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Products & Services Medical Affairs Medical Communication

Medical Affairs’ Critical Role in Payer Interactions

ID: POP-271


24 Info Graphics

28 Data Graphics

450+ Metrics

7 Narratives

Pages: 67

Published: 2016

Delivery Format: Shipped


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Biopharmaceutical companies depend largely on their relationships with payers to leverage formulary access for their products. With payers laying greater emphasis on real world evidence and economic value, many organizations have turned to their Medical Affairs function to effectively streamline the dissemination of medical information.

However, Medical Affairs organizations often face challenges in the planning and management of payer engagement and market access activities. Best Practices, LLC undertook this benchmarking study to understand the role of Medical Affairs in critical payer interactions and highlight strategies for building and maintaining effective relationships with payers.

Additionally, the study provides benchmarks around the required resource levels, talent acquisition and training for creating effective payer relationships, and payer segmentation and prioritization.

Industries Profiled:
Pharmaceutical; Biopharmaceutical; Biotech; Manufacturing; Chemical; Health Care

Companies Profiled:
Abbvie; Alkermes; AstraZeneca; Baxalta; Biogen; CSL Behring; Daiichi Sankyo; EMD Serono; Genentech; Genomic Health; Lundbeck; Incyte; Janssen; Medivation; Mesoblast; Novartis; Pacira Pharmaceuticals; Pfizer; Pharmacyclics; ProStrakan; Santen; Servier; Shire; Teva Pharmaceutical Industries Ltd; Upsher-Smith; ViiV Healthcare

Study Snapshot

Best Practices, LLC engaged 29 executives from 27 leading biopharmaceutical companies for this research. Eleven research participants represented large biopharmaceutical organizations, while 9 participants represented medium companies and the remaining benchmark class emerged from small companies. Also 17 companies form a US-only segment, while 12 companies form a Global segment.

Key Findings

Capturing Payer Insights: Medical Affairs plays a critical role in probing payer needs and perspectives. The top three activities that Medical Affairs groups design and manage are:
Clinical presentations and discussions with payers (used by 100% of the benchmark class)

Advisory boards / forums for payers (used by 93% of the benchmark class)

Outcomes research presentations (used by 90% of the benchmark class)

Payer Field Resources and Trends: Seventy-six percent of the participants don’t’ have specialized health outcomes liaisons to interact with payers. A majority deploys medical science liaisons to the field in order to build and maintain relationships with payers.

Table of Contents

Executive Summary, pgs. 3-10

    Research Overview, pg. 4

    Participating Companies & Segmentation, pgs. 5-6

    Key Recommendations, pg. 7

    Key Findings & Insights, pgs. 8-12

I. Capturing Payer Insights and Partnerships with Payers, pgs. 13-23

II. Field Resources for Payers, pgs. 24-30

III. Talent Background and Training, pgs. 31-39

IV. Knowledge Sharing, pgs. 40-48

V. Payer Segmentation and Prioritization, pgs. 49-54

VI. Medical Affairs and Payer Resource Ratios, pgs. 55-58

VII. Medical Affairs Leadership and Structure, pgs. 59-62

VIII. Demographics, pgs. 63-65

IX. About Best Practices, LLC, pgs. 66-67

List of Charts & Exhibits

Critical elements of strong payer communications
Role of Medical Affairs professionals in carrying out activities designed to probe payer needs and perspectives

Success factors for strong payer teams

Number of projects or studies to be conducted by Medical Affairs organizations in collaboration with payers by the end of this year

Effectiveness of payer and market access services at different product lifecycle stages

Critical factors for payers in partnership decisions

Type of field-based resources deployed by Medical Affairs organization to support payers

Market access and payer activities staffing trends

Frequency of access to payer or market access organizations

Impact of product portfolio diversity on Medical Affairs groups’ access to key payers

Effectiveness of staff’s educational backgrounds for payer services

Effectiveness of staff’s experiences for payer services

Necessary qualifications for success in payer communication

Scope of training for Medical Affairs employees serving payers

Critical success factors for strong communication with payers

Knowledge sharing via an internal group

Collaboration of Medical Affairs group with supporting functions that directly interact with payers

Knowledge sharing channels and their effectiveness

Collaboration with field-based teams

Effectiveness of segmenting payers by listed criteria and strategies

Importance of different influencers/payers on market access

Medical Affairs spend as percentage of total revenue

Medical Affairs spend per Medical Affairs FTE

Payer staff as percentage of total Medical Affairs employees

Current structure of participants’ Medical Affairs organization

Leadership for thought leader management