Bringing a pharmaceutical product to market is more challenging than ever. Payers demand stronger evidence, formularies are increasingly restrictive, and evolving policies like the Inflation Reduction Act are reshaping pricing dynamics. 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.
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Why the Right Market Access Strategy is Critical to Successful Commercialization
Learn More About TJP’s Expert Payer Access Team
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.
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:
A well-structured pricing and reimbursement strategy is essential for maximizing payer acceptance while sustaining long-term commercial viability. For example, a tiered pricing approach can help balance affordability and profitability, accounting for factors such as willingness to pay and the broader competitive landscape.
To achieve optimal pricing, pharmaceutical companies should develop flexible models that account for payer cost constraints while maintaining revenue goals. This includes evaluating reference pricing benchmarks, exploring value-based agreements, and leveraging real-world evidence to justify pricing decisions. Reimbursement negotiations should proactively address payer concerns around budget impact and long-term cost savings, ensuring alignment between clinical value and economic sustainability.
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:
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.
Engaging with KOLs early in the market access process allows pharmaceutical companies to build credibility and generate advocacy that strengthens their value proposition.
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.
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.
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:
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.
Establishing alignment across this diverse team requires structured collaboration from the outset. Market access specialists must work closely with HEOR and medical affairs to refine evidence-based value propositions, while commercial teams ensure messaging resonates with payer priorities and field execution needs. Regulatory affairs must stay engaged to anticipate compliance hurdles, while pricing and reimbursement experts develop strategies that balance affordability and profitability.
Fostering cross-functional integration from early development through launch is the best way to connect these diverse experts through a market access strategy that is both adaptable and cohesive. From the inception of a market strategy, all team members should have clearly defined roles and responsibilities, ample opportunities to provide input, and a cohesive vision of the over-arching market access strategy.
The pharmaceutical market is constantly shifting due to policy changes, payer consolidation, evolving value-based care models, and new cost-containment measures. A rigid market access strategy can quickly become outdated, making adaptability essential for long-term success.
To stay ahead, companies should monitor payer trends, regulatory updates, and competitor moves in real time, adjusting strategy accordingly. For example, the Inflation Reduction Act contained critical provisions for shaping market access strategies:
The future of market access strategy is increasingly data-driven, with AI and predictive analytics playing a growing role in optimizing payer engagement, pricing models, and patient access strategies. These tools can help pharmaceutical companies make smarter, faster decisions by identifying trends, forecasting reimbursement challenges, and refining value propositions based on real-time insights. Potential use cases include:
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:
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:
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.
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.
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.
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.