When Early Access Programs Go Bad

A well-run early access program (expanded access, named patient supply, compassionate use, managed access program), in addition to providing a promising medicine to patients with no other options, can provide long-term positive corporate benefits from; generating goodwill amongst future prescribers, gaining early market share, to the generation of data from the first patients to be treated outside the confines of a clinical trial.

But early access programs don’t always go the way you anticipated. Issues can arise from both operational considerations (Are physicians initial enquiries not being responded to in a timely manner?, Are physicians not being adequately supported through the regulatory process? Is product not being shipped in a timely manner?), and also from an expectation point of view i.e., is uptake not as high as anticipated? Forecasting uptake in the early access setting is notoriously difficult as it depends on a broad range of factors, some of which are intangible; awareness of the product, perception of benefit of the product, whether there are existing products on the market for the indication, the level of unmet need and of course the price of the product, if you are charging for access. If you are not receiving demand prior to putting a program in place, there is little chance of demand becoming apparent just because you have put a program in place. Vendors should be advising companies of potential barriers to uptake during the initial program discussions, so expectations are set early on, prior to a program being launched.

A poorly advised, or poorly run program can have significant long-term negative impacts on patient and physician experience and perception of your company, as well as being a wasted investment of both time and resource.

But, what should you do if you find yourself in this situation? The first step is to hold a detailed, honest review with your vendor to discuss issues and agree approaches to address them. A fundamental value of a vendor should be the provision of trusted honest advice, based upon extensive experience of the early access environment. At the same time, their advice should also address the specific nuances of the disease area in which you operate and aim to provide you with a solution tailored to your needs. Operational issues should be straight forward to resolve, and should be detailed in a comprehensive documentation, including Service Level Agreement, Regulatory Plan, Storage and Logistics Plan, Quality Technical Agreement and Communications Plan. Where uptake is lower than expected, then some compliant communications activities to ensure physicians and patients seeking access to a product are aware that a route of early access exists, can be implemented.

Business relationships are like all relationships; some work better than others. If attempts to resolve issues with your vendor fail, then the next step should be to consider transitioning your program to another vendor. This is not as daunting as it sounds (and if done properly should see a smooth transition for physicians and patients already registered on the program) and is often the only way to save or reinvigorate an underperforming access program.

Getting into an early access program is easy. Getting out of one is trickier, but still feasible, and sometimes it is the best option. Inceptua has a ‘Program Transition Toolkit’ which is based on experience of transitioning ongoing early access programs in a seamless manner, to minimize costs to you and disruption to your physicians and patients. Please contact us for more information.

Stuart Bell, Vice President, Inceptua Early Access

Stuart Bell, VP,  Inceptua Early Access

Stuart Bell has more than 20 years of healthcare consulting experience, with the last 10 years focused on early access. Stuart has been involved in over 100 early access programs. Stuart is responsible for Inceptua’s consulting activities, including: strategy and policy, feasibility analyses, real-world evidence development and communications. He pioneered the development of global corporate strategies on early access, the concept of detailed Feasibility Analyses for early access, and developed the first early access-specific EDC for real-world data collection.

Contact: stuart.bell@inceptua.com + 0044 7387 265 293

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CEO and Board Member

Stefan Fraenkel

Stefan Fraenkel is the CEO of the Inceptua Group and is also on the Inceptua Board. He has extensive experience in the pharmaceutical industry. Before joining Inceptua, he held senior management positions at Sobi (Swedish Orphan Biovitrum), Sweden’s largest publicly listed specialty pharmaceutical company, leading Marketing & Sales and serving as Head of Corporate Development and Strategy.

Previously, Stefan worked at Pfizer and Wyeth in international commercial leadership roles across Europe and the USA, gaining deep insights into global pharmaceutical markets and strategies. Stefan has also spent part of his career in management consulting. Stefan holds a PhD in International Economics, an MBA, and a BSc in Engineering.

