Unlocking market access in healthcare & navigating pharmacoeconomics

In today’s ever-evolving healthcare landscape, market access for new medicines and treatments is more complex than ever and pharmacoeconomics has become a critical tool. We sat down to discuss these challenges with Johan Eykens, our Managing Director, and Philippe Van Wilder, consultant at Smart&Bi and Professor in Health Economics and Health Technology Assessment (HTA). 

With a collaboration spanning over 20 years, these two seasoned consultants share their insights on healthcare economics, market access, and the intricacies of pharmacoeconomics in Belgium. 

Philippe, can you give us a brief overview of what you do at Smart&Bi? 

Philippe: Sure. Smart&Bi was founded in 2010 with a focus on market access, particularly in healthcare. Our primary goal is to help secure access to medicines. Today, the process of gaining access is deeply tied to the framework of social security. Since joining Smart&Bi in 2016, my focus has been on healthcare economics and HTA, especially helping clients navigate the complex reimbursement landscape. 

So, Johan, how did you begin working together with Smart&Bi? 

Johan: Vera Bormans (Smart&Bi’s founder) and I met 20 years ago while working in the pharmaceutical industry. Our partnership began informally, mainly as sparring partners. We used to bounce ideas off each other about market access strategies. Market access is so challenging and strategic that you really can’t address it alone. 

Philippe: Exactly: it’s very helpful to get a second opinion on a dossier you’re working on. When you’re fully convinced of the story you’ve built, you can get tunnel vision. In that case, it’s very helpful for a third party to investigate your proposal with all its pros and cons and give their two cents. By working together for two decades, we got to know each other’s strengths and rely on them. I have a lot of respect for the dynamic and knowledgeable E&A team. As pharmacoeconomics became more important, our collaboration became more formal. Aside from pharmacoeconomics, we also collaborate on mock negotiations. 

What makes pharmacoeconomics such a critical tool in healthcare today? 

Johan: Pharmacoeconomics is about comparing new treatments to existing ones, evaluating the benefits, costs, and long-term impact on patients and society. It’s a complex field because you need expertise in everything, from economics to clinical medicine to statistics. But, when done well, it can make a huge difference in positioning a new treatment within the healthcare system. 

Philippe: I agree. In Belgium, there’s still a lot of work to be done to improve the integration of pharmacoeconomics into the decision-making process. But as more governments begin to appreciate its value, it will become an even more vital tool to ensure patients can access the best possible treatments. 

Could you elaborate more on this work that Belgium still needs to do? 

Philippe: Absolutely. Belgium has been slow to modernise its approach to pharmacoeconomics, but our federal knowledge centre is actually updating its guideline on pharmacoeconomics and budget impact. There’s often scepticism toward efficient products and positive stories, which can complicate discussions around the price and value of new treatments.  

The government expects companies to adjust their pricing based on these evaluations, but the models used to determine the value of new treatments often face undue criticism; a model always includes uncertainty, but the various sensitivity and scenario analyses aim to provide you with the range of possible outcomes. The competent authority should not only look at the worst outcome but also at the most likely one; the companies should be transparent and document clearly about their model assumptions and the structural choices made.   

Johan: To add to that, in Belgium, there’s a tendency to quickly jump to conclusions. The methodology of pharmacoeconomics is incredibly complex, with many hypotheses involved in forecasting long-term outcomes. But in Belgium, the value of these hypotheses is often underestimated, and the models are sometimes criticised as a way to push prices down. It’s always easy to comment on a dossier and say, ‘There are too many hypotheses.’ 

How do you handle these challenges with your clients? 

Johan: Transparency and trust are key. If we believe a product won’t add significant value to the market, we’ll share our opinion with our customers and explore potential solutions. But if we see a need, even for a small patient population, we go all out to secure access. It’s all about ethics for us. We’re not just customer-focused but also put the patient first in everything we do. 

Philippe: Exactly. It’s crucial to have early and honest discussions about the potential pitfalls and opportunities for each dossier. We work collaboratively and iteratively with our clients, making sure they understand the complexities of the process from the start. We brainstorm potential challenges, opportunities, and strategies to strengthen the case. Together, we bring a wide range of expertise to the table - health economists, data analysts, and pharmacologists, to name a few. 

Johan: Constant dialogue with our customer and with the government is crucial to reach our end goal: getting the patient access to the treatment. This way of working has proven to be very successful. We often work on client projects from start to finish and have a lot of strong relationships with long-term customers.