A Day in the Life of a Market Access Leader…

It is late morning on a Wednesday. As one of the Market Access Leaders in Europe you have just enjoyed the latest MTRC Reimbursement updates. You lean back, satisfied you’re all caught up, when an email from the head of marketing lands. She needs your help, swiftly that is, to develop an argument to convince a hospital customer to buy ZeusZone™ at a 10% price premium over the prior generation.

“Can you build one of your models and send it over, please? Thanks, as ever.”

Attached to the mail, in case you had forgotten, is the US study showing a 24% reduction in re‑hospitalisations within a year, thanks to fewer complications.

Your first instinct is to write: “It’s not that easy. And it will take a while.” But you remember the last management training and don’t hit send. You start to work. Or better: improvise. Because you already see the mismatch between the value proposition and what hospitals pay for. Why would they pay a premium under capped income per procedure, only to end up with less income through fewer re‑hospitalisations?

You look for situations where avoided re‑hospitalisations might matter. You remember the 30‑day penalty, likely behind the design of the US study. You ask your team to check where in Europe such penalties apply. The result is sobering and too weak to build a broad story on. So you think deeper. There is obvious payer value here — you just need the link to customer value. But the square peg and round holes come to mind. Sigh.

The afternoon passes. You look at policy priorities, come across “best practice tariffs” again, and finally think: “What if hospitals fill the avoided re‑hospitalisation with another patient — a more lucrative one?” A long shot, but still.

A week passes. Marketing is still chewing on your ideas when the General Manager needs you, swiftly that is. “EU regulatory approval for AthenaAssist™ has been accelerated, we can launch next quarter” and you cannot quite tell whether that is excitement or anxiety on his face. “Global wants us to get a price premium of 25% over competition”. It is anxiety, you are sure now. “Good news: the pivotal trial met all endpoints.” Your head is already spinning.

“Now I leave you to your magic” was the last thing you heard and something like “but keep it simple”. 

You start working. Improvising. You think of a model using the single‑arm efficacy data, hoping the endpoint matters to payers. Comparator data would need to come from literature. Someone needs to search cost data. And if that’s not enough for the evidence‑hungry markets, you could niche the product for high‑need patients. Limited numbers, yes, but a start.

Your team begins initial research and back‑of‑the‑envelope calculations. 

Things are moving when the Head of Clinical appears. “Good news”, she starts “I was thinking of you.” They are finishing the protocol for the EU registry for the new generation of ThemisTrack™, another potential growth driver. They want this to support reimbursement - that’s what Commercial said is needed, as uptake is lower than hoped. She drops the draft protocol on your desk. “Let us know what you want added. Swiftly that is. We need to finalise by end of week.”

Once again, you start to work. Improvise. Single arm, no control. Still better than nothing. You add the traditional tools: resource‑use collection, EQ‑5D, maybe cost collection in a few centres. Another long shot. Unlikely to move reimbursement needles. But maybe, with Public Affairs and Marketing, it could build awareness and support therapy development.

Do these situations look familiar to the Health Economics/Reimbursement/Market Access experts among you?

🛠 Wrong hammer for the nails

Value depends on perspective. Patient, provider, payer — all different. Nothing wrong with different value propositions. Better if you have them. But they must match your message and your audience, not force square pegs into round holes.

⏱ Time pressure

OK, the few days in the made-up examples above were poetic license, but we have all been in these situations, where we were trying to make the best out of what is still possible last-minute. “It’s not that easy. And it will take a while” was the initial thought of the Market Access lead. This is not an excuse. It is reality. Market Access is highly localised and each country has its own reimbursement realities. Companies can cross‑fertilise activities across countries, but every market is different. There is no Global Access Strategy. At best, 5–7 local ones under one roof.

With the US making up 50% of global revenue potential, activities understandably start there. But the remaining 50% sits across very different markets. Assuming US analysis applies elsewhere is a cardinal mistake. Costs, prices, reimbursement structures, standards of care can differ fundamentally. Conscious adaptation to OUS realities needs time.

📄 Wrong evidence

The single‑group multicentre study was needed for regulatory approval. But not enough for premium reimbursement. “Listing” countries (such as France, Belgium, Japan, Australia) need comparative evidence over standard of care. Companies are often reluctant to generate that post‑launch.

One solution: pool evidence‑driven countries into a multi‑country comparative analysis. Expensive, yes. Time‑consuming, yes. But instead of sequential regulatory then reimbursement evidence, companies should consider designing trials that combine both from the start. Globally. It may be faster and more cost‑effective.

🌍 In my ideal world…

Market Access is part of a company’s mindset, next to classics like patient centricity and quality. This ideal company starts from the end by asking:

• What is a realistic premium given comparator prices in key markets?
• How will hospitals buy a premium device under current reimbursement?
• Will payers consider it valuable enough for premium reimbursement?
• Do we have compelling evidence on clinical and cost effectiveness?

I call this Early Value Assessment (EVA). And yes, long before NICE borrowed the acronym.

Too often these questions come too late, close to launch. Then there is no room for strategy — only improvisation.

🚀 What I mean by “early”

Early enough to influence pivotal trials.

Early enough to shape evidence strategy.

Early enough to think Value Guided pricing.

Early enough to shape the value proposition - maybe even the launch decision.

Market Access by Design is multifunctional. Clinical, Regulatory, R&D, Marketing, Gov Affairs, Public Affairs, Commercial leadership — all involved. It cannot be delegated. It requires a team.

HE&R / Market Access must continue advocating for a strategic, conscious, company‑wide approach — all the way to leadership.

For more information, get in touch: markus@metismarketaccess.be