Senior Vice President, Market Development, at ConnectiveRx.

Chris Dowd, ConnectiveRx

The first 24 hours after a prescription are crucial—nearly half of patients are lost immediately without efficient onboarding. Rapid, streamlined hub services are essential to keep patients engaged and on therapy.

Digital and Multichannel Enrollment Is Key. 

Combining traditional methods (fax, phone) with digital tools (EHR integration, portals, NCP channels) improves enrollment efficiency, reduces friction, and captures more patients early.

 With ongoing policy uncertainty, hubs must prioritize adaptable, resilient designs—focusing on process speed, modularity, data tracking, and selecting partners who can evolve with regulatory change.

It’s an understatement to say there’s a lot going on right now that could impact pharmaceutical companies’ and drug brands’ patient access strategies. With pricing, Medicare frameworks, pharmacy benefit manager rebates, and more seemingly up for redesign, it would be hard not to fixate on regulatory uncertainty. And, by the time this article is published, it’s likely that even more chaotic policy and regulation conversations will be afoot.

I urge you to remember that, amid this uncertainty, one constant remains where manufacturers maintain direct control: hub services that get patients started on therapy faster. Rapidly connecting patients to their prescriptions through well-designed access and support processes is a fundamental component of any drug’s performance in the market, and one that will endure regardless of which policy changes materialize.

The unchanged truth: The first 24 hours still decide patient access

With current data indicating that nearly half (44%) of prescribed patients for any given medication are lost within the first minute due to lack of coverage, manufacturers must maintain laser focus on the speed and efficiency of their hub onboarding tactics, particularly in those critical first 24 hours after prescription. The goal at this point is to quickly preserve those patients subject to a national drug code block (formulary exclusion) while simultaneously engaging the remaining eligible patient segment.

From welcome calls and prior authorizations to case management and financial assistance programs, hub services are designed to conquer a range of medication access obstacles with a complex ecosystem of patient support. But if a brand’s hub program doesn’t include a smooth, straightforward patient enrollment and onboarding process that engages the prescribed population immediately, the rest of the hub’s services will be out of reach, making your investment in the whole system far more expensive in terms of ROI.

The first critical job a hub does is create momentum

Rapid hub onboarding creates essential momentum that carries patients successfully to therapy. Speedy enrollment is the crucial first step to securing consent, swiftly clearing insurance hurdles, and unlocking access to benefits like financial support so patients stay engaged. This momentum becomes the difference between a prescription that gets filled and one that becomes another abandonment statistic.

There are key steps brand teams and their hub partners can undertake to ensure patients are able to quickly and easily start on therapy:

Traditional channels such as fax and phone remain viable and necessary options in order to maximize healthcare professional interaction with your hub.

But digital enrollment channels have become the norm, including direct electronic health record integration that enables providers to enroll patients within the prescribing workflow, reducing administrative burden and accelerating the onboarding process from the moment of prescription. In addition, the non-commercial pharmacy channel further expands enrollment opportunities by connecting patients at the pharmacy level, capturing those who might otherwise fall through traditional enrollment gaps.

Digital portals provide a self-service option, allowing prescribers and patients to initiate enrollment 24/7 through a user-friendly website. These entry points are complemented by real-time electronic benefit verification capabilities that deliver immediate insurance coverage insights, dramatically reducing the traditional wait times from days to minutes.

As artificial intelligence (AI) progresses, hub providers will begin to integrate advanced AI tools into patient relationship management software as a background application that helps hub agents identify and implement the “next best action” for each patient.

As a result, we envision a near-term future when the entire onboarding process is accomplished with even greater operational efficiency.

Understand the minimum information required for enrollment

Hub enrollment can often be completed with just five “minimum viable enrollment” fields: first name, last name, date of birth, sex, and zip code. This reduces friction and boosts immediate hub enrollment, while other identifiers (e.g., household income, concomitant meds) can be collected later as needed.

