Commentary
Article
Pharmaceutical Commerce
Hubs as Revenue Protection: Rethinking Patient Access in the Era of Disruption
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Amid intensified competition—and evolving IRA and PBM dynamics—leaders in the access space must now adopt a strategist mindset.
The access landscape is shifting. Specialty drugs still dominate, but the programs designed to help patients start and stay on therapy are under more strain than ever. As a result, what was once considered a support function is now central to a brand’s survival.
Hub services can no longer be viewed as nice-to-have extras or back-office costs. In today’s market, they’re a revenue protection strategy. Every prescription that doesn’t convert to a therapy start isn’t just a missed chance—it’s lost income, poorer patient outcomes, and an opening for competitors.
The Inflation Reduction Act (IRA) and its so-called “pill penalty,” as well as aggressive pharmacy benefit manager (PBM) practices and escalating gross-to-net pressures, have changed the economics of access. The challenge for pharmaceutical leaders is no longer whether to invest in hubs, but how to evolve them into smarter, leaner, and more strategically aligned operations that safeguard revenue.
Why hubs still matter even as margins tighten
Specialty medications now account for more than half of new drug approvals and spending. For many patients, moving from prescription to treatment isn’t simple. Specialty drugs often require refrigerated storage, complicated injection protocols, and insurance appeals that can stretch on for weeks. This is exactly why the hub model has become indispensable, even as drugmakers face relentless pressure to trim costs.
The drop-off data is grim. According to IQVIA, out of every 100 new prescriptions for a specialty medicine:
- 44% are not filled due to lack of insurance coverage.
- 14% are lost to prior authorizations or plan restrictions.
- 5% disappear because of distribution limitations.
- 7% fall away for other reasons.
- Only about 30% of prescriptions ultimately get filled.
The challenges surrounding specialty access make it clear that hub programs are not optional—they’re essential. By reducing coverage denials, guiding providers and patients through payer requirements, and preventing therapy abandonment before it starts, hubs get patients on the path to treatment. From the moment a prescription is written, coordinated and proactive support is the only way to overcome PBM restrictions, pharmacy drop-offs, and insurance denials. Without it, patients get lost in the cracks—and brands lose income.
From cost center to competitive differentiator
For years, patient access services were seen primarily as a compliance requirement or a necessary expense. Today, forward-thinking manufacturers are reframing the investment as a market advantage.
And the competitive landscape has shifted. A brand is no longer competing solely against therapeutic alternatives. It is also vying against:
- Biosimilars, which put downward pressure on price and erode market share.
- Direct-to-consumer access models, which promise patients faster and simpler pathways to therapy.
- Other manufacturers’ patient support experiences, which can determine whether a prescriber stays loyal or switches scripts.
What happens in the first 24 hours after a prescription is written often decides whether a patient stays on therapy. Delays with benefit verification, prior authorization, or pharmacy communication can undermine patient confidence and frustrate prescribers. The brands that move quickly keep patients engaged, reinforce confidence with physicians, and secure revenue that might otherwise slip to competitors who act more quickly.
What’s different about planning for 2026
Looking ahead to 2026, patient access leaders face a radically different set of planning assumptions than in years past.
- Economic constraints: The IRA has introduced new pricing pressures, including gross-to-net compression that squeezes available budgets for patient support. Meanwhile, PBMs continue to deploy aggressive tactics that limit coverage or push patients toward preferred alternatives.
- R&D shifts: Because of the IRA’s pill penalty, investment is increasingly directed toward specialty biologics rather than small-molecule drugs. This only amplifies the complexity of access.
- Environmental volatility: Ongoing payer consolidation, evolving policy landscapes, and distribution channel disruptions mean past playbooks can no longer be relied upon.
The bottom line: patient access leaders must plan for structurally different conditions, not temporary turbulence. What worked five years ago will not work in 2026.
Elements of competitive positioning in access
In a crowded market, differentiation comes down to how efficiently and effectively a brand can move patients from script to therapy. The leading access organizations will focus on:
- Experience as retention. Both patient and healthcare professional experience drive long-term brand equity. Frustrating patient access journeys can undo even the best clinical profile.
- Speed to therapy start. Time to initiation is an objective, measurable differentiator. Brands that reduce delays will win loyalty from prescribers and patients alike.
- Flexibility in workflows. The ability to rapidly adjust patient hub processes in response to new payer restrictions or channel shifts will separate resilient brands from those left scrambling.
- Scalable partnerships. Creating patient hub relationships that flex with demand—growing when volume is high and scaling back when it slows—helps pharmaceutical brands stay resilient without piling on fixed costs, even as market conditions shift.
In today’s environment, patient access is inseparable from revenue protection. Specialty therapies may offer breakthrough clinical value, but without efficient, strategically designed hubs, too many pharmaceutical prescriptions will never reach the patient.
For 2026, access leaders must shift from thinking like operators to thinking like strategists.
That means aligning every element of hub design with the ultimate goal: protecting income by ensuring patients start and stay on therapy.
Pharma brands and their teams can’t afford to see patient access as just paperwork. The ones that succeed will be those that build smarter hubs—tools that don’t just improve efficiency, but actively protect revenue.
About the Author
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
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