Bridging the Gap: Market Access From Three Sides of the Table with Vidhya Segar

Bridging the Gap: Market Access From Three Sides of the Table - with Vidhya Segar

Real Pharma, hosted by Na-Ri Oh and Ian Wendt, with intern Amos Fung

Health technology assessment is usually described as a system. Vidhya Segar describes it as a negotiation between people who are each asking a different question. When she worked in government, the question was always why: why this drug, why now, why this population. In industry, it became why not. In this episode, Na-Ri, Ian, and Amos talk with Vidhya, a pharmacist who has worked as a hospital clinician, as an evaluator at Singapore's national HTA agency, and now in market access at Ipsen. Using Singapore as the working example, the conversation covers how a drug gets from approval to reimbursement, what the US most favored nation (MFN) policy looks like from Southeast Asia, how agencies handle rare disease evidence, and what each side of the table could do to make the other's job easier.

Vidhya Segar is a pharmacist turned national health policy expert turned market access strategist. She began as a hospital pharmacist in Singapore's public health system, working across inpatient and outpatient settings and designing training programs for early career pharmacists. She then moved to the Agency for Care Effectiveness (ACE), Singapore's national health technology assessment body, where she was Senior Assistant Director in the Technology Access Division and led the national rollout of medical device subsidies. Today she is Market Access Manager for Singapore and Malaysia at Ipsen. She is also a regular speaker and moderator at regional pharmacy and health policy conferences and an active voice on LinkedIn on health economics, HTA, and the evolving role of the pharmacist.

[00:00] Intro: The show open and the guest introduction, read in alternating paragraphs by Na-Ri and Ian.

[02:05] Three chairs, one problem: Amos opens with Vidhya's path from acute care pharmacist to national HTA agency to industry. Her version: it was not a grand plan, but sitting on three sides of the access problem changed how she sees it, including the discomfort of realizing that funding one thing means not funding another.

[05:06] There are no bad guys: Why Vidhya thinks most access fights get adversarial, and why people who spend an entire career on one side of the fence tend to lose the ability to see the other side's constraints.

[06:23] A day in the life of a market access manager: What the job actually involves, from dossier submissions to patient access programs to securing tenders, and why the role looks different in a fully reimbursed market than in a partially reimbursed one like Singapore.

[09:30] Why versus why not: The double agent question. What it is like to carry a payer mindset into a business, and why Vidhya thinks the space between "why" and "why not" is where negotiation, and growth, happens.

[10:34] How Singapore's system works: Ian sets the scene with Singapore's reputation for efficient care, then Vidhya walks through the path from regulatory approval to reimbursement: the Health Sciences Authority, the self-pay option inside the government channel, the advisory committees that make the funding decision, and why there is no such thing as 100% reimbursement when everyone is means tested.

[14:04] Real-world evidence and what HTA actually is: ACE's new guidelines on real-world data, why randomized trials remain the gold standard, and Vidhya's argument that people confuse an assessment with a funding decision. Na-Ri adds the US parallel: an FDA approval that cannot find its way onto the market.

[16:25] ACE compared with NICE and ICER: Is ACE stricter than its peers? Vidhya says no, but Singapore's tight link between assessment, funding, and a defined go-live window changes what "access" means in practice.

[18:23] Price, reference baskets, and MFN: How reference pricing works in Singapore, what MFN looks like from Southeast Asia, and Vidhya's concern that industry could overcorrect and underprice drugs for lower-affordability markets. Ian's follow-up: what happens when MFN pressure pushes up the prices Singapore references.

[22:18] Rare disease, cell and gene therapy, and thin evidence: How ACE has approached therapies where robust data is hard to generate, why Vidhya expects case-by-case decisions to continue for the foreseeable future, and what a company can do when reimbursement may not be the answer.

[25:02] Living with uncertainty: Ian asks how a company decides between more randomized trials and a real-world evidence package when the agency's reception is unclear. Vidhya's reframe: both sides want certainty, and certainty is itself a negotiation.

[28:42] What would you change? Vidhya's wish for industry (bring access voices into trial design, because you cannot retrofit evidence) and for agencies (a way to revisit reimbursement decisions as new evidence arrives), plus the resource reality that keeps agencies from doing it.

[32:03] What ACE wished industry understood: Three things: know how the health system you are working in actually funds care, build both a sponsor-friendly and a realistic payer case, and remember it is a long partnership. The elephant hiding behind a pole makes an appearance.

[34:29] Advice for pharmacists thinking about industry: Access work is meaningful even on the industry side, and the best access professionals are corporate polyglots who can speak sales, marketing, medical, and policy. Ian and Na-Ri add their own take on moving from clinical roles into pharma and translating technical work for cross-functional teams.

[38:54] Why she is still in healthcare: Amos closes with the question of what inspires her. Vidhya shares two stories: a clinician's reply to a thank-you email about a rare disease patient group in Singapore, and her grandmother's experience of Parkinson's, which is how she first became curious about drugs.

[42:07] Wrap: Thank yous, and Ian's note that the show is usually very US focused, with some requests to widen the aperture.

On the premise of the whole conversation: "There are no bad guys in this problem. We're all just operating from different constraints with different motivations and different incentives."

On the two questions that frame the negotiation: "When I was in the government, we were always trained to ask why. Why this drug? Why now? Why this population? Why, why, why? On the business side of things, I'm asking, why not?"

On what HTA is and is not: "It is a rigorous assessment. It is a noble assessment, but it is an assessment."

On designing trials with access in mind: "You cannot retrofit evidence."

On keeping the relationship healthy: "Any reimbursement decision that's won with more tension than is required is a Pyrrhic victory, because we're all humans at the end of the day. We remember things."

On communicating across the business: "If you are not accessible to your business partners, you are of no use."

• Agency for Care Effectiveness (ACE), Singapore's national HTA body
• Health Sciences Authority (HSA), Singapore's regulator
• NICE and ICER, as points of comparison for ACE
• Singapore's Drug Advisory Committee and Medical Technology Advisory Committee
• ACE's guidelines on real-world evidence and real-world data
• The US most favored nation (MFN) pricing policy
• Living HTA
• Bloomberg Health-Efficiency Index
• Ipsen