Policy changes are coming; that’s a given. Here’s how to make sure your hub keeps getting patients on therapy regardless of what Washington decides:

Prioritize fundamental process velocity over policy prediction

. Use strategies such as multichannel enrollment, be ready to enroll with minimum viable patient data, maximize digital tools when they help with scale and accuracy, and prioritize thoughtful technology integrations that boost results rather than flashy consumer technology that are simply nice-to-haves.

Evaluate hub providers based on their adaptability.

 You’re designing a hub that works precisely for today’s prescription journey, but be sure your partner will talk openly about how change may impact your drug in the future and how your hub would need to respond.

 Think about modular approaches, data interoperability, operational playbooks, and other tactics that will help you retain the strongest and most effective parts of your hub if and when change is necessary.

Measure what matters through any policy environment.

 Build in the ability to track key metrics such as time to therapy, abandonment rates, and financial impact of hub performance.

Budget cuts may be coming, driven by drug pricing changes or economic pressures. As a result, you could find yourself being forced to explain how the hub needs to serve more patients now to accomplish revenue goals. Be ready to defend your hub by showing how it directly improves prescription lift, fills, and patient adherence.

By prioritizing a “true north” of speedy enrollment to capture the widest patient population and taking thoughtful approaches to future-proof the hub design for best outcomes, you’ll have a strong case for the hub being indispensable to your company’s brands. 

Chris Dowd is Senior Vice President, Market Development, at ConnectiveRx. With a nearly 30-year career spanning leadership roles across Big Pharma, healthcare startups, and the patient support space, Dowd is a preeminent industry voice in patient access and adherence.

Articles

Doubling down on patient access and support fundamentals will win out over Washington’s next move.

Policy Whiplash? 24 Hours in the Hub Still Matters More 

Let's start with an alarming pair of statistics. First, 40% of specialty product prescriptions actually get filled, and second, when a patient’s copay or out-of-pocket cost exceeds $250, the abandonment rate is nearly 70%.

Pharmaceutical manufacturers are focused on making massive investments in product launches, field force training, marketing, and healthcare provider (HCP) education, but what happens to that momentum once the prescription is written and it is in the hands of the patient to fill? The disconnect in the level of pre- and post-prescription focus is easy to understand because the complexities of each require wildly different solution thinking. Across the specialty medicine market, we are seeing that unaddressed post-prescription issues have serious impact on patients, prescribers, and the pharmaceutical manufacturers that serve them.

Once a specialty prescription is written, fulfillment can become derailed at any number of points in the process. It can be helpful to look at these roadblocks and the key strategies for reducing or eliminating prescription abandonment under the framework of “the 4 Es”: enrollment, engagement, entry point (or access), and execution (or delivery).

Reducing friction in the hub enrollment process is the first step in helping patients get and stay on their therapy. Meeting HCPs in the electronic health record (EHR), where they spend a large percentage of their day, can vastly improve speed to therapy. Allowing HCPs to access key features and data without leaving their familiar in-EHR clinical workflow means they don’t have to switch between different applications, reducing the time to enrollment and the risk of data entry errors since the patient information is already there.

As non-commercial pharmacies (NCPs) are increasingly integrated into hub enrollment strategies, the EHR as a mechanism for enrollment is more common. For self-administered products covered under pharmacy benefits, including treatments such as oral therapies, self-injectables, and self-administered drugs, the NCP can serve as a valuable enrollment channel.

In these situations, HCPs don’t need to enter the patient data because it is already in the EHR, and the relevant information (i.e., diagnosis codes, demographic data, etc.) is automatically transferred to the prescription. In-workflow EHR prescribing can give patients access to the medication days or even weeks faster. The time HCPs would normally have spent dealing with enrollment can now be used where it belongs, with their patients.

In addition, digital portals can streamline documentation submission by providing a centralized platform where HCPs can upload, access, and manage patient information.

This eliminates the need for paper forms, manual data entry, and faxing—and ultimately leads to improved accuracy and communication.

