A complex U.S. healthcare system with competing incentives is increasing the pressure on pharma leaders to activate new levers that expand patient access, improve affordability, and drive brand performance.

This blog summarizes the most common and challenging questions our market access consulting team answers for customers in this new era of economic compression. Additionally, supplement your exploration of the macro forces shaping the U.S. healthcare landscape by watching our webinar, A Brave New World: State of the Industry, focused on how rising policy complexity, margin pressure, and global market dynamics are influencing behavior and long-term strategies.

IQVIA’s U.S. Market Access Strategy team helps pharmaceutical and biotech companies navigate payer complexity, optimize reimbursement, and improve patient access across the product lifecycle through a combination of advanced analytics, payer insights, and strategic expertise. that measurably impacts overall patient access, affordability, and brand performance.

Q: What are some of the most common, yet complex market access challenges customers are trying to solve?

Ross: Many of our customers are focused on developing effective payer strategies to address their market access challenges. They are seeking actionable recommendations to improve access and utilization which requires a combination of payer analytics, real-world data, and unique strategies for their brand or therapeutic area. A few examples include:

• Identifying and mitigating payer restrictions and formulary barriers
• Prioritizing payers and accounts for contracting and engagement
• Understanding patient cost sharing, affordability, and access barriers, and designing patient assistance strategies (copay cards, bridge programs, denial conversion, etc.)
• Quantifying the impact of payer tactics like alternative funding programs (AFPs), accumulators and maximizers, and developing mitigation strategies
• Optimizing pricing, contracting, and reimbursement strategies
• Understanding manufacturers’ holistic gross-to-net dynamics and developing strategies to optimize product net value
• Identifying the impact of federal policies such as the Inflation Reduction Act (IRA) and the 340B program, and running scenario-planning to enable smart decision-making

Q: How can IQVIA help with payer strategy, contracting, and formulary access?

Ross: IQVIA helps manufacturers navigate increasingly restrictive payer environments by developing strategies that improve coverage, access, and return on investment, such as:

• Payer segmentation and prioritization
• Contracting strategy and rebate modeling
• Formulary access optimization and tier positioning
• Contract performance analytics and execution

Q: Patient access and affordability can significantly impact brand performance. How does your team assist with pinpointing the barriers?

Ross: Our priority is our customer and the patients they serve. The goal is to help customers reduce access barriers and ensure that patients can start and stay on therapy, improving both outcomes and brand performance. We design and optimize patient access strategies and patient support programs to address affordability and adherence challenges. This includes:

• Patient access journey mapping
• Copay assistance and affordability strategy
• Patient support program design and optimization
• Analysis of out-of-pocket costs and patient behavior

Q: A third and equally important set of stakeholders is healthcare providers (HCPs). What does your team provide to enhance engagement with them?

Ross: We ensure commercial teams focus on the providers and accounts most likely to drive uptake based on access conditions by aligning commercial strategy with market access insights in the following areas:

• HCP targeting, segmentation, and pull through
• Provider economics and reimbursement analysis
• Access-based segmentation and targeting strategies
• Planning and field execution strategy

Q: Lastly, it’s more difficult than ever to keep up with federal policies changes. What does your team do to understand and evaluate the implications of policy evolution?

Ross: Staying ahead of policy change is critical to sustainable access and profitability in today’s market. We’ve been partnering with customers to navigate evolving health policy and market access regulations, including the IRA, 340B program dynamics, and reimbursement policy changes. Our work includes:

• Assessing financial and access impact of policy changes
• Modeling gross-to-net and pricing implications
• Identifying strategic responses to payer and regulatory shifts via scenario-modeling