One Size Does Not Fit All: Think Payer Strategies, Not Strategy

Donna Kerney Correia, PhDStrategy

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Your product is nearing (or has already achieved) FDA-approval. You are putting together your commercial launch plan. Among other things, you need to formulate the payer strategy. But more realistically, there are payer strategies to consider.

Payers are unique.

Not all payers are the same. As such, it’s important to keep in mind that the payer component of your overall market access strategy will not be a one size fits all approach.

Think of it this way. Marketing today focuses on “targeted messages” and “customer-specific content”. It’s about having the right message for the right consumer. The same concept applies to the payer space. You want to achieve the best access you can for your product. You want payers to understand your value proposition. Obviously, the core features and clinical benefits of your product are unchanged; but how those particulars are perceived and valued by each payer could vary. And, realistically, what payers look for in financial considerations also varies.

Know your audience

Marketers emphasize knowing your audience. The same principle holds for marketing to payers. As noted in a previous article, payer research is essential for providing some guidance on trends in the attitudes of the payer community toward the therapeutic category and your product specifically. However, the key is to understand what each payer looks for when reviewing new products and making decisions about coverage and reimbursement. They operate in different ways and have different structures.

There are national plans and regional plans; PBMs that control the formulary; plan sponsors who act as custom clients of the PBM and those who opt for use of the national formulary, and the list goes on. Each holds its own value as a “customer” for your organization. This is where a solid, experienced, and well-connected market access team is essential (but that’s a story for another time). For now, it’s enough to acknowledge that while there will be common threads important to payers, such as cost considerations or clinical impact, the extent to which any given payer prioritizes those parameters varies as does the personnel making the decisions. What resonates with one payer may not matter so much to another. Communicating the right message to the right decision-maker is necessary.

Keep your options open

While your organization has a broad vision for the payer component of the market access strategy, it should be implemented with an understanding that adjustments may be needed. The goal is to have your product available for the right patients. What works at one payer to make that happen may not fit with another payer. Flexibility is one of three essential elements of a good market access strategy, and that includes the payer component.

When putting together the payer component, think in terms of strategies. Use target account profiles and payer research results to evaluate potential possibilities. There are likely some general guidelines in terms of financial considerations like rebates, or willingness to accept management criteria like step therapy, as part of your plan. But given all of the power that payers have in implementing these, you need to approach with multiple strategies – like contracting at the national PBM for unrestricted T3 access; while allowing restrictions at a regional plan and not providing a rebate. This type of thinking can be useful in light of the overall goals of the organization in terms of access and product utilization. One size doesn’t fit all. Be willing to adjust to get just the right fit.

Viking Healthcare Solutions has established itself as the premier provider of corporate account services and strategic planning support for the pharmaceutical and biotech industries. VHS Insights, our research division, specializing in payer profiling, market research and analytics, can help you find answers to inform your payer strategy. We support traditional and rare/specialty products to create, maintain, defend, and protect access to your product throughout its lifecycle. Bank on our experience to help you achieve successful product commercialization. Contact us at

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