Technological advances are helping put patients at the center of their care more than ever before, enabling them to become more actively involved in making decisions about their treatment instead of passively receiving care.

Among the tools that are available to patients are mobile-first solutions that can help boost adherence while giving pharmaceutical manufacturers more information about the types of support patients want most. Best-in-class offerings include text-to-enroll capabilities, digital communication channels for updates and reminders, and patient self-service options through mobile platforms.

Leveraging patients’ reliance on their phones as a first stop for information, mobile care platforms can connect in a single place the individual silos that are supporting them. Funneling everything through one service to keep patients well informed benefits not just them and HCPs, it also gives brands more leverage to incorporate the best option for each of those silos.

Engaging different generations of patients, including both digital natives, such as Gen Z and Millennials, and older generations, who are not as familiar with digital platforms, is an important aspect of a pharmaceutical manufacturer’s engagement strategy for their brands. To address the widest range of patient needs and preferences, an effective engagement strategy should incorporate both traditional and digital channels.

With prescription drug pricing as volatile as it is today, never has an access strategy been more important in helping patients start and stay on their medication. If they haven’t already, pharmaceutical manufacturers should develop comprehensive programs that make their brands available, affordable, and easily obtainable. 

An effective access strategy should include a number of key elements, including:

Effectively addressing prior authorizations (PA) denials. 

Pharmaceutical organizations should leverage technology, including electronic PA and real-time benefit verification systems to streamline processes; build strong relationships with payers; educate HCPs about specific PA requirements; and monitor denial trends—with the ultimate goal of minimizing the strain on HCPs and reducing speed to therapy for patients.

These programs often provide a lifeline for patients who otherwise cannot afford their prescribed medications. They deliver a temporary free supply of medication to the patients while hub agents work through coverage restrictions and then seamlessly transition the patient from bridge to commercial product once coverage is obtained.

 Seamlessly connecting a copay support program with a patient’s insurance plan allows the dispensing pharmacy to automatically calculate the patient’s out-of-pocket cost and apply the discounted price.

Developing a smart execution strategy that ensures patients receive and start therapy is critical to improving adherence. Providing patients with tools that allow them to track the progress of their prescription, including patient engagement platforms that feature “pizza tracker”-style visibility, offers ways to further engage patients in their own treatment. Offering visibility into the fulfillment process, not just for patients but for all stakeholders, can increase engagement, loyalty, and, ultimately, adherence.

Pharmaceutical manufacturers that place as much focus on their patients’ post-prescription journey as they do on pre-prescription brand marketing and sales efforts are likely to be rewarded with more engaged patients and increased adherence. Using the 4 Es as a framework for combating prescription abandonment, companies can evaluate their current approach and determine if changes need to be made. 

- Kristine McGaughey, Vice President, Implementation at ConnectiveRx, contributed to this article.

The key strategies for reducing or eliminating post-prescription abandonment.

From Prescription to Patient: Four Ways to Increase Speed to Therapy 

2024 was a pivotal year for the patient support landscape, as the space underwent a substantial shift shaped by market dynamics, regulatory changes, and the evolving needs of patients.

After a quarter marked by intense discussions at industry conferences and candid conversations with pharmaceutical leaders grappling with unprecedented change, one thing is clear: 2025 will fundamentally transform how drugs are covered, paid for, and filled in America.

Here are five predictions for how the landscape will shift in the year ahead:

By mid-2025, we'll witness the most significant healthcare policy battle since the Affordable Care Act. The Republican-controlled Senate, pursuing Trump administration priorities, is likely to substantially challenge key Inflation Reduction Act (IRA) provisions, particularly around drug price negotiations. While the slim Senate and House majorities could make it difficult to institute a full repeal of the IRA, parts of it are vulnerable.

As North Star Opinion Research Vice President Jon McHenry noted in a recent panel discussion, Republicans will likely use unspent IRA funds to help offset the continuation of Trump-era tax cuts expiring in late 2025. However, the $2,000 out-of-pocket cap for Medicare beneficiaries will likely survive, creating an interesting dynamic where manufacturers must navigate a hybrid policy landscape.

