Senior Vice President, Market Development, at ConnectiveRx.

Chris Dowd, ConnectiveRx

Pharma brands should evaluate AI in patient services

 by asking outcome-focused questions—how it improves patient care and brand performance—not just how it reduces costs.

Effective AI solutions should preserve human touchpoints

, have clear escalation paths when automation fails, and maintain strict data governance to protect patient information.

Access leaders must ensure AI is used strategically

 to solve specific brand challenges, rather than adopting it simply because it’s trending.

Almost every patient services request for proposal (RFP) from pharma now includes artificial intelligence (AI) questions. But my round-up of market access experts reveals that most ask the wrong ones. With brand budgets shrinking, it’s natural to focus inquiry on where AI can bring cost savings. But the companies seeking real ROI should ask fundamentally different questions about implementation, outcomes, and risk. Seasoned technology leaders suggest the difference in approach lies not in what AI can do, but in knowing when it should—and shouldn’t—be used.

I sat down with Steve Randall, ConnectiveRx’s chief technology architect, to discuss the evolving role of AI in patient support services. We talked about the many closed-door conversations happening during vendor evaluations, RFP processes, or internal strategy meetings and identified some core questions access experts should be asking teams—internal or external.

Brand executives often get dazzled by automation promises and cost projections. What questions should they ask to cut through the pitch and focus on what really matters?

There are two easy lenses for that. There’s no question AI can be extremely helpful in leveraging data to improve back-office functions, document management, OCR (optimal character recognition), sentiment analysis, data anomaly detection, and a better understanding of the impact of cost-sharing programs and patient benefits. Using AI this way leads to better program quality and faster output.

But, when evaluating patient-facing applications, first ask, “Will this AI help us achieve better patient outcomes, or just the same outcomes more cheaply?”

If you design your support programs around efficiency metrics only—automating every touchpoint, minimizing human involvement—you risk turning a deeply personal experience into a transactional one. The key is distinguishing between cost-focused automation and outcome-focused enhancement.

Second, ask, “How do we ensure AI efficiencies translate into superior brand performance rather than just cost reduction?”

The brand’s goal should be “enculturated AI”—technology that enhances rather than disrupts patient care relationships. Success metrics should include adherence rates, successful prior authorizations (PAs), and reduced pharmacy abandonment—not just operational savings.

Let’s talk about patient experience. How should access leaders probe whether AI strengthens or weakens those critical patient relationships?

You can get to the core of what a partner is willing to think through for your brand in two ways. Start with this question, “How does your AI solution maintain the personal connection that builds brand loyalty?” Listen for answers that point to “enculturated AI” rather than one magic bullet tool. You want technology designed with human values that will strengthen provider-patient relationships and patient-brand relationships. Potential partners should explain how AI helps identify when human intervention is needed, not how it eliminates human touchpoints.

Then, double down and ask, “Can you show me where AI failed with a patient interaction and how that was handled?” Strong vendors will have specific examples of escalation scenarios—like when a patient’s case doesn’t fit standard models during PA approval, or when someone experiencing adverse effects needs real-time support beyond “contact your doctor.” They should demonstrate clear paths for human specialists to step in with empathetic, personalized care when AI reaches its limits.

How can executives test whether vendors are truly accountable—that they understand when AI should and shouldn’t be used?

See if they are as willing to unsell it as they are to sell it. Try this: “Have you ever advised a client not to use AI for certain functions? Can you give an example?” Strong vendors will acknowledge that trying to address complexity with pure automation doesn’t work. They should have specific examples where they recommended human-centered solutions over AI automation, particularly in emotionally sensitive or clinically complex situations.

Data use should also be a major concern not only for an access leader but for compliance in their greater pharma organization. Be direct about this: “What patient data will the AI access and how is that data secured from exploitative use?” Vendors should address concerns about sharing protected health information and maintaining competitive advantage by keeping data under wraps. You’ll want them to be clear they won’t be providing that information to public AI models. Look for vendors who can explain in detail how they handle data governance and avoid feeding sensitive information into shared systems.

Access leaders are caught between bosses who want cost savings and competitive advantage from AI, but they’re also responsible for protecting program quality. How do they manage that tension?

An access leader’s job is to take calculated risks needed to build the most effective program possible. To prepare for that, ask, “What’s our fallback plan when AI provides uncertain or incorrect guidance?” Look for a vendor with clear escalation processes when AI reaches its limits. For example, when the PA process hits a snag because their case doesn’t fit the standard model. There’s no clear escalation path, and the AI doesn’t have the contextual awareness to resolve it within the program standards.

Last, I asked, “If you had to boil this down to one essential question access experts should ask themselves about AI, what would it be?”

His answer: Are we pursuing AI because we’ve identified specific brand challenges it uniquely solves, or because everyone else is talking about it?

To me, that cuts right to the heart of it. We’ve seen AI transform pharmaceutical R&D for years—accelerating drug discovery, optimizing clinical trials, and reducing development timelines. But as CEOs try to turn it on commercialization, many leaders are discovering that an AI playbook that works in research doesn’t translate to patient services and market access. The questions that matter most aren’t about technology capabilities—they’re about business outcomes in a highly regulated, human-centered environment.

At the end of the day, don’t fall in love with the tool—fall in love with the outcome. 

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

Conversation with chief tech expert explores AI’s rise in the support 
space—and separating the substance from the noise. 

Questions Patient Access Leaders Should Be Asking About AI (But Aren’t)

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. 

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.
