Challenge:   Austria has had a stringent reimbursement system in place for many years. New products, especially relatively expensive biotech therapies, have faced high hurdles to securing patient access. For one chronic, crippling disease, restrictive rules have been in place since 2000 whereby patients must first fail on at least two older, less expensive treatments before becoming eligible to receive a biotech option. It is typical for patients with this condition to go 12-18 months from diagnosis of a need for a new therapy to eventual treatment with one. KOLs have endorsed early and aggressive treatment with biotech products to enhance quality of life and overall patient performance outcomes. New entrants into the biotech arena to treat this disease are arriving, raising patient and doctor awareness that better options are available. The sickfunds, however, had held steadfast in allowing biotech product access only to those most severely affected. The company decided to challenge the government's treatment paradigm for reimbursement as the only option to grow its product and expand the market.

Strategy :   The first step was to create a thorough stakeholder plan and involve every person in the Austrian affiliate who had regular contact with anyone on that stakeholder list. Previously this had not been the case as the relationships were too compartmentalized and there was no systematic vehicle for all affiliate team members to know what was happening with stakeholder contacts outside their particular sphere. Once the stakeholder diagnostics were complete and the tracking mechanisms in place, the policy changing tactics were introduced in a synchronized way under the direction of the General Manager. It began with generating issue recognition among health professionals, trade unions, patient advocacy groups and others. The next step was to put the new treatment paradigm on the political agenda employing third party advocates and the media. Next, the company focused on the policy formulation, providing politicians with the evidence of biotech value and offering a clear proposal of biotech product access after one failure by an older product. The support for a firm option to the existing paradigm grew and the negotiations commenced once the reimbursement authorities were pressured by politicians to address this problem.

Outcome:   As with the stakeholder plan, the company then applied the circle of value/7-elements negotiations model Monere advocates in its projects. Systematically it analyzed each of the negotiation components, held simulated negotiations in its office and questioned itself repeatedly if it understood completely the reasons why the reimbursement authorities were reluctant to change the treatment policy. Distinguishing the authorities' interests from their positions was essential in determining what would be the insurers' best alternative to a negotiated agreement (BATNA). In the end, 18 months of step by step advocacy and negotiation practice paid off when the company's product was granted reimbursement conditional on one failure with an older therapy. This new paradigm is applied only to the company's product, not that of competitors. This new reimbursement paradigm stimulated major growth in the product's sales. Where patients previously had to wait at least 18-24 months to access a biotech product, the time has been reduced by two-thirds. Patients and the company equally benefitted from this outcome.