To stay ahead of the IRA roller coaster in the coming year, stakeholders in the patient support ecosystem—from providers to hub and patient services teams—need to work overtime to understand the evolving nuances of what’s changing and communicate it effectively. A PDR survey of US healthcare providers (HCPs) reveals that 38% of providers “know nothing” about the pharmaceutical provisions in the IRA, while an additional 55% only know “a little.” This highlights myriad opportunities for pharma manufacturers to also provide welcome education to HCPs about changes in access to their branded drugs.

The death of the dominance and attention on “traditional” copay programs, the surge in prevalence of accumulator adjustment and maximizer programs, and the continued usage of alternative funding programs will force a complete reimagining of manufacturer support. By Q3 2025, we'll see the emergence of matrix support programs that combine product access, procedure coverage, treatment-journey assistance, and patient success programs in entirely new ways.

Buy-and-bill programs already account for half of specialty product assistance. With the gross-to-net (GTN) pressure on brands to do more with less, including the evolution of copay affordability programs over the last five years, these matrix support programs will only continue to grow in necessity. High-end specialty medications are a prime example: In the same way biologics took the market by storm over the last seven to 10 years despite initial skepticism, cell and gene therapy pipelines and approvals are continuing to escalate—and programs supporting their adoption and adherence will be key.

As the market shifts from traditional copay programs to more sophisticated matrix programs, pharma brands need to seek out best-in-class support options to serve patients. They should consider establishing working groups in their organizations to meet with their field reimbursement managers as well as marketing and managed care teams to stay on top of what patients and providers are expecting (and demanding) in order to build programs that raise the bar.

Pharmacy benefit managers (PBMs) currently “don’t have any friends in Washington,” as McHenry noted in the recent panel. Pressure on PBMs by both federal and state governments in the form of anti-PBM legislation is unprecedented, and, considering RFK Jr.’s reformist views and the power he could wield, their influence will likely wane in the coming year.

With that in mind, the bipartisan "Patient Before Monopolies Act" will pass in 2025, fundamentally restructuring the PBM industry. As Sens. Elizabeth Warren and Josh Hawley's unlikely alliance pushes the legislation forward, we'll see initial steps to dismantle vertical integration between insurers, PBMs, and pharmacies. This will create immediate market disruption but ultimately lead to more transparent drug pricing models by year's end.

Staying on top of these developments is paramount. Whether through internal or external resources, manufacturers should remain in ongoing contact with state government relations teams to understand how legislation is evolving and how they can react.

4. The rise of ‘anti-abandonment’ programs

Even with a mature patient services model, fewer than half of specialty patients make it through payer controls to fill their prescriptions at 90 days, according to the IQVIA Institute.

With new-to-brand abandonment rates hitting 35% to 40% and the industry losing billions in potential revenue, 2025 will see manufacturers pivot away from traditional adherence programs, toward sophisticated early-intervention models. These programs will leverage predictive analytics to identify at-risk patients before they abandon therapy, combining financial support, behavioral interventions, and digital engagement in novel ways. This shift is particularly crucial as the industry grapples with expanding formulary exclusion lists from major PBMs such as CVS Caremark, Express Scripts, and OptumRx.

Leveraging patient data and AI-driven targeting models can help brands build effective anti-abandonment programs. By scoring key demographic information such as age, drug class, prior experiences, and previous adherence (or lack thereof), early-intervention algorithms can help determine the likelihood of abandonment. From there, brand teams can build tailored programs to improve adherence.

