The Role of Patient Journey Mapping in Access Programs
For pharmaceutical companies, an effective patient access strategy starts with an in-depth...
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Bringing a pharmaceutical product to market is more challenging than ever. Payers demand stronger evidence, formularies are increasingly restrictive. Without a strategic market access plan, even the most promising therapies risk delayed uptake, poor reimbursement, or limited patient reach.
In this article, we take a deeper look at actionable market access strategies, including practical frameworks, frequently asked questions, and emerging technologies.
Contents:
Why the Right Market Access Strategy is Critical to Successful Commercialization
Learn More About TJP’s Expert Payer Access Team
Why the Right Market Access Strategy is Critical to Successful Commercialization
Research from Deloitte argues that “market access strategy is critical to therapy launch success, but traditional approaches can lack nuance…The average cost of bringing a pharmaceutical asset to market has reached US$2 billion, yet more than a third (36%) of all new launches in the United States fail to meet expectations.”
In our experience, this conclusion holds: a well-executed market access strategy is the difference between a successful launch and a stalled product. A carefully orchestrated strategy is key to reaching payers, providers, and policymakers, who each play a role in determining whether a drug gains the requisite coverage, reimbursement, and adoption for long-term success.
The following strategies provide a roadmap for pharmaceutical companies to navigate these complexities—aligning with payer priorities, demonstrating value, and ultimately providing a runway for patients to access the treatments they need.
Across all of these strategies, messaging and data should be carefully tailored to specific audiences. Formulary and coverage decisions are not always made by payers alone—responsibility can lie with pharmacy benefit managers (PBMs), managed care organizations (MCOs), government agencies, and other entities. The growing influence of group purchasing organizations (GPOs) adds further complexity, and pharmaceutical companies must be more systematic than ever about identifying ultimate decision-makers.
Pillar 1: Craft Compelling, Data-Rich Value Propositions That Speak to Payer Priorities
A strong market access strategy must be founded on a value proposition that directly addresses payer concerns. Payers prioritize cost-effectiveness, clinical differentiation, and real-world outcomes when evaluating new therapies.
To gain favorable coverage, pharmaceutical companies must clearly demonstrate how their product improves patient outcomes, reduces healthcare costs, or fills an unmet need compared to existing treatments. A well-crafted value proposition should be data-driven, payer-centric, and tailored to different stakeholders across three central messaging pillars:
Pillar 2: Be Proactive About Early Payer Engagement
Engaging payers early in the commercialization process is critical to ensure a smooth path forward for market access. Waiting until launch to introduce a product to payers can lead to delays, suboptimal coverage decisions, and missed opportunities for formulary placement. A proactive approach to early engagement should include:
- Pre-launch consultations: Conduct advisory board meetings or informal discussions with payers to gauge initial reactions and identify potential coverage barriers.
- Pilot programs and real-world data (RWD): Where feasible, explore limited launch pilots or RWD collection strategies that demonstrate the product’s value in clinical settings before broader commercialization.
Pillar 3: Focus on Key Opinion Leaders
Key opinion leaders (KOLs) hold significant sway over payer decision-making, helping to shape formularies, treatment guidelines, and reimbursement policies. These experts—whether leading physicians, researchers, or healthcare policymakers—can offer critical, authoritative insights into clinical and economic considerations that matter to payers.
A variety of tactics may be helpful in this regard. First, instituting advisory boards or roundtables can help provide a formal forum for KOLs to share insights on unmet needs and potential coverage challenges. Second, sharing preliminary clinical and health economic data may help address potential objections or issues early in the process. Finally, enthusiastic KOLs should be supported in disseminating a therapy’s potential through venues like conferences and peer-reviewed journals.
Pillar 4: Maximize HEOR Impact with Thoughtful Market Access Integration
Effectively integrating Health Economics and Outcomes Research (HEOR) as part of a robust market access strategy is critical for demonstrating the greatest possible value in payer negotiations. HEOR insights should not operate in isolation but serve as a foundation for data-driven engagement that resonates with payer priorities.
First and foremost, HEOR evidence should be distilled into data-driven value propositions that speak directly to payer priorities by emphasizing cost-effectiveness, improved patient outcomes, and system-wide efficiencies. Wherever possible, supplement this foundational data with budget impact models, cost-effectiveness analyses, and comparative effectiveness research to further emphasize fit with payer needs.
Proactively aligning HEOR findings with payer concerns will help pharmaceutical companies ensure that their economic value story is not just compelling but indispensable to securing optimal formulary placement and reimbursement terms.
Pillar 5: Plan Proactively for Formulary Placement
Formulary status is more than just a coverage decision. The difference between a preferred placement and a restricted tier can significantly impact uptake and long-term commercial viability. To maximize formulary access, pharmaceutical companies should:
- Engage early with payers and PBMs: Establish relationships well before launch to understand formulary decision criteria and potential barriers to access.
- Demonstrate clear economic and clinical value: Integrate compelling HEOR data, AMCP dossiers, and real-world evidence to justify inclusion in preferred treatment tiers.
- Anticipate step therapy requirements: Many payers implement utilization management tools that restrict access. By proactively addressing these hurdles with cost-benefit analyses and provider education, brands can improve positioning and uptake.
