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Trends and challenges in the Value, Evidence, and Access landscape: an interview with David Sykes, Head of VEA, Fishawack Health

For this installment of tHEORetically speaking, David Sykes sat down with HealthEconomics.com to provide an overview of Fishawack Health (FH) and its core competencies, what sets FH apart from other solution providers for life science commercialization, and digital applications offered by the company. David Sykes also describes current trends and challenges in the VEA landscape that FH is helping its clients solve, as well as how recent FH acquisitions are working together to deliver full-service capabilities to clients.

What is FH and what are the core competencies of the organization?

FH is a leading global commercialization partner for the biopharmaceutical, medical technology, and wellness industries. FH was created to offer integrated services for pharmaceutical and biomedical development and commercialization across four core disciplines: consulting, medical, marketing, and VEA.

Each discipline is brought together under a client partnership model that connects clients with the broader capabilities of the group. Under this model, we develop bespoke teams around each client’s unique challenges. These teams work independently but collaborate across our four capabilities and 22 offices in North America, Europe, and Asia to give clients access to a seamless and agile strategy that meets all their stakeholders’ needs.

We have a strong scientific background with more than 150 medical experts, writers, and PhDs on the team. While the organization started out in medical communications, businesses that offered closely affiliated services in healthcare marketing, consulting, health economics and outcomes research (HEOR), and market access have been added to the group over the last decade. With the addition of these services and expertise, FH can work end-to-end across the product lifecycle, provide better health outcomes for patients, and improve business results for our clients.

How has FH built out its functional expertise in the VEA category?

FH’s commitment to growing capability in HEOR and market access began with Skysis and PRMA Consulting joining the group in 2020 and 2021, respectively. With the addition of PAI, FH now has one of the largest and fastest-growing teams dedicated to VEA, all elements of which are critical to the commercial success of new products. We have broadened our specialism beyond market access.

PAI’s team of more than 30 professionals is joining FH’s growing team of strategy consultants and technical experts. Combined with PRMA Consulting’s global skills in market access and HEOR and Skysis’ experience in the increasingly complex US market access landscape, we now offer unsurpassed global expertise. We have designed an offering that empowers our clients to make critical decisions earlier in the product development lifecycle and mitigate some of the risks of bringing new molecules and indications to market, all while meeting payers’ demands for more sophisticated evidence.

What are the current trends and challenges in the VEA landscape that FH is helping clients solve?

The VEA landscape is becoming increasingly complex and challenging, but several key trends can be discerned. A disconnect is emerging between evidence regulators and payers, which impacts the evidence on which pharma needs to focus. Payers are becoming increasingly evidence hungry at a time when pharma is looking to go to market as quickly as possible with the smallest dataset that will satisfy regulators. Satisfying the regulator does not guarantee market entry; to negotiate successfully with payers, they must feel that they are getting value for money.

Where regulators might ask for endpoints like objective response rates, payers want data on hard endpoints. For example, advances in multiple myeloma have meant that the progression-free survival rate has been moved out by several years, making it more challenging to set up a clinical trial to demonstrate incremental clinical value. Consequently, the pharma industry is looking at minimal residual disease status as a potential surrogate endpoint, but payers will be reluctant to pay for any such surrogate outcome, and certainly not at full price. There’s also a growing need to provide longer-term trial data and real-world evidence from years down the track to validate trial evidence and associated claims.

Another trend is around budgetary scrutiny: an insatiable demand for improved healthcare means that public sector budgets are now more challenged than ever before. Increasingly, we are seeing more complex managed entry or risk-sharing agreements with pharma. The final theme pricing pressure, which is closely linked to budgetary scrutiny. In the US, there is political and public concern surrounding pharmaceutical prices and a heavy degree of pressure to do something about it. Prices are being challenged and there’s a growing focus on achieving better value.

PAI and PRMA Consulting both have a long legacy in the HEOR field. Skysis has also been delivering market access services for more than a decade. How do these three acquisitions by FH complement each other and deliver full-service capabilities to clients?

FH has brought together best-in-class global expertise with multidisciplinary skill sets and deep knowledge of both HEOR and payer landscapes in Europe, North America, and the Asia-Pacific region. With this global reach, we can build bespoke, best-in-class teams around the client’s challenge and bring in expertise across the capability and the organization.

We have brought these three deeply specialized companies together to develop a full service offering across VEA that supports our clients in navigating the increasingly complex VEA landscape. We are building a truly global, integrated, and technology-enabled consultancy, partnering with clients across market access, strategic pricing, health economics, and policy.

Working in collaboration with FH’s three other capabilities, the VEA team will play a crucial role in realizing the organization’s vision of creating the connections that make better health happen. By building these connections across the product and portfolio lifecycle, FH can ensure that its clients gain a rigorous understanding of the evolving needs of an interconnected stakeholder network, driving a seamless and agile strategy from early development to launch and beyond.

