Editor's note: Even the strongest evidence can fall flat if it’s delivered out of order. This piece breaks down a simple, four-question framework to structure your value story the way decisions actually get made, so you can turn data into action, and “maybe” into yes.

(4 Min Read)

How to structure value communications that influence access decisions

You can have strong clinical evidence, robust models, and a polished value dossier, and still get a “no.”

This happens more often than most teams expect. Not because the treatment lacks merit. But because the story wasn’t built for the way decisions are actually made.

Market access isn’t a single decision made by a single person. It’s a multi-step process that unfolds across functions - clinical, operational, financial - each with its own lens, priorities, and risks.

The most effective value communications reflect this reality. They present evidence AND guide decision-makers through a logic path that mirrors how choices happen in the real world.

A Structured Approach: The Four Questions That Drive Access

Whether preparing a Global Value Dossier, an AMCP submission, or a payer presentation, there are four fundamental questions that decision-makers must answer, consciously or not, before they move forward.

1. Do we have a problem? Make the burden visible. That includes failure rates, system inefficiencies, and downstream costs. If the status quo feels tolerable, no one will take the risk of change.
2. Do we need a new solution? Don’t jump straight to the product. First, show where existing standards fall short; clinically, operationally, or financially. Create urgency before introducing a fix.
3. Does this solution work for us? Even a highly effective therapy will be rejected if it doesn’t fit into real-world practice. Evidence should demonstrate how the treatment aligns with existing care pathways, resource availability, and system-level objectives.
4. Can we afford it? Affordability is more than price. It includes implementation costs, workflow disruptions, opportunity costs, and long-term financial impact. Decision-makers must be able to justify the investment within their own context.

This sequence matters. When value dossiers or payer decks skip steps, by leading with pricing or jumping into comparative data, they break the logic chain.

Sidebar: What Is a Value Dossier?

A Value Dossier is a foundational tool used to support access and reimbursement decisions. It compiles the evidence supporting a treatment’s value - clinical, economic, and humanistic - into a single, structured narrative.

There are several forms:

• Global Value Dossier (GVD): A comprehensive document that includes all available evidence and value messaging. Used as an internal training tool on the value story and master source for local adaptations.
• AMCP Dossier: A format tailored for U.S. payers, following the guidelines set by the Academy of Managed Care Pharmacy. Structured to support health plan pharmacy formulary decision-making.
• Local Adaptations: These include payer slide decks, HTA submissions, and tailored summaries used in specific market contexts.

These tools are typically prepared pre-launch and refined throughout the lifecycle. They support interactions with payers, HTA bodies, pricing and reimbursement agencies, clinical stakeholders, and internal teams.

One Question, Many Perspectives

The four questions may be consistent, but each decision-makers interprets them through very different lenses:

• Medical Directors want to see clear improvements in outcomes that are guideline-aligned and supported by sound evidence. They assess whether the treatment improves patient care without creating clinical ambiguity.
• Pharmacists and P&T Committees focus on safety, dosing complexity, distribution logistics, and formulary positioning. They ask, How easily does this fit into our current systems?
• Finance and Contracting Teams look at cost exposure, rebate strategies, and total value. Their role is to protect the organization’s financial risk profile.
• Population Health and Quality Teams evaluate broader implications: impact on readmissions, care continuity, and system-wide quality metrics.
• Frontline Providers and Clinical Champions prioritize ease of use, workflow impact, and patient experience. Even small friction points can make adoption difficult.

Understanding these diverse perspectives is essential. A one-size-fits-all argument almost never works.

A Practical Example: Oncology in an Integrated System

Imagine a novel infused oncology therapy preparing for launch into a large integrated delivery network; where the payer, provider, and care delivery infrastructure are housed under one organization.

A conventional dossier might lead with:

“In a randomized controlled trial, the therapy demonstrated a significant improvement in progression-free survival.”

But a decision-maker in this setting is balancing more than just efficacy.

Here’s how the same story could be reframed using the four-question sequence:

Problem: Current therapies fail in 40% of patients within 12 months, leading to emergency admissions that cost $15,000 each. The system manages over 200 such cases annually.

Need: Existing options require complex monitoring, creating delays and resource strain, especially in infusion centers and nursing teams.

Fit: The new therapy reduces failure to 15%, integrates with once-monthly infusion schedules, and cuts monitoring visits by half, without requiring additional staffing or equipment.

Affordability: Although the acquisition cost is 20% higher, the system projects $2.3M in net annual savings through reduced admissions and improved resource utilization.

Same data. Different structure. Much stronger case.

Putting the Framework into Practice

Translating this approach into everyday work requires discipline, but it’s highly achievable. Here are four practical ways to begin:

1. Start with the questions. Before building a slide or opening a template, map your story using the four-question structure. Assign responsibility across functions to bring relevant data to each answer.
2. Tailor by stakeholder. Think through how each decision-maker type interprets risk, value, and uncertainty. Adjust your emphasis and evidence accordingly.
3. Use mock reviews. Pressure-test your communication by role-playing different stakeholders. Ask: If I were the head of pharmacy, what would I say yes to? What would make me hesitate?
4. Align with decision timelines. Generating the right evidence is not enough, it has to be ready at the right time. Coordinate evidence development with known formulary, HTA, or contracting milestones.

Final Thoughts

Access isn’t just about the data you have. It’s about the story you build and whether that story mirrors how decisions are made.

Too often, teams treat value communication as an exercise in completeness. But the most successful strategies are those that prioritize clarity, structure, and stakeholder relevance.

When your value story answers the right questions, in the right order, to the right audience, it goes beyond information and into influence.

Betsy J. Lahue is the Chief Executive Officer of Alkemi, where she helps teams build the strategy and evidence they need to get their treatments access.

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