AI and the Access Gap: What's Actually Changed?

In the first part of their interview with Pharmaceutical Commerce, live from Asembia AXS26 in Las Vegas, Miranda Delatore, VP, Product, and Megan Wetzel, VP, Product, Access and Affordability at CoverMyMeds, offer a practical look at where AI is delivering results in medication access workflows, and where the specialty pharmacy journey still has critical gaps to close.

On the question of AI moving from pilot to daily necessity, Delatore points to prior authorization. Rather than a future promise, she describes AI as already embedded in everyday workflows, pulling data that exist across the ecosystem, applying it intelligently to answer authorization questions, and cutting down on the manual processes that can delay access for patients and burden providers.

When the conversation turns to access bottlenecks, Delatore identifies a simple but significant barrier: the lack of clarity around whether a specialty therapy will be processed under a patient's pharmacy benefit or their medical benefit. According to Delatore, that uncertainty can stall the post-diagnosis journey before it even begins. Wetzel adds another layer to the problem, noting that too many access and affordability solutions are being applied downstream, after a patient has already hit a wall, rather than being built into the workflow from the start. The pair agree that the path forward lies in anticipating those hurdles early, tailoring solutions to the complexity of each individual patient's journey, and ensuring that no patient is left without answers at the moment they need them most.