Market Access

Support Areas

• State market intel
• Managed Medicaid and FFS strategy
• Carve-out positioning
• Message testing
• Rebate strategy (supplemental)
• Competitor analysis
• P&T support

Typical Projects

• Multi-variate market targeting model
• Agency messaging strategy
• Stakeholder sequencing analysis
• Pilot partner diligence and support
• Health plan unit talk tracks and sequencing
• Capture projections and revisions
• National logo health plan strategy and execution support

Typical Key Objectives

• Identify top 5 markets for near-term coverage enhancement opportunities
• Develop milestones plan for market sales launch
• Identify major pathways and checkpoints for national logo plan sales conversations

Staff Training

Support Areas

• Quarterly staff summit learning content
• Stakeholder Q&A sessions
• Flexible direct support
• Custom training content development

Typical Projects

• Large staff industry sessions
• SME monthly retainer for sales teams
• Custom online course development for in-house use
• Executive workshops focused on Medicaid market vs other markets

Typical Key Objectives

• Create sales team HHS training syllabus and learning objectives for relevant knowledge area
• Profile target market for pre-launch knowledge transfer

Regulatory Analysis and Diagnostics

Support Areas

• State regulatory analysis
• Budget and committee trends assessment
• Situation analysis

Typical Projects

• True-barrier analysis
• P&T scope review and recommended coverage strategy
• Legislative committee analysis and agenda support
• Legislative drafting support (in coord. with in-house GA team)

Typical Key Objectives

• Identify key regulatory sections driving coverage challenge
• Compile state agency regulations and rules from model states
• Prepare content for agency decision maker discussions

National Managed Care sales strategy

Scenario

Manufacturer sales executive team assumed national Medicaid plan logos made centralized coverage decisons. After 2 years of limited success, decided to explore fundamentals of Medicaid market in depth

Solution design

Classification for centralized/de-centralized nature of 6 national Medicaid Managed Care orgs; drill down into specific state market opportunities and sales paths; recommended staging of local vs national HQ efforts

Results

Client right-sized sales effort and was able to staff effectively using a hybrid local and national approach

State Medicaid Market Access Playbooks

Scenario

Manufacturer sales team struggled to meet aggressive covered lives targets in Medicaid markets and realized a strategy reset was needed in core target states

Solution design

Comprehensive analysis of state Medicaid market, including: coverage landscape, PBM dynamics, Key Opinion Leaders (KOLs), regulatory assessment, P&T assessment, managed care sales paths and time to increased coverage modelling

Results

Sales projections aligned with market realities; Key stakeholder meeting sequence and opportunity windows used by Client team to redirect efforts

Medicaid market sales collateral enhancement

Scenario

Manufacturer sales team recognized the need to adapt sales decks and talk tracks to the Medicaid managed care space

Solution design

Collateral review for commercial content; redesign for Medicaid audience

Results

Increased engagement in Medicaid health plan sales meetings; reduced time to complete health plan sales path

Enhanced Supplemental Rebate strategy

Scenario

Manufacture client sales team identified consistent losses of market share to competitor in state markets and decided to explore a revised supplemental rebate strategy

Solution design

Assessment of client competitor success for same product class; targeting for high opportunity state PDLs; initial modeling of supplemental rebate impact

Results

Enhanced strategy for competing in key markets with competitor product; Progress with decision maker dialogue at PBM target

Legislative barrier diagnosis

Scenario

Manufacturer government affairs team was unable to move coverage efforts forward in 2 key markets

Solution design

Situation analysis / diagnosis; comprehensive review of submitted legislation related to coverage of client product; local level intelligence gathering; key contact identification and profiling

Results

Client government affairs team able to focus on precise regulatory challenge and move efforts forward in session more effectively

Coverage pilot project design

Scenario

Manufacturer market access team needed to develop case studies showing benefit of product for Medicaid population

Solution design

Identification of key stakeholder partners in state market; development of value proposition to pilot participating organizations; initial study design and talk tracks for state stakeholders; financing model recommendations tied to Medicaid reimbursement

Results

Engagement with key local stakeholders; Early education about coverage benefits with agency staff

P&T engagement strategy

Scenario

Client team struggled to manage the differing requirements and methods of pharmacy and therapeutics (P&T) committees in multiple states

Solution design

Profile of P&T committee rules and general decision-making process; evaluation of evidence submission guidelines; review of major decisions in past 2 years; suggested presentation content; local-level intel on key influencers on committee

Results

Increased stakeholder engagement rate as measured by follow-up completion and agenda positioning

Carveout strategy (NY and CA)

Scenario

Manufacturer identified disruption risks in major state markets tied to state removing pharmacy benefit management from Medicaid managed care plans.

Solution design

Evaluation of Medicaid carve-out efforts in 5 major state markets; legislative and implementation tracking; recommendations for positioning post-move and during transition

Results

Enhanced strategy for largest Medicaid market to reduce transition risk and ensure better placement post-carve out

Sales staff training

Scenario

Manufacturer market access team needed long-form training workshop to support major coverage effort launch

Solution design

Collected questions from sales team in advance of session, content development by former HHS executives and pharma experts, coordination with client GA team for compliance; day 1 for knowledge transfer, day 2 for sales team role-play exercises

Results

100+ account managers trained of specialized topics critical to market access targets; enhanced capacity for unique selling topics in the Medicaid space

Our unique advisory  model

• Focus on Key Objectives and Impact Statements ensures focus and results
• Right amount of right brain avoids “FTE deadweight” and optimizes expertise fit
• Project management discipline delivers results on time and on-budget AND gives client line of sight into progress

A Focus on Key Objectives

• The so-what: We stay laser focused on your results

Example key objectives from a recent client project

How it all fits together

The Right Amount of the Right Brain

The So-What: You get optimized expertise and no FTE deadweight

How: our precise needs discovery model and Key Objectives focus allows for very precise expertise planning

Project Management Discipline

The So What

• Objectives Are Met
• There Are No Surprises
• The Work is On Time