This year’s winner of the inaugural National Market Access Lead category at the PharmaTimes Marketer of the Year competition, Gawain Shirley, talks about the huge challenges surrounding market access in the UK

Congratulations on your win. What does it mean to you to have come out on top in your category?

Thank you. It’s fantastic to have won the category and a real honour. What’s particularly nice is that it externally sense-checks the approach we take in Lundbeck to market access. There are so many challenges facing the NHS currently, particularly in mental health (the therapy area we work in), that demonstrating the value of new therapies is more important than ever. But in some ways, it’s more difficult to do because there’s so much other noise and our customers are under so much pressure. It’s great to have won the award and reassuring that, despite the challenges both we and our customers face, the way we approach market access in Lundbeck has been recognised as strong. It gives confidence that we’re taking the right approach.

What inspired you to take part in the competition?

I’ve been in the National Market Access Manager role for just over 12 months so it was a good opportunity to benchmark what I’ve learnt, combined with some encouragement to enter by colleagues!

How did you find the process?

I really enjoyed it. The case study for the exercise was very good with plenty to get your teeth into and think about, and whilst it was fictional it represented a lot of the challenges we face which meant that I could apply many of the things I’ve learnt over my career to the exercise itself – whilst keeping within the time limit!

What advice would you give to others who are considering taking part?

Do it. Because the case study is so relevant to market access in the UK it gets you to really think and put into practice the key elements of the role, so it’s a great learning experience. The question and answer session also gets you thinking on your feet. Time management is critical though so it’s important to not get too bogged down, prioritise, and keep focused on the endpoint. Irrespective of the outcome at the end it’s certainly a good learning experience which will allow you to apply skills you’ve developed in your day-to-day role, while also giving plenty you can take away with you.

What is your background and current role?

I did a biology degree before joining the industry, where I got my first job as a primary care representative before moving to a hospital specialist role. I then joined Lundbeck, initially as a key account manager, and then became a regional account director. I was then divisional sales manager before getting the role of national market access manager just over 12 months ago.

What does your day-to-day work involve?

It’s incredibly varied and there are quite a few different aspects which is great. Developing the tools and resources that help us to build the value propositions and facilitate market access is one key element. For example, working with organisations like Wilmington Healthcare to develop the resources that allow the analysis of HES and other data sets so we can help our customers understand the impact that illnesses like depression and schizophrenia have on a local health economy, and any pinch points in pathways. Developing budget impact models and return on investment calculators is also important, so customers know what they may spend but equally what return this could give. Once these are in place a lot of my time is spent working with our Sales and Access Managers (SAMs) to develop local value propositions tailored to specific accounts. I’m field-based so still get out to meet customers, working with the SAMs to support the uptake of the value proposition and patient access to our products, and then with the customers themselves to support the development of business cases. There’s also a lot of cross-functional work with marketing and medical, and I’m also involved in brand planning and brand team meetings, so it’s a good mix of national level and local level, whilst still having the customer interactions that help maintain the insight.

What do you foresee as being the greatest challenge in your role in 2018?

I think the biggest challenge is NHS finances and staffing; budgets are tighter than ever before and there are huge gaps appearing in the workforce, both of which are very likely to get worse in the next 12-24 months with things like Brexit. In some ways, this creates opportunities because the value piece becomes even more important, particularly if you can show benefits in reducing hospitalisations, contacts and general resource utilisation. It should, I hope, shift things away from a siloed, acquisition cost focus, and more towards a longer-term view on the value medications can provide as tools that help make pathways more efficient and improve patient outcomes in order to reduce pressures on the system. The shift to STPs and Accountable Care Systems certainly makes it feel like the focus is moving away from short-term silo thinking to a more system-wide approach, but the challenge is if there’s even less money, combined with gaps in the workforce, the firefighting becomes so intense that whilst the ‘invest to save’ arguments become even more powerful, they also become even harder to implement.

Have you seen a significant change in the approach to maximising market access in the UK in recent years?

My experience here is relatively narrow in the sense it’s been focused on mental health for the last ten years which has its own challenges that relate to the reductions in funding and commissioning by block contract, but I would say the approach to market access has become a lot more sophisticated, and more difficult, particularly from a patient access perspective.
From my experience, in the past market access used to involve a relatively straightforward formulary application based on the clinical data for the product and a simple budget impact assessment, which if approved generally meant patients in that area could access the treatment, whether or not a positive HTA was in place.

Nowadays this isn’t the case and it’s a multi-stage process where the first step is to secure a positive HTA to allow you to get reasonable local market access. However, even with the mandatory funding requirements this doesn’t always translate and there can still be blocks to access so you then need to navigate the various Drug & Therapeutic Committees and Area Prescribing Committees to convert the HTA into local market access. Once the local formularies are in place you then need to build the local value propositions and business cases to secure patient access. The ICERs used by bodies like NICE don’t really translate into value for local commissioners and payers, so a lot of work now goes into building a local case that demonstrates a product’s value in relation to hospitalisations, potential cost savings, and other impacts on the system. It’s become a lot more complicated as a process, and the decision-making units have also become increasingly complex. I’ve come to realise just how important our role in industry is, because, certainly in mental health, new technologies approved by NICE don’t necessarily filter down to the clinicians and patients – there aren’t the systems in place to translate a NICE TA into patient access and there are still a lot of hurdles to overcome. Without the work of industry, I think many new technologies, even if shown to be cost-effective for the NHS, would just get stuck and not reach the patients that need them.

Is it becoming easier or more difficult to demonstrate the value of new products?

In some ways it’s become easier because more NHS data is available for us to use – it’s easier to identify and understand where the costs in the system sit, where the gaps or pinch points in the pathways are, and to demonstrate what the costs of doing nothing are. A lot of the data resources we work on building offer huge value to our customers because they allow a bigger picture view, and then you can position your product in line with this and take an approach more focused on optimising the whole pathway. The gap sits more with the clinical trials themselves and what’s needed to secure regulatory approval for new products, because the outcomes aren’t always easy to translate into a meaningful impact on things like hospitalisations or healthcare resource utilisation.

What single thing would make your job easier?

Access to customers. They’re so busy and stretched it’s increasingly difficult to get in front of them, and there are many that won’t engage with industry. Whilst we’ve become a lot more sophisticated and can provide a lot more value than perhaps we did as an industry in the past, it feels increasingly difficult to have those conversations and translate them into action.