Oncology: A Pinnacle of Innovation in Biopharmaceuticals
Oncology products stand out as a **cornerstone of biopharmaceutical innovation**, propelling both **revenue growth** and **scientific breakthroughs**. With the global oncology drug market projected to reach **$409 billion by 2028**, its significance in industry pipelines and sales cannot be overstated1,2.
Yet, despite the immense potential, **securing market access for oncology therapies** presents a unique set of challenges. The **high-stakes** nature of cancer care, coupled with rapid scientific advancements and increasing payer and regulatory pressures, necessitates a more **specialized approach** beyond conventional market access strategies.
The Shift in Market Access Strategies
Foundational market access principles—such as **robust clinical evidence**, **early engagement** with healthcare stakeholders, and **compelling value propositions**—remain essential. However, the nuances of oncology—which include **personalized medicine**, **diverse treatment modalities** like immunotherapy, and evolving payment models—demand a more intricate strategy.
Success hinges on **deep market expertise** and a **seamless integration** of tactics that span market access, patient services, and medical affairs, allowing biopharma companies to craft **effective, tailored strategies**. Without a forward-looking approach, companies risk falling behind in an increasingly competitive market.
Understanding Oncology Market Access Dynamics
Unlike other therapeutic areas, oncology market access is rarely dictated solely by **payer negotiations** or **coverage**. It demands a **sophisticated, multi-dimensional strategy** that interweaves **clinical expertise** with an in-depth understanding of various stakeholders within the healthcare ecosystem.
Market access leaders must navigate a complex landscape that encompasses **clinical**, **operational**, and **financial factors** across diverse customer segments—including **integrated delivery networks (IDNs)**, **group purchasing organizations (GPOs)**, **oncology-oriented benefit managers**, **specialty pharmacies**, and **community oncology entities**.
Multi-Stakeholder Perspectives in Oncology
Multi-stakeholder engagement is particularly pivotal in oncology due to the influence of **medical benefit design** on combined drug regimens and multi-modality treatment plans, which may involve surgery or radiation. Key considerations include **oncology pathways**, **value-based care models**, **site-of-care optimization**, and **patient support programs**.
These elements enhance access at critical junctures of the patient journey, from **patient identification** and **biomarker testing** to **adherence** and management of financial and clinical toxicity. Simply securing **formulary placement** or a favorable coverage policy is merely the first step in a larger fulfillment—comprehensive market access requires a deeper approach for successful adoption.
1. Clinical Evidence: Elevating Market Access
A compelling clinical value story is not just a competitive differentiator; it is a **necessity**. In oncology market access, strategies must extend well beyond payer-focused tactics to encompass **clinical pathways**, **institutional protocols**, and real-world treatment settings. Failing to present a robust value proposition may result in a product achieving **FDA approval** and **NCCN guideline recommendations** but struggling to secure a preferred pathway position, thereby limiting access and commercial success in unanticipated ways.
The Impact of Oncology Pathways on Product Access
Clinical pathways significantly influence treatment decisions. As an example, MMIT highlighted a case where multiple PD-1 inhibitors were **FDA-approved** for late-stage urothelial cancer and covered by payer formularies. However, an IDN's pathway program designated only one PD-1 inhibitor as preferred, potentially restricting prescriber options and access to other viable treatments3,4.
This situation emphasizes the need for value propositions that align with pathway placements among various stakeholders, as each has distinct incentives that may not consistently align.
2. Cultivating Trust with Healthcare Professionals
Building trust with healthcare professionals (HCPs) is crucial in oncology. The complexity of treatment decisions, rapid innovations, and tailored regimens make this engagement particularly challenging. Unlike other therapeutic areas, oncology often stretches across both **medical** and **pharmacy benefits**, involving multi-specialty treatment modalities—extending from **diagnosis** to **survivorship**.
To foster this trust, biopharma companies must showcase a profound understanding of the **clinical**, **operational**, and **financial intricacies** oncologists encounter. This engagement necessitates an **omnichannel approach**, emphasizing educational resources that enhance decision-making and **outcomes management** throughout the patient journey. Studies show that oncologists manage over **200 cancer conditions** with limited field engagement, highlighting the need for **efficient**, **meaningful messaging**5,6.
A dearth of effective field tactics can hinder oncologists' prescribing ability, particularly against a backdrop of staffing shortages. **Compliant tactical solutions**—like order sets and seamless collaboration between commercial and medical teams—must underpin educational initiatives to facilitate scientific exchanges regarding toxicity management and adherence, ultimately nurturing trust and enriching relationships across the biopharma landscape7.