Gerry Oster, PhD, Managing Partner of PAI, has played an important role in the growth of HEOR over several decades. What will his role be in the new organization?

Gerry is one of the industry’s leading health economists and will become FH’s global Head of Health Economics. He will also serve as an internal expert and external thought leader across FH’s various businesses, while also helping shape the overall vision for VEA. In his 30+ years in HEOR, Gerry has authored more than 200 publications in top-tier journals and consulted on HEOR strategy and evidence generation for more than 100 biopharma companies; he will continue to leverage his expertise with clients and team members alike.

What is hēRo3 and the suite of PRMA Consulting digital applications, and will these solutions still be offered by the new organization?

hēRo3 is a cloud-based economic modeling platform used for evidence reviews of new prescription drugs, medical tests, and other healthcare interventions. This platform increases transparency, reduces errors, and accelerates evaluations. Since its introduction, hēRo3 has been used by more than a dozen large biopharma companies, colleges, and universities throughout the US and other countries, as well as the largest drug-pricing watchdog in the US.

FH’s suite of technology enabled VEA applications to leverage strategy, data, and artificial intelligence, and are designed to accelerate access to life-changing therapies. Both PRMA and PAI have been innovators in developing technology-based consulting solutions and building out platforms like hēRo3 to help clients achieve greater consistency, speed, and agility in their decision-making throughout the governance process.

PRMA Consulting’s secure and intuitive cloud-based solutions help you unlock and optimize product value from early development to successful country submissions. Specifically:

  • PRMA Healthcheck® helps maximize the value of your assets at all development stages.
  • PRMA Navigator® supports the improvement of multiple HTA and payer submissions, and helps shorten the time to market access.
  • PRMA Tracker® informs your payer evaluation and HTA strategy, enabling you to adapt to evolving payer expectations and improve submission quality.
  • PRMA Access Accelerator® allows you to gain competitive advantage with virtual advisory boards, forums, and online surveys that fast-forward your market access strategy.
  • The suite of digital applications is an integral part of FH’s new VEA team, which helps the company become a powerful presence in HEOR and market access by building on both organizations’ experience, expertise, and innovative digital skills.

What sets FH apart from other solution providers for life sciences commercialization?

With a new leadership team including Jon Koch, CEO and Liz Landon, CPO, FH has ushered in a new phase of growth and impact that is focused on delivering an integrated and innovative end-to-end service offering. To support its accelerated global growth, FH has built a people-focused environment where employees are empowered to think differently, thrive, and produce award-winning work that meets the evolving needs of biopharmaceutical, medical technology, and wellness clients.

The company re-imagined its vision and values and unified its 1,300 global team members under a common aspiration: “We imagine a healthier world and create the connections to make it happen.” This new purposeful vision empowers teams to work cross-functionally to develop effective solutions to the most complex healthcare challenges across the product, service, and portfolio lifecycle.

FH has created a fresh way to develop, launch, and grow brands, offering a full suite of best-in-class services for development and commercialization of pharmaceutical and biomedical therapies. We shape and affect connections between people and life-enhancing therapies, and we empower people with the knowledge and motivation needed to improve outcomes.

In the two decades since our founding, we have built capabilities in medical and marketing consulting, and with the addition of PAI we also have unsurpassed capabilities in the critical realm of VEA. By combining our skills in integrated teams, we are ready to deal with complexity and the ever-changing needs of commercialization.

PAI and PRMA Consulting are exhibiting at the first ISPOR US in-person conference in two years. What should delegates expect to see?

PAI and PRMA Consulting are very excited about the strength of our joint offering. We have only been together for approximately six months but we are already identifying several new opportunities to collaborate with clients. By bringing our two teams together at ISPOR, we have the opportunity to showcase the value of our combined experience, insight, and capability to a wide audience. Clients will see two teams that offer complementary services around consultancy and digital applications and appreciate that we can better serve their needs in early pipeline through to patient access by working together.

Our digital applications are at the cutting-edge and are helping re-shape the future of market access. We are providing new solutions for driving proactive planning and agility, enhancing real-time decision-making, accelerating cross-functional productivity, and linking global thinking with local needs and implementation.

Delegates at ISPOR 2022 will be able to see for themselves how breakthrough digital applications are transforming internal HEOR and market access decision-making and resource allocation. The online and in-person conference provides the perfect opportunity to discuss the digital transformation of HEOR and market access processes. Our expert team looks forward to meeting delegates and understanding more about the issues that we hope to help solve.


Market access success doesn’t have to stretch your budgets, or create more work. A great place to invigorate your thinking is this collection of landmark studies on the US payer landscape and the evolution of ICER’s influence.

tHEORetically Speaking

tHEORetically Speaking is the official blog of HealthEconomics.Com.

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