Optimizing Access: Balancing Speed-to-Therapy and Gross-to-Net

Today’s guest post comes from Sahil Naik, Chief of Staff to the CEO at Phil, Inc.

Sahil discusses how manufacturers can balance patients’ access to therapy with gross-to-net (GTN) goals. Visit https://phil.us/ to learn more about how Phil helps improve the patient experience while managing GTN.

Read on for Sahil’s insights.

Optimizing Access: Balancing Speed-to-Therapy and Gross-to-Net

By Sahil Naik, Chief of Staff to the CEO, Phil, Inc.

Enabling timely access to therapy without compromising gross-to-net (GTN) is aspirational for most manufacturers. Understanding the GTN impact of access programs intended to increase adoption is crucial for sustainability. However, most brands lack the channel visibility and business rule control to do so. Thus, identifying a partner equipped to translate data into insights is essential for brands seeking sustainable growth across the lifecycle.

THE IMPORTANCE OF STREAMLINING PATIENT ACCESS TO THERAPY

It’s evident that delays to therapy increase abandonment, yet one-third of patients experience access difficulties due to delays, denials, and costs. Accelerating therapy initiation significantly improves the odds of patient and brand success - particularly if done effectively at scale.

By eliminating barriers in the access journey, commercialization teams positively impact the stakeholder experience to increase adoption and loyalty. If physicians realize they can start a patient on therapy with minimal friction, they will continue to prescribe; If patients can easily access therapy, they are significantly more likely to adhere as prescribed.

IMPLICATIONS OF COMMON SPEED TO THERAPY STRATEGIES ON GTN

While there is some variance in strategies for increasing speed-to-therapy across the lifecycle, the three most common tactics involve manufacturer-sponsored financial assistance:

1. Free drug samples shared at the point of care to allow a patient to start on therapy immediately.
2. Bridge or quick-start programs expedite treatment initiation by sending out a free drug for a specified period - often while awaiting insurance approval, due to benefit changes, or an expired prior authorization (PA).
3. Copay cards or coupons, for covered and/or uncovered patients, which allow patients to reduce or eliminate their out-of-pocket obligation.

Each approach has a different impact on GTN and level of control from the company's perspective. For example, with drug sampling, tight control and visibility is quite limited. Whereas, copay programs typically produce data that can be measured enabling refinements over time. Financially, these strategies are incremental to gross revenue. More patients are getting started on the therapy, so the brand is realizing a higher total prescription volume. However, since the manufacturer subsidizes these programs, they risk margin dilution with overutilization.

FINDING THE ELUSIVE “TIPPING POINT”

The “tipping point” occurs when the efforts to boost speed to therapy begin to erode GTN. All too often, the recognition that the brand has crossed the tipping point occurs in hindsight. Generally, brand teams go in at the launch phase knowing they want to prioritize speed to therapy - ensuring prescribers see results, creating positive experiences that establish the brand in a specific therapeutic area. When a drug has been on the market for years, priority will skew towards a GTN focus because market access, physician behaviors, and a broader program are established.

Many variables impact performance, but at the end of the day, striking the right balance between therapy access and GTN comes down to optimizing the percentage of total dispensed prescriptions that are covered by insurance.

THE KEY TO BALANCING TIMELY ACCESS WITH POSITIVE GTN REVENUE

The key to expediting medication access without compromising GTN revenue is twofold:

1. Visibility

2. Influence

There are plenty of commercialization and patient access tools available, but it’s essential to have the capability to leverage them to make necessary adjustments as the brand evolves. Set your branded therapy up for long-term success

When Phil partners with brand teams, we provide rules-based levers that can control their access channels. As brands transition into a coverage-focused environment, we help them implement a more nuanced approach. We bring real-time data and drug trajectory experience to serve as consultative partners. By working with key stakeholders – from market and patient access to finance teams – to translate that data into insights and recommendations, we offer strategic roadmaps to reach their goals.

Recently, our team contacted a partner’s patient access team when we noticed patients were abandoning after the third refill. We advised that it would be beneficial to reduce the copay on the fourth fill to $0 from $20, explaining that based on prior fill data, the buy-down would lead to additional refills, translating to more GTN revenue and a better patient experience.

A tech company at heart, Phil provides flexibility to evolve with a brand as it grows. For example, we can strategically apply benefits pathways as a brand wins coverage, something particularly relevant for emerging digital therapeutics. We continue to invest in our platform to help brands unlock patient access. Visit https://phil.us/ to learn more.

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