3. Financial Value Proposition: Navigating Diverse Payment Models
In the diverse landscape of oncology, a well-outlined **financial value proposition** is paramount, especially given the nuances of payment models and practice economics. A staggering **over 50%** of revenue for oncology practices originates from buy-and-bill drug reimbursements, contrasting starkly with practices like primary care, which rely more heavily on evaluation and management services8.
Misunderstandings surrounding the non-clinical influences on prescribing can muddle strategic direction, often to the detriment of market access. Here are key financial levers to consider when constructing contracting strategies and payment models:
Key Financial Considerations
Payer Arrangements: Effective contracting strategies must address both **fee-for-service (FFS)** and **value-based care (VBC)** models, focusing on drug margins and rebates while considering evolving drug pricing regulations like the **Inflation Reduction Act (IRA)**9,10.
Product Complexity and Site of Care: Treatment regimens involving **bispecific antibodies** often require inpatient initiation followed by outpatient maintenance, creating multifaceted financial considerations. Costs can differ immensely based on the **site of care**, further impacting product adoption and economic viability11.
Alignment with Practice Goals: For oral therapies governed by pharmacy benefits, a robust **network dispensing strategy** is crucial, especially for limited distribution products. Aligning market access strategies with network design enhances engagements with **community oncology practices** and bolsters medication adherence12.
Biopharma companies must adopt **flexible financial value proposition strategies** that deliver value across varied customer segments and payment models. Conventional rebate-focused tactics may fall short at the practice or IDN level. Instead, **value-based contracting** or other flexible pricing strategies can provide greater adaptability and value across the patient journey.
The Path Forward: Embracing Oncology Expertise
To thrive in the intricate world of oncology market access, a tailored approach that surpasses traditional frameworks is necessary. As drug costs rise and payer controls tighten, the future will demand uniquely crafted managed market strategies that balance **product access** with **affordability** and **outcomes**. Forward-thinking oncology strategies should encompass:
**Integrated insights and omnichannel engagement**, utilizing educational tools and support programs to foster collaboration across different health sectors for streamlined adoption.
**Comprehensive clinical expertise** that spans the entire patient journey from diagnosis to end-of-life care, incorporating insights from diverse stakeholders like IDNs and GPOs.
A **forward-looking clinical and economic value**, aligned with evolving payment models across both **FFS** and **VBC** structures, addressing future challenges in the healthcare landscape.
In this era of rapid innovation and evolving payment paradigms, possessing oncology-focused market access expertise is not merely a competitive advantage; it is an imperative. Biopharma companies that adopt this specialized methodology will better optimize product launches and ensure that transformational therapies reach the patients who need them most.
References
1. www.drugdiscoverytrends.com/top-50-pharma-companies-by-drug-discovery-patents-and-other-insights/.
2. www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/global-oncology-trends-2024.
3. www.nccn.org/professionals/physician_gls/pdf/bladder.pdf.
4. www.mmitnetwork.com/thought-leadership/pathway-or-perish-the-two-pronged-hurdle-to-ensuring-access-in-oncology/.
5. www.zs.com/insights/restricted-access-pharma-reps-rethinking-sales-planning-oncology.
6. www.cancerresearchuk.org/about-cancer/what-is-cancer/how-cancer-starts/types-of-cancer.
7. www.pharmexec.com/view/driving-innovation-how-collaboration-between-medical-affairs-and-commercial-teams-is-transforming-the-industry#.
8. www.appliedpolicy.com/the-impact-of-the-inflation-reduction-act-on-physicians/?utm_source=chatgpt.com.
9. www.valuebasedcancer.com/issues/2023/december-2023-vol-12-no-6/3001-avbcc-panel-explores-value-based-contracting-in-oncology-care?utm_source=chatgpt.com.
10. https://www.cardinalhealth.com/en/services/specialty-physician-practice/resources/healthcare-policy/inflation-reduction-act.html.
11. www.ebri.org/health/publications/issue-briefs/content/cost-differences-for-oncology-medicines-based-on-site-of-treatment.
12. www.prnewswire.com/news-releases/prime-therapeutics-finds-1-1-million-waste-reduction-opportunity-with-medically-integrated-dispensing-compared-to-central-specialty-pharmacy-301559458.html.
