2025 Planning: Key Considerations for Market Access Strategies

The market access landscape continues to evolve rapidly, with specialty products, new regulations, and innovative technologies all impacting market access strategies. The past few years have seen significant shifts, particularly in the complexity of navigating market access for higher-cost specialty treatments. Market access professionals must continue to adapt and innovate in 2025 to fully realize the access potential of their products.

2025 Market Access Trends and Challenges

Each year brings new market access trends and challenges, and 2025 will be no exception. Early adoption of the right strategies and tactics can be the difference between gaining competitive advantages or falling behind. Following are key trends our team has identified to focus on during 2025 business planning:

Shift from Coverage-Based to Criteria-Based Access Strategies

As opposed to the traditional focus on coverage, market access strategies must now take shape a level deeper. Policy criteria and details that can either create barriers or facilitate entry for specialty products are becoming drivers of access success. Moving beyond broad coverage data to capture and translate policy details into clear messaging can be a key differentiator across biopharma in 2025.

Increasing Complexity of Market Access for Specialty Products

Specialty products continue to drive new drug approvals, bringing with them increased utilization controls. Payers are tightening restrictions with additional prior authorization (PA) criteria and step therapy requirements, making it increasingly important to understand the nuances of PA requirements and where access can be more or less burdensome for patients and providers.

Impact of the Inflation Reduction Act (IRA)

The IRA is transforming Medicare, with 2025 bringing key changes that include a $2,000 out-of-pocket cap for patients. While this is positive news for patient affordability, the introduction of negotiated pricing has many manufacturers rapidly seeking to understand the long-term implications of new policies.

Crowded Categories and Access as a Differentiator

As more specialty products and biosimilars enter the market, clinical differentiation is becoming less apparent. Manufacturers can therefore increasingly leverage access support as a key competitive advantage, using data-driven insights to offer better access pathways to successful treatment for appropriate patients.

Upskilling Field Teams and Engaging Office Personnel

Communicating complex access criteria to healthcare providers and office staff requires skilled field teams. This includes both increasing the size of Field Reimbursement Management (FRM) teams and investing in upskilling Sales Reps to navigate access intricacies and effectively engage with biocoordinators and billing personnel.

Data Integration and Pre-Call Planning

Market access teams are beginning to double down on data integration, overcoming the challenges of bridging disparate data sources. Reinvesting in technology to facilitate market access pre-call planning and pull-through is becoming a key focal point, helping Sales Reps and FRMs present more complete and accurate information to HCPs and office staff regarding coverage and criteria.

Harnessing AI for Competitive Advantage

AI is beginning to play an important role in both payer and manufacturer strategies. By applying multivariate analysis, companies can gain deeper insights into competitive access scenarios and fulfillment challenges. AI also enables early identification of performance patterns in contracts, allowing manufacturers to proactively address issues before they escalate.

Customized Field Strategy

Teams must ensure that their market access strategies are tailored to the capabilities of their field teams. Are they experienced and widely distributed? Less tenured and selectively deployed? Do they have a voice in shaping their market access toolkits? The proper alignment of strategy with field team capabilities is essential to effective tactical execution.

As we look ahead, teams working on their 2025 strategies are encouraged to focus on conducting a detailed payer landscape review, using data to refine customer segmentation, targeting, and positioning, and tailoring strategies to field capabilities. By focusing on these areas, companies can navigate the increasingly complex market access environment and position themselves for future success.