Pillar 6: Emphasize Site of Care Optimization
Manufacturers should work with HCPs, pharmacies, and payers to ensure patients receive treatment at the most cost-effective and clinically appropriate location, whether that is a hospital outpatient department, a standalone treatment center, or at home.
From a payer perspective, site-of-care decisions directly affect the total cost of care. For example, hospital-based infusions often come with higher reimbursement rates and facility fees, making them a frequent target for utilization management. Payers may favor alternative settings that offer comparable clinical outcomes at a lower cost.
For market access teams, that means ensuring coverage clarity, coding support, and infrastructure planning are in place to make alternative sites viable. Clear documentation on medical necessity, logistics, and safety in non-hospital settings can help target potential access barriers and ease payer concerns.
Pillar 7: Build a Team with Cross-Functional Expertise
A successful market access strategy requires coordination across multiple internal stakeholders to ensure alignment between clinical, commercial, regulatory, and payer engagement teams. By assembling a cross-functional team early in the commercialization process, companies can proactively address access challenges and streamline execution while assembling the right collection expertise.
Pillar 8: Use HUB Services to Streamline Prior Authorization and Reduce Payer Friction
Prior authorization (PA) remains one of the most persistent barriers to timely access. Even when therapies are covered, administrative complexity and inconsistent payer requirements can lead to delays, denials, and provider frustration.
A centralized HUB can play a key role in reducing that friction. The HUB supports benefits verification and coordinates the PA process to ensure that provider submissions are complete, timely, and aligned with payer expectations. This work includes collecting necessary documentation, flagging common omissions, and providing pre-populated templates that reduce the administrative lift for prescriber offices.
Importantly, a strong HUB can directly improve payer-facing execution. By streamlining documentation and minimizing back-and-forth, HUBs help shorten approval timelines and reduce the volume of rework and appeals.
Pillar 9: Ensure the Right Tools are in Place
The right tools can play a critical role in shaping a successful market access strategy by providing payers with clear, data-driven justifications for coverage decisions:
- Cost calculators: These tools help quantify the financial impact of a therapy, allowing payers and providers to assess potential cost savings, budget impact, and long-term economic benefits compared to alternative treatments.
- Budget impact models: Used to demonstrate how a new therapy will affect a payer’s budget over time, these models incorporate real-world data, utilization forecasts, and cost-offset scenarios to highlight value and affordability.
- Messaging platforms: A centralized system for managing and tailoring market access messaging across payer, provider, and policymaker audiences, ensuring consistency while allowing for customization based on stakeholder priorities.
Pillar 10: Plan to Optimize Pull-Through
Securing payer coverage is only half the battle. True market access success depends on ensuring that coverage translates into provider adoption and patient uptake. An effective pull-through strategy bridges the gap between formulary wins and real-world utilization, aligning key stakeholders to drive both prescription and treatment adherence. To optimize pull-through, pharmaceutical companies should implement a structured framework that includes:
- Targeted messaging: Equip teams with clear, data-driven messaging tailored to providers, reinforcing formulary status, reimbursement pathways, and patient benefits.
- Stakeholder collaboration: Engage payers, providers, specialty pharmacies, and patient advocacy groups to streamline access, minimize administrative burdens, and improve treatment initiation.
- Performance metrics: Track prescription trends, provider engagement, and patient adherence data to identify gaps and refine pull-through efforts dynamically.
Frequently Asked Questions
What Is Market Access In the Pharmaceutical Industry?
Market access refers to the process of ensuring that patients can obtain a drug by securing coverage, reimbursement, and formulary placement from payers while demonstrating clinical and economic value.
What Is A Market Access Strategy?
A market access strategy is a structured plan that pharmaceutical companies use to optimize payer engagement, formulary positioning, and reimbursement, ensuring that new therapies reach patients efficiently and cost-effectively.
What Market Access Factors Should Pharmaceutical Marketers Be Aware Of?
Pharmaceutical marketers must consider payer expectations, formulary restrictions, pricing and reimbursement landscapes, real-world evidence, and evolving healthcare policies to develop an effective market access strategy.
Learn More About TJP’s Expert Payer Access Team
Success in market access requires more than a great product—it demands a strategy that aligns clinical value with payer priorities, anticipates regulatory shifts, and adapts to an evolving healthcare landscape. From early payer engagement to data-driven decision-making, each element of a market access strategy must be carefully executed to drive product uptake and patient access.
At TJP, we bring deep expertise in payer access strategy, leveraging real-world insights, robust HEOR capabilities, and proven commercialization frameworks to help pharmaceutical brands secure coverage and maximize adoption. Whether you’re planning a launch or optimizing market access for an existing therapy, our team provides the strategic guidance and execution support needed to navigate complexity and achieve sustained success.
Learn more about our approach to market access strategy and how TJP can support your next launch.
About the Author
Michael Price
Michael Price is Vice President and Director of Payer Marketing at TJP, where he has spent over a decade helping pharmaceutical brands overcome market access challenges. He leads the development of strategic payer platforms, digital engagement tools, and commercialization plans that drive brand differentiation and pull-through. With experience across specialty and rare diseases, Michael is known for connecting data, content, and strategy to improve access outcomes. His work empowers clients to navigate the evolving payer landscape with confidence.