FDA approved. Payer restricted. That gap is not random.
I work with VPs and Heads of Market Access, HEOR, and RWE to anticipate how payer and HTA dynamics will shape access—before launch strategy is locked in.
Institute for Clinical & Economic Review precedent analysis
NICE
National Institute for Health & Care Excellence HTA review
CMS
U.S. payer behavior & coverage decision tracking
RWE
Evidence designed to move coverage decisions—not just inform them
The access gap
Approval and access are not the same event.
Across therapy areas, the pattern is consistent. Strong clinical data. Regulatory approval. And then—restricted access, slow uptake, missed forecasts. That gap has a structure.
The pattern
Payers and HTA bodies apply a different evidentiary lens than regulators—and that lens is knowable before launch.
The risk
Forecasts built on clinical adoption curves—without modeling access friction—consistently overestimate real-world uptake.
The opportunity
Evidence strategy aligned to how payer decisions are actually made can be designed before launch. Most teams build it reactively.
What drives the gap
Four forces payers weigh that regulators don't.
01
Uncertainty at launch. Payers price in evidence gaps that regulators tolerate. If your dossier doesn't address residual uncertainty explicitly, restrictions follow.
02
Comparator relevance. HTA bodies evaluate against their standard of care—which often differs from your trial comparator. That gap shows up in rebate demands and prior authorization criteria.
03
Real-world performance. Coverage decisions increasingly hinge on whether launch-era RWE confirms or challenges trial findings. Most RWE programs are not designed to answer that question.
04
Budget impact. Population-level cost projections shape formulary tier placement more than cost-effectiveness ratios in many U.S. payer decisions.
What I do
Three places where access strategy can fail—and where I work.
Each engagement is structured around a specific decision point: before launch, at strategy review, or when RWE needs to change coverage outcomes.
01
Access Friction Identification
Using analog HTA decisions and payer behavior patterns, I identify where prior authorization intensity, step therapy, and eligibility constraints are likely to create friction—before your launch strategy is locked.
Pre-launchPA / Step TherapyAnalog Analysis
02
Access Strategy Pressure-Testing
I run your evidence strategy against real ICER, NICE, and U.S. payer precedents to surface vulnerabilities before they surface in negotiations. The goal is finding what breaks before decision-makers do.
ICER / NICE ReviewPayer PrecedentGap Analysis
03
Coverage-Aligned RWE Design
I design real-world evidence programs aligned to the specific uncertainties driving payer restrictions—not to publication objectives. RWE that doesn't map to a decision rarely changes one.
RWE StrategyCoverage DecisionsEvidence Design
Market Access Signals
How access decisions actually play out.
A running analysis of payer and HTA decisions—what they signal for launch strategy, where forecasts miss, and when RWE actually changes outcomes.
Issue #4 · 2025
When RWE Actually Changes Payer Decisions — And When It Doesn't
RWE Impact
Recent Signal
Why Forecasts Miss Access Friction: Prior Authorization, Step Therapy, and Time-to-Coverage
Forecasting
Recent Signal
How Payer Behavior Diverges From Regulatory Approval — and Why It's Predictable
Payer Divergence
View All Signals →Published weekly for VPs and Heads of Market Access, HEOR, and RWE
Who this is for
Senior leaders who own the access problem.
I work best when the stakes are specific: a launch window, a strategy review, or an access trajectory that isn't matching the forecast.
VP or Head of Market Access
Preparing for launch or managing post-launch access friction. Needs early-warning analysis on where payer behavior will diverge from the plan.
Head of HEOR
Building the evidence package for an HTA submission or payer dossier. Needs an external read on where the strategy is vulnerable to ICER or NICE scrutiny.
RWE Lead or Evidence Strategy Director
Designing evidence generation programs. Needs RWE scoped to the specific uncertainties driving restrictions—not to journal publication criteria.
Market Access Consultancies
Boutique or mid-size firms needing senior overflow capacity for a specific engagement without adding headcount.
Who I am
PhD-trained. Payer-focused. Senior from day one.
Every engagement is led directly by me—not delegated to junior staff.
Bradford Ochigbo, RPh, PhD
Health Economist · HEOR & RWE Scientist · Licensed Pharmacist
PhD in Social Policy (Health Policy), Brandeis University Heller School
Postdoctoral Fellow, Global HEOR — SMPA Pharmaceuticals (formerly Sunovion)
Tufts Medical Center, Center for the Evaluation of Value and Risk in Health (CEVR)
HEOR / RWE — Takeda Pharmaceuticals
Published: Clinical Therapeutics (2024), Journal of Global Health Reports (2021)
Licensed pharmacist — Massachusetts and Texas
Is your evidence strategy built for how payer decisions are actually made?
If you're pressure-testing how payer and HTA dynamics could impact your launch, access, or forecasts, I'm happy to compare notes.