When the Covid-19 pandemic hit the UK, many processes were put on hold, including in-person clinical trials and face-to-face meetings. The pandemic has certainly created huge barriers for how the NHS engages with patients and manages treatments, but health authorities are committed to working with industry to ensure new treatments or strategies are fit for purpose and have continued to hold formulary meetings, albeit virtually.
After emergency measures settled in response to the crisis, payers and clinicians have seemed even more open to engage in providing insights to the industry. There seems to be an understanding that the great challenges of our day necessitate collaborative working and understanding of NHS payer perspectives not only due to Covid, but also the new restructuring of the NHS. These discussions have created opportunities to discuss novel added value initiatives by the industry, including wrap-around care packages or innovative payment and access schemes.
However, the path to managing locally offered packages – those not approved for the whole population through NICE – is complex. Indeed, there can be significant variation between individual trusts or health boards when it comes to a new type of treatment, depending on capacity, expertise and what they are looking for. Companies and their market access consultancies have had to be prepared to understand and address those differences, and be aware that, by its nature, the NHS is not designed to handle ever-changing and out-of-the-ordinary offers in a nimble way. Having said that, Covid challenged this preconception and the NHS became incredibly agile, to the surprise of its internal and external stakeholders.
The good news for the pharmaceutical industry is that there is a big England NHS restructuring in the works aimed at creating a more holistic approach to the health needs of the population. What that means, though, is that companies will have to demonstrate the value of their products to the healthcare system as a whole rather than a single trust or clinical commissioning group (CCG). It will no longer be enough to simply say this drug saves X number of days in hospital; rather, the argument must consider what happens next and whether the burden has simply shifted to the community setting. System redesign has now fallen into the sphere of health economics which previously just considered Drug A vs. Drug B in one healthcare setting or budget pot.
How pharmaceutical companies and their consultancies manoeuvre the intricacies of current and future NHS expectations can be fraught. It requires knowledge of the system, the ability to engage with the right people to gauge their opinion, and an understanding of how to use the information gathered to shape submission to NHS decision makers.
At Gatehouse ICS, we have built a reputation for rigorous and strategic research and strategic advice for market access consultancies and their pharmaceutical customers. We have a team of experienced stakeholder engagement research analysts who search consistently and persistently for the right people.
Typically, our interview-based research for big pharma is outsourced via consultancies. These businesses turn to us for a wide range of support – from finding clinical or payer contacts that they haven’t been able to reach, to filling gaps in recruitment, to conducting the interviews, preparing the reports, and presenting that to the pharmaceutical end-client.
Typically, we work as part of the consultancy, embedded within their system, using their email, attending client pitches and regular update meetings with the client to contribute to the market research and help shape the project, and keeping all parties updated on the project’s progress.
People, process, compromise
Recruitment is a huge issue for companies as they seek to gain insights to shape and inform their strategy for getting trusts to consider their product. Our extensive LinkedIn network means we are able to reach the right people with the knowledge and experience in the disease area, local environment and clinical need to help the company gain important insights. We can also support the consultancy in areas such as the discussion guide and questions, whether by providing input or reviewing what has been developed.
Typically, we have regular ongoing calls with the pharmaceutical customer and the consultancy early in the project to clarify the types of insights they are seeking to uncover with the research; for example, are they looking for a strategy to do a product launch, do they have a scheme or package in mind, or are they simply looking to message test how they would market and sell their product?
We also work with the customer to determine where they are seeking insights, such as which countries they want to involve, and the proportion of interviewees from each market. For example, in the UK we often see the largest focus on England, but with some interviews requested from the devolved nations of Wales, Scotland and Northern Ireland. For European projects the panel often extends to the rest of the EU5 countries (Germany, France, Italy and Spain in addition to the UK). The type of experience the customer needs is also integral to our outreach, whether that is clinicians with experience in certain aspects of patient conditions, pharmacists, payers, and so on.
Once the research is complete, we pull together a clear but comprehensive report, detailing paraphrased key themes and reporting the core qualitative and quantitative data, providing meaningful insights from the interviewee responses to inform decisions.
I have been working with a company that is seeking to launch a product in a crowded marketplace and wanted to find out what they could offer with the product to make it more appealing to the NHS. The challenge for the company is that there was a large variation in responses, but that is fairly standard across the NHS, where each locality has to look at its own needs and capacity. In such a case, our report can be detailed and qualitative as key common trends are difficult to elicit.
What we do is to assess what each trust is willing and able to process. If there are challenges with what is being proposed, I ask for an alternative: What would be the ideal offering from the pharmaceutical company. While these can be poles apart, it is helpful to know the two ends of the spectrum with the objective of finding a middle ground.
This is where my background helps. I have been in market access for 15 years and have experience across all stages of the process – pre-launch, HTA submission preparation, advanced budget notification and formulary inclusion strategy, and research to formulary application and listing, to much further in the lifecycle where an established product is looking to expand its reach. I have an ability to look at the big picture to try to find the win-win opportunities for both sides while understanding the details needed to ensure the process is properly validated.
As the NHS undergoes restructuring and faces ever-increasing financial pressure, that ability to determine need, find compromises and solutions for all parties and uncover those aspects of the strategy and product that perhaps are not properly understood will become more and more important.