expert insight from our experienced consultants—guides global teams through four key steps required to develop an optimal global strategy.

  1. Situation analysis: You need to understand payer thresholds and boundaries. Have their expectations changed? What issues have HTAs raised in the past? What do clinical guidelines say? What is currently being reimbursed?
  2. Gap analysis: Market by market, how are payers going to view your evidence package? Are you generating the most impactful evidence? Where are the gaps and opportunities?
  3. Prioritize: You can spend forever filling gaps, but which opportunities will make the biggest difference?
  4. Mitigate: Determine how you will mitigate key issues.

The methodology—powered by real-time, real-world insights—gives teams a granular understanding of each market, but, crucially, it also helps them identify common opportunities so they can make agile and efficient investment decisions at the global level.

 

Access on-demand

The anytime, anywhere approach is helping global teams—in collaboration with local affiliates—fine-tune their market access readiness. Leading pharmaceutical and biotechnology companies have harnessed the real-time insight powered by the PRMA Healthcheck® to:

  • Reorient their evidence generation strategies
  • Critically evaluate pricing to assess risks/opportunities under variable development scenarios
  • Identify critical risks for payer decision-making
  • Demonstrate value using new approaches to economic modeling.

As companies teams prepare to make payer submissions in ever-evolving markets, shared visibility of payers’ needs and perspectives has become an essential requirement. It’s no surprise that many are finding the solution is up in the Cloud.

The PRMA Healthcheck® is a gateway to real-time insight that drives evidence-based decision-making, giving access teams both the tools of collaboration and a common language for value demonstration. Powered by our expert understanding, it provides a systematic framework to validate your evidence generation strategy—whenever you need it, wherever you are.

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