“Uncertainty has been weaponised by payers”
“Uncertainty has been weaponised by payers”
Last week during the second session of our P&MA strategy course (a collaboration between Windrose and Cambridge University), our guest Andrew Walker produced this nugget:
“Uncertainty has been weaponised by payers”
It is exaggerated for effect, but is nonetheless an important message.
Uncertainty equals risk > Risk erodes value > Willingness to pay and reimburse are inhibited. More specifically payers have tools at their disposal to manage uncertainty and balance risk, such as:
Suboptimal clinical-assessment outcomes (signalling that price should be limited)
Lower ICER thresholds
Access limitations (remove the uncertainty from the equitation)
Downward pressure on price and protracted negotiation
Uncertainty comes in many forms, but the hallmark for payers is a lingering question around their financial risk exposure:
Positioning: target population (clarity, alignment with clinical practice, size)
Evidence: inappropriate / inadequate treatment comparison, endpoint selection (validity, objectivity), trial population (demographic representation), trial duration (long-term safety / efficacy)
Interpretation: ability to understand trial outcomes in a meaningful way, ability to compare outcomes to other options (related to comparator selection above), consistency of effect, economic model selection and design
Treatment exposure: dosing (where variable or weight based), treatment duration
Uncertainty is inevitable, and we can't address it all, but there are strategies we can use to minimize it, or at very least show payers we have done what we can. These may include:
Market shaping: filling in gaps in our knowledge and creating certainty around assumptions to ensure payers are primed to appreciate the value proposition
Evidence generation: adjusting our evidence plan to incorporate the payer viewpoint, or generate new, supplementary data
Value communication: crafting a narrative that helps payers understand product value (this addresses “interpretation-related uncertainty”)
(Re) Positioning: to focus on where we demonstrate the most value
Innovative contracting: reducing payers financial exposure to uncertainty (addressing the symptom, not the cause)
The important thing to bear in mind is that, as with access strategy in general, we need to have cross-functional discussions around uncertainty, we need to have them early, and we need to look broadly across different market situations. Many mitigating strategies require collaboration between access, HEOR, commercial, policy and medical teams, and they take time to successfully develop.
Please get in touch if you would like to discuss identifying and addressing uncertainty.