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Understanding Payers: The Six Buckets of Payer Need. The Six Buckets of Payer Need. Market Access. Understanding Payers – The 6 Buckets.

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understanding payers the 6 buckets
Understanding Payers – The 6 Buckets
  • 1. Clinical Performance - The extent to which the brand performs vs. accepted clinical KPIs in the given therapeutic area. This is the key driver and will need to be in place to maximise the impact of any subsequent area of brand performance.
  • 2. Effectiveness - Payers do not want to see precious budget wasted. If it can be demonstrated that any therapy will be fully utilised (e.g. clear start-stop rules; and targeting at known responders), it is more likely to secure support from Payer bodies.
  • 3. Value For Money - what are the economic benefits of product performance; looking at the big ticket items such as hospitalisations but also reductions in co-morbidities and delaying progression to more costly stages in the disease pathway.
understanding payers the 6 buckets cont
Understanding Payers – The 6 Buckets cont.....
  • 4.  Human Impact - More important in some geographies and in some therapeutic areas than others but always of some importance; the impact of a therapy on the health of a patient, care givers or society can be critical to some decision-making bodies.
  • 5. Stakeholder Satisfaction - Payers make decisions based on the rules of the game. These rules (formal or informal) are set by external stakeholders; the extent to which a product can be seen to meet the drivers of key stakeholders (KOLs, Politicians, Patient Groups, HCPs, local budget holders) will - if effectively leveraged - influence payer decision-making.
  • 6. Assurance - So the RCT produced great results but will it work in the real world? Payers are looking to ensure that the post-reimbursement the benefits and savings will be realised; strategies need to be formulated to assure payers of real world performance.
and finally
And Finally...
  • Delivering evidence to support clinical outperformance will ensure a good hearing.
  • If this can be converted into an intelligent understanding of real payer Need with evidence of how the brand actually delivers in each area (and associated economic impact), the chance of Reimbursement at Optimal Price will be that much higher. 
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