Market Access Before the Budget Locks

Every August, market access leads at pharma and biotech companies sit down to answer a hard question. What does the payer workstream need to look like for the launch coming in 2027, and what needs to be in the 2027 budget to make that work possible? The window to answer well is short. Once the budget locks, the workstreams that were not funded get deferred into a quarter that may not have room for them.

For teams evaluating whether to bring on a market access agency for the year ahead, the pre-budget window is when the decision actually gets made. This post is written for that moment, and for the market access lead who is deciding right now what to have in hand before the budget closes.

Why the pre-budget window matters more than it used to

The market access environment has changed in ways that make 2027 planning materially different from 2020 planning.

Deloitte’s Rethinking Market Access analysis attributes 57% of US drug launch failures to limited market access, more than any other single factor. ZS’s 2025 study of 340 launches found that even clinically differentiated therapies still miss expectations one-third of the time. And the Inflation Reduction Act adds a further pressure point: the first set of Medicare-negotiated prices takes effect in 2026 at an average 38% reduction from 2023 list prices, which means net-price assumptions that anchored brand forecasts five years ago no longer hold.

The 2027 launches being built right now will land in that environment. The market access work they need is more strategic, more evidence-heavy, and more integrated with the rest of the brand than it has been in prior cycles. That is a resourcing question, and a resourcing question is a budget question.

What to have in hand before the budget closes

For a market access lead building the 2027 plan this fall, five things are worth having in hand before the budget window closes. Some are internal artifacts, some are decisions, and one is the answer to whether an outside partner is needed and for what.

A defensible payer value story, in draft

The single most important artifact to have in hand before budget lock is a draft payer value story. Not the final version. A working draft that has been stress-tested against the current evidence, the likely competitive set, and the payer objections the brand will most likely face. The reason to have it in draft form now is that it is the input every other budget decision runs against. The HEOR studies you commission, the submission materials you build, the internal teams that need to align around a single narrative: all of that gets shaped by what the draft value story says. Budget requests without a value story to point to are hard to defend. Budget requests grounded in one are easier to fund and easier to sequence.

A clear-eyed assessment of the evidence gap

The second thing worth having is an honest read on where the evidence needed for payer conversations does not yet exist. Real-world evidence, budget impact models, cost-effectiveness analyses, indirect comparisons: which of these are already in hand, which are in progress, and which need to be commissioned or produced before payer engagement begins. That inventory is what tells the budget how much needs to be allocated to evidence generation and how much needs to be allocated to evidence communication. The two are different line items with different partners and different timelines.

A named set of payer segments and archetypes

By the time the budget locks, the market access team should have a working segmentation of the payer market the launch is going to engage with. National plans, regional plans, integrated delivery networks, PBMs, employers, government payers. Each segment has different priorities, different evidence expectations, and different formulary decision timelines. Building materials before the segmentation is settled produces work that has to be rebuilt. Building materials after the segmentation is settled produces work that ships.

A sequenced view of the access workstream

The third thing to have in hand is a sequenced view of what has to be built and in what order. Formulary submission materials come earlier in the timeline than most brand teams realize, especially for launches targeting P&T review shortly after approval. P&T committee presentations, payer-facing visual aids, and rebuttal materials have to be ready before the field team walks into any payer conversation. HEOR communications and RWE storytelling need lead time to be produced with the rigor payers now expect. A sequenced view of what has to be built lets the budget request itself be sequenced, which is what makes it defensible to finance.

A working answer on whether a partner is needed

The final thing to have in hand is a clear read on whether the workstream can be delivered internally or whether an outside partner is going to be part of the plan. For most launches, the answer is that some parts of the work need a partner and some parts do not. Value story development, HEOR communication, and payer-facing creative are the pieces that most in-house market access teams benefit from bringing to a partner, so their internal expertise can stay focused on payer strategy, account planning, and stakeholder management, where institutional knowledge is the largest asset.

The market access agency or payer marketing agency a team selects is going to be inside the launch for the next eighteen months at minimum. That is the wrong decision to make in a hurry, and the pre-budget window is exactly when the decision can be made carefully.

Where a market access partner fits in the plan

For a market access agency to add real value in a 2027 launch, the work it takes on has to be defined against the strategic frame the internal team owns. The specific capabilities a partner is best positioned to bring include payer value story development, formulary submission materials, P&T committee presentations and rebuttal documents, payer-facing visual aids, HEOR communications, real-world evidence storytelling, and cross-functional integration across the payer, brand, and medical workstreams.

Those capabilities have the highest impact when they are engaged early, sequenced against the launch timeline, and built with the internal team’s payer strategy as the input rather than developed in parallel to it. The partners that produce the strongest work are the ones who understand that their job is to sharpen and execute against the internal team’s strategy, not to hand over a strategy of their own.

Before the budget locks

The 2027 budget window closes in weeks, not months. What is in the plan when it locks is what the launch will be resourced against for the next eighteen months. What is not in the plan gets deferred, and deferred market access work compounds into launch-year problems that are more expensive to fix than they would have been to fund.

If your team is evaluating market access or payer marketing partners for the 2027 launch, or wants to compare notes on what the pre-budget plan should include, we would welcome the conversation. The window to have it well is now.