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.