Clinical pathways: What are they, and how do they affect access?

By Lindsay Lorenzen
VP of Solution Consulting, Norstella

Pharma manufacturers working within oncology, and a few other select fields, face a unique challenge when bringing their therapies to market: clinical pathways.

According to MMIT Pulse Analytics data, roughly 62% of U.S. oncologists are currently exposed to a clinical pathway. And of those using pathways, adherence is high, with 80% sticking to the recommended treatment guidelines.

If a brand fails to secure a place on a pathway, or if they are placed but more restrictively, they may face lasting negative effects on perception, uptake and utilization.

The potential for these undesirable outcomes makes finding quick, actionable data to inform a holistic commercial strategy crucial.

What are clinical pathways?

A clinical pathway is a map that outlines a sequence of treatments or procedures a provider should prescribe to a patient based on their specific condition. They are different from a formulary, which provides a list of covered drugs, as they essentially tell a physician what to prescribe next based on where a patient is in their journey.

Pathways are either created by payers or providers and sometimes large healthcare conglomerates called integrated delivery networks (IDNs). While clinical pathways are primarily used within oncology, other emerging use cases exist for conditions such as Crohn’s disease, psoriasis, gastroenterology and rare diseases.

The intended goal of clinical pathways is to control costs, standardize treatment, and improve patient outcomes. However, they also tend to limit and control physician prescribing habits and reduce visibility into other products on the market.

This, as one can imagine, is a considerable barrier to access and poses a challenge to companies manufacturing drugs or treatments for conditions that adhere to clinical pathways. To ensure coverage and patient access, manufacturers need a comprehensive, data-driven market access strategy that spans the drug development and commercialization life cycle.

Important considerations and actions at different points in the drug development life cycle

Depending on where a pharma company is in the drug development life cycle, there are different considerations and actions they must take to drive access and utilization, especially when dealing with clinical pathways.

At pre-launch, it’s important to gain a deeper understanding of the key pathways that pertain to their specific treatment and predict pathway placement, restrictions and variations from label.

At launch, in addition to tracking coverage data across payers and PBMs, it’s essential to track clinical pathway placements, compare them against competitors, and identify key influencers to achieve optimal placement.

After launch, pharma companies must continue to track, optimize and evolve their pathway strategy to ensure long-term coverage.

Clinical pathways are a gatekeeper to market access

Without actionable answers to your company’s most pressing questions, you risk missing performance expectations and lost revenue.

To succeed, pharma companies need answers to clinical pathway coverage questions such as:

• Is my product on an IDN’s pathway?
• How is my product performing compared to competitors at key accounts?
• What clinical pathway is being used?
• Who develops and influences the placement on pathways?
• Which providers have my drug on pathways that are more restrictive than label?
• How are my target providers organized and how does that influence decisions on drug access and utilization?
• Are providers likely to make prescribing decisions that align with the pathway, or do they deviate?

From identifying who uses internal vs. third-party pathways to finding key decision-makers and recommending how to influence pathway placement, smart manufacturers are ensuring that clinical pathways play a key role in their commercial strategies.

To see how your brand is placed on clinical pathways across hundreds of providers, learn about Norstella’s PULSE Analytics solution, which offers a complete picture of over 255 brands and 77 indication-specific pathways to help you develop a comprehensive commercial strategy.

Gain a deeper understanding of your brand’s market access position and get your life-saving drug into the hands of patients. Let’s connect.

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