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Member of the Board

Chris Hasslinger

Chris Hasslinger is a Partner of Vesey Street Capital Partners and serves as a member of the Firm’s Investment Committee. He joined VSCP in 2023 and is responsible for sourcing and evaluating new investment opportunities and general portfolio company management. Mr. Hasslinger has nearly three decades of experience in healthcare and technology strategy and deal-making within the industry as well as in investment banking and private equity. He has extensive M&A experience, having closed over $20 billion in transaction value, and has established and structured a number of large commercial partnerships.

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Executive Vice Chairman

Alan Raffensperger

Alan Raffensperger has a robust leadership background in the pharmaceutical industry, having served as CEO of Inceptua and COO of Sobi (Swedish Orphan Biovitrum), along with significant international executive roles at Amgen, Roche, and Pharmacia.

He has also been CEO for venture capital-owned medical device companies, showcasing his versatility in healthcare leadership. Alan’s early career as an advanced life support paramedic provided a strong foundation in emergency healthcare.

He holds an MBA and a BA in Emergency Health Care Management.

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Member of the Board

Blake Goodner

Blake Goodner is a founder member of the investment firm Bridger Capital. He previously worked as a healthcare analyst at Tiger Management and a healthcare investment banker at Morgan Stanley. He currently serves as an advisor and board member for a range of healthcare companies. Mr. Goodner has been a member of the Trinity College Board of Visitors and the Duke Annual Fund Executive Committee. He is a current advisory board member with The Duke Margolis-Center for Health Policy.

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Member of the Board

Adam Feinstein

Adam Feinstein is the Managing Partner of Vesey Street Capital Partners. Mr. Feinstein has 30 years of investment experience exclusively in the healthcare services sector. Prior to founding Vesey Street Capital Partners in 2014, he was a Managing Director on Wall Street and a healthcare industry executive. He held the position of Senior Vice President of Corporate Development, Strategic Investments, and Office of the Chief Executive Officer at LabCorp. Before his tenure at LabCorp, he spent 14 years as the Managing Director in Equity Research at Lehman Brothers/Barclays Capital. Mr. Feinstein is the Chairman of VSCP’s investment committee. He is also actively involved in working with portfolio company executives and sourcing new investment opportunities. At the same time, he oversees all of the firm’s investment activities and employees.

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Member of the Board

Larry Marsh

Larry is a General Partner of Vesey Street Capital Partners and serves as a member of the Firm’s Investment Committee. He joined VSCP in 2016, and currently sits on the Board of QualityMetric, Safecor Health, and HRGi. He is responsible for portfolio company management and for evaluating new investment opportunities. Prior to VSCP, Larry was EVP, New Market Development & Chief Strategy Officer at Fortune 10 AmerisourceBergen. Prior to that, Larry was the #1 ranked Healthcare Technology & Distribution analyst on Wall Street for over a decade, at Barclays, Lehman Brothers, Salomon Smith Barney, and Wheat First Butcher & Singer. Larry worked with Adam, Bryan, Dan, and Joe at Barclays and Lehman. Larry received a B.S. in Economics & Management as well as an M.B.A. from the University of Richmond, and an M.P.H. from Columbia University.

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Member of the Board

Heyward Donigan

Heyward Donigan is a seasoned healthcare CEO, Board Member, and Private Equity Advisor with broad industry experience and a track record of profitable growth. From 2019 to 2023, Ms. Donigan served as Rite Aid’s president and chief executive officer, making her one of the few women CEOs of a Fortune 500 company. While at Rite Aid, Ms. Donigan led the company to through a major brand, merchandise and technology transformation, debt reduction/refinancing, while also leading the company through a pandemic. Ms.Donigan is currently a strategic advisor to Vesey Street Capital Partners, Arima Health, and a board member of OnMed.

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Executive Chairman

Doug Cook

Doug Cook is the Executive Chairman at Inceptua. Mr. Cook began his career driving the early success of Livingston Healthcare, leading to the purchase by UPS to become what is today UPS’s Global Healthcare business. After Livingston Healthcare, Mr. Cook moved to AmerisourceBergen (now called Cencora/COR) in 1998 and had an impressive career overseeing most of Cencora’s high growth, manufacturer-facing business. Mr. Cook ultimately served as the Executive Vice President, President Commercialization and Animal Health for COR.

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