When any new drug entering the market for a specific indication, will need to be priced, and in some cases also approved for reimbursement before it can be effectively commercialized. In fragmented markets, pharmaceutical companies may need to submit reimbursement applications to various private and public payers, however in some countries with a single-payer system, one entity would be responsible for facilitating access to a new product or indication
Today, one of the biggest challenges pharmaceutical and biotechnology manufacturers faces is ensuring they can bring the right treatments to the right patients at the right price
Market access is a complex process that takes multiple steps and a large allocation of resources to properly navigate. It can take up to $1.5 billion to complete the research and development necessary to bring a new therapy to the market
For manufacturers, pricing and reimbursement rates are a crucial component of any market access strategy, as they have a profound impact on revenue and, of course, profitability. Manufacturers must find the right balance in pricing, so that drugs are appealing to insurers, both public and private, while still remaining profitable throughout their lifecycle. Arguably, lower drug prices may mean greater adoption by insurers, whereas higher prices may prevent patients from being able to afford and purchase drugs
Market Access: By considering the reimbursement environment, developers can proactively address potential barriers and challenges that may hinder adoption of their products. Careful market analysis helps identify reimbursement or evidence gaps, coverage limitations, and navigate existing federal or state legislative policy allowing developers to navigate and align regulatory and reimbursement requirements and develop strategies to facilitate product adoption and market penetration
Coding & Pricing Strategy: Market access analysis guides developers in formulating an effective pricing strategy. By understanding the existing reimbursement landscape, including the use of billing codes recognized by payers in the competitive market at different sites of care where the product is used, developers can optimize pricing decisions and ensure affordability and access for patients. It helps strike a balance between pricing competitively and generating sufficient revenue to sustain innovation and further product development
