Market Access: Differentiate or Lose

How Innovative Strategies Accelerate Market Access in the Life Science Sector

Market Access is one of the central topics in healthcare and the Life Science industry. Especially in a highly regulated market like Austria, innovative strategies are essential for quickly and efficiently placing new products. At PharmaBranding & Beyond, we use an approach that stands out through differentiation and targeted market analysis.

?? Why Differentiation?

Competition in healthcare is tough. Many products are vying for the same spot in the reimbursement system of social insurance providers. This is where we come in: by differentiating, whether through innovative use of Market Access data or creative approaches in sales and marketing, we manage to stand out from the rest and maximize the chances of a successful market launch.

?? Case Study: Rare Diseases

Consider this scenario: A company brings a drug for a rare disease to market, it's approved for use, and the medical benefits are proven. Initially, this drug is listed in the No Box, meaning that reimbursement from social insurance providers is only possible through individual approvals and special efforts.

?? Green, Yellow, Red Box, and No Box: What Do They Mean?

In the Reimbursement Code (EKO), drugs are categorized as follows:

• Green Box: Medications that are freely prescribable and reimbursable without special approval. Costs are covered by social insurance providers.
• Yellow Box: These medications are also reimbursable but require chief medical officer approval from social insurance providers. The Yellow Box includes the subcategories RE1 (prior approval needed) and RE2 (documentation required and post-review).
• Red Box: Drugs reimbursed only in exceptional cases, for which an application for inclusion in the Reimbursement Code has been submitted.
• No Box: These medications are not listed in the Reimbursement Code and are typically not reimbursed. They can be prescribed through individual approvals, which involves a more complex process.

?? Complex Mechanisms in Market Access

To facilitate market access, the Life Science company submits an application for inclusion in the Yellow Box (RE1) of the EKO, which is approved by the umbrella organization of social insurance providers after a cost agreement. ?? This product now has a six-month reimbursement approval (RE1) and differentiates itself from two other products that cause double the costs for the healthcare system. A success, but only the first step. ??♀?

In different regions (federal states) of Austria, there are varied approaches, which slow down the switch from No Box products (non-reimbursed medications) to Yellow or Green Box products. ????

?? Networking and Differentiation

The solution? Raising awareness among prescribing doctors and the chief medical officer service. ?? A summit on rare diseases aims to address the urgency of this switch, bringing together experts from the healthcare system and opinion leaders to discuss the issue. The goal: cost savings for the healthcare system and a faster shift from No Box to reimbursed products that are less expensive. A clear differentiation strategy from competing products encourages decision-making.

PharmaBranding & Beyond supports with a comprehensive approach to Market Access, which we constantly adapt to deliver more effective solutions. We focus on innovation and succeed in bridging the gap between data and decisions, as well as between systems and patients, in line with our motto "Close the Gap" – also in the fields of healthcare and reimbursement, for the benefit of patients and the healthcare system.

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The expert network: Agnes Kohl Ursula Koller Thomas Philipp Michael Dewald Dr. Wolfgang Gollneritsch, Ph.D. Paul Stricker Christian Wieser Sonja Kupka-Wolf Heidi Birkmayer-Asali

We are pioneers in the Life Science industry, eager to try new things and effectively close gaps in companies. Close The Gap.

Let’s talk: #DigitalTransformation #HealthcareStrategies #ProductLaunch #InterimManagement #Innovation #MarketAccess

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