In 2025, GLP-1 agonists will face unprecedented restrictions and rejection rates from payers due to cost, demand, and indication alignment (e.g., trends that include moves by Kaiser, Independence Blue Cross, and Blue Cross Blue Shield of Michigan). While Medicare may expand coverage under the new administration, commercial payers will simultaneously implement a new generation of sophisticated access barriers that go far beyond traditional prior authorization—requiring documented participation in behavioral health programs, mandatory step therapy through lower-cost alternatives, and possibly even time-limited authorizations tied to demonstrable outcomes. And to further complicate the long-term GLP-1 reimbursement landscape, the US Department of Health and Human Services has announced that Ozempic, Rybelsus, and Wegovy will be included in the 2025 round of Medicare drug price negotiations, with adjusted prices becoming effective in 2027. Taken together, these multiple challenges will push pharmaceutical manufacturers to repeatedly reimagine GLP-1 access and support.

Learning from oncology's experience with advanced patient support programs that integrate financial, clinical, and behavioral support, we will see companies move away from traditional copay assistance toward more holistic “lifestyle support hubs” that combine financial assistance with digital coaching, behavioral modification tracking, and outcomes documentation. Traditional support models that “help with copays and prior authorization” will be enhanced by end-to-end patient success programs that help patients navigate increasingly complex payer requirements while supporting long-term therapy success. According to Kevin Herwig, health policy manager at the HIV + Hepatitis Policy Institute, we've already seen this evolution in HIV treatment support programs, where successful adherence increasingly depends on providing comprehensive social, behavioral, and financial support—GLP-1s will accelerate this trend dramatically across all chronic conditions.

The multiple disruptions looming this year will create a clear divide between brands that embrace these changes and those that maintain traditional commercial approaches. For brand leaders, the time to prepare is now, while there's still opportunity to gain first-mover advantage in their therapeutic areas. The future belongs to the bold.

Chris Dowd, Senior Vice President, Market Development, at ConnectiveRx, is a new guest columnist for Pharmaceutical Commerce, covering the patient support space. With a nearly 30-year career spanning leadership roles across Big Pharma, healthcare startups, and patient support, Dowd is a preeminent industry voice in patient access and adherence.

From matrix programs to anti-abandonment strategies, predictions for a new era.


Breaking Point: How 2025 Will Reshape Patient Support Services

The drug pricing reforms introduced by the Inflation Reduction Act of 2022 (IRA) are expected to significantly impact pharmaceutical companies’ revenues and profitability. The IRA requires the US Department of Health and Human Services to negotiate drug prices, introduces penalties for drug price increases greater than inflation, and makes manufacturers responsible for 20% of catastrophic care costs for Part D patients whose spending exceeds the $2,000 out-of-pocket (OOP) cap.

The USC Schaeffer Center for Health Policy and Economics reports that “taken together, these provisions have been estimated to lead to an approximately 31% decrease in US pharmaceutical revenues through 2039 and result in 135 fewer new drug approvals.” Similarly, an analysis from 5POINT10 predicts a more than 20% hit to the operating income of global biopharma (even more in the US).

Despite the challenges created by the IRA, brand leaders must keep their focus on the day-to-day work of helping patients access—and pay for—their medications. So, what does the IRA mean for patient access leaders, pharma brand managers, and patient service owners? I recently moderated a panel on the topic with three industry experts whose insights I’m sharing here.

According to Sarah Butler, chief commercial officer at ADVI Health, four key areas will be affected, and manufacturers will need to adjust their strategies going forward.

Pre-IRA, the market incentivized biopharma companies to launch a drug first in a smaller population, such as rare disease, because they could continue to earn revenue on the drug while conducting ongoing R&D to expand to additional indications. Now, companies have to make difficult decisions to choose which indication is launched first because once the molecule is on the market, the clock starts ticking to be selected for IRA negotiation.

Because manufacturers need to consider how to delay getting on the list as much as possible, looking at volume projections is more important than ever. Even with a medium- or lower-priced drug, if the volume is high, the drug can appear on the IRA negotiation list sooner than you might think. Market dynamics and the competitive environment also play a crucial role. For example, GLP-1s launched this year in weight loss and have completely impacted the order of drugs on the IRA negotiation list. Paying attention to those market dynamics while preparing for launch is critical.

Manufacturers are likely to launch new drugs in Europe or Asia first in order to develop the drug, conduct additional studies, and prepare to file for the indication that will have the greatest impact in the US. Restricting drug access in the US to potentially groundbreaking drugs is likely to cause a backlash among patient advocacy groups and other healthcare stakeholders.

In addition to changes in launch strategy that are likely to happen as a result of the IRA, brands are likely to face hard decisions around adjustments to copay assistance programs, hub eligibility criteria, the amount of free product they’re able to offer and where they go overall with the brand in order to continue providing support to patients who need it.

Data points to a potential reduction of as much as 40% in the number of FDA-approved drugs over the next 10 years—up to 139 therapies—as a result of the IRA. Some manufacturers may consolidate resources around fewer products and lower investments, while others could pursue assets they might not otherwise approve, and some may discontinue trials. Alexion, for example, has gone on the record and publicly discussed delaying some investments in R&D.

Manufacturers are also beginning to change their organizational structures and adjust engagement strategies to respond to IRA negotiation and create more alignment with their global pricing colleagues. Teams focused on government are getting larger.

Once the negotiated prices are announced in September before taking effect in 2025, the spillover effect on the commercial market will be significant, particularly with Part D, where pricing designs will likely become even more complex. It is important for manufacturers to know their places on the list and use projections to avoid any surprises in terms of submitting evidence packages to the Centers for Medicare & Medicaid Services.

When new laws directly impact patients, it is critical to educate them about how these regulations will affect their medication journey.

“It’s all about getting the information out to the patient, explaining it to them in ways they can understand it, and meeting them where they are—and not just the patient, but of course, caregivers as well,” said Richard Fahrer, oncology marketing director, patient solutions, at Pfizer.

Copay smoothing is one area Part D patients are likely to need help understanding. Designed to put a $2,000 OOP cap on medications and spread patient costs evenly over the course of the year to make monthly costs more predictable, guidance on this is evolving and still being released.

“For patients to be able to take advantage of the program, they need to understand how it works, how to enroll, and how to smooth out that copay,” noted Fahrer. “They’re also going to need to make sure they make their payments on time, because if they opt-in to copay smoothing and then miss payments, they risk being dropped from the program and expected to pay a lump sum.” Interestingly, in a post-webinar conversation with an attendee, Fahrer learned that at least one independent patient assistance charity is suggesting that patients who expect to gain charitable support should not sign up for smoothing as it could disrupt the charity’s qualification and approval processes.

Making that information available to both patients and caregivers, in multiple languages wherever possible, and also educating prescribing physicians, practice managers, reimbursement specialists, and other patient advocates—as well as internally within the pharma manufacturer—is also critical.

In addition, hub services vendors have an opportunity to act as an intermediary to enroll patients in the copay smoothing program “because that’s going to be a little bit tricky in 2025,” explains Butler. Since patients aren’t able to enroll at the pharmacy counter and need to do so via paper, phone, or online application, the process needs to be as easy as possible.

Payers are poised to buckle down and do all they can to shrink their risk around the IRA impact. According to Don Sawyer, senior vice president of market access at Stemline Therapeutics, “The negotiations are going to get much more extreme and they’re going to leverage everything they possibly can do.

In the absence of information, payers “are going to backstop themselves, and who’s going to be there to backstop them is who has always been there to backstop them, the manufacturers,” added Sawyer. Payers are also likely to raise premiums, potentially reduce the number of Part D options, and use a more restrictive benefit design with existing plans.

In anticipation of the IRA and expected reduction in hub, patient assistance programs, and affordability program budgets, manufacturers should be looking to streamline their patient support operations. Leveraging artificial intelligence, electronic benefit verifications, more sophisticated benefits support, and blended staffing models all can help brands do more with less without shortchanging patients. 

Chris Dowd is Senior Vice President, Market Development, at ConnectiveRx.

What does the legislation mean for patient access leaders, pharma brand       managers, and patient service owners? Industry experts weigh in.
