The ROI Moment Pharma Keeps Missing: Point-of-Care as Revenue Protection

For the past year in this column, we've been talking about the business of market access—how hubs, affordability programs, and adherence infrastructure drive revenue protection. I want to explore something that's financially connected but often treated separately: point-of-care engagement—the moment when prescribing decisions actually happen.

First, brands invest millions in payer negotiations to achieve 75%, 80%, even 90% coverage. Yet prescribers often don't know about that coverage when they're making the prescribing decision. The contract exists. The coverage exists. But without visibility at the point of prescribing, the investment doesn’t convert to a prescription.

Second, brands fund copay programs to drive fills and adherence. Yet in many top therapy areas, less than half of eligible prescriptions use this support. Recent data from IQVIA shows that in oncology, ophthalmology, dermatology, and antithrombotics, only 30% to 40% activate copay programs.¹ Diabetes copay utilization dropped 50% in one year. The investment exists. The support exists. But without activation, it doesn't drive the prescription.

I sat down with Lisa Prowker, ConnectiveRx's SVP of messaging operations, to understand what's at stake for pharma’s revenue at the point of prescribing. Lisa is an industry innovator and thought leader in the electronic health record (EHR) and pharmacy healthcare provider (HCP) messaging network space.

Lisa, when it comes to formulary and coverage, the partnership with the payer may be there, the investment is there, coverage is secured. But that knowledge is invisible the moment the prescribing decision is being made. What’s the problem?

The investment is at risk. Access teams work incredibly hard to negotiate with payers and achieve strong formulary positions. But when prescribers assume the brand isn't covered, they switch to an alternative. The contract and coverage are in place but, without visibility at the point of prescribing, that investment never converts to a prescription. In that situation, the brand doesn’t need a marketing plan—they need an activation strategy.

Another huge patient access investment are copay support programs. When I look at that copay utilization data—patient usage can be low, such as 30% to 40% in some categories—my first thought is that's a demand problem. But you're saying it's something else?

It's an activation problem. Copay support is a strategic investment in access, but when prescribers and patients don't know it exists, the brand gets excluded for affordability reasons before the support ever has a chance to work.

So it's a visibility issue. But I'm assuming most brands think they've already solved that with their marketing spend—TV ads, digital campaigns, website information. What's missing?

Our industry spent roughly $23 billion on copay support last year.² And when is copay awareness most critical? Usually when a medication is prescribed or being seriously considered as the best clinical fit. If a prescriber or patient doesn’t know that copay support exists when this decision is being made, that investment is never activated. That isn't just a patient access problem—it's an ROI problem.

That single moment in the workflow—the EHR screen, the real-world cost that appears, whether the provider feels they can stand behind the recommendation—that's where confidence gets shaped. Confidence writes prescriptions. And in order to be confident, an HCP needs to be aware.

That's a pretty fundamental reframing. Most commercial leaders I know would absolutely call point-of-care a marketing tactic. You're saying it's something different?

It's revenue preservation. Point-of-care ensures the investments brands have already made—formulary wins, copay support, hub services—are actually used.

CFOs and brand leads are being asked to show durable, traceable return on every dollar spent on patient support—especially under IRA (Inflation Reduction Act) cost constraints and increased payer pushback. So the question isn't whether a brand offers help. It's whether the help is actually being used.

Walk me through what that looks like in practice. How do manufacturers actually show up in that prescribing moment without crossing ethical lines?

The key is transparency, not persuasion. Here's what's already happening: payers pushed hard to standardize Real-Time Benefit Check (RTBC). Today, over half of US prescribers use RTBC embedded into their workflow. It shows a patient's out-of-pocket cost and lower-cost alternatives.

But here's the problem—it often doesn't reflect the brand's copay savings. So a branded medication may appear far more expensive than it actually would be for that patient after support is applied.

So payers are already in the workflow influencing the decision, but brands aren't?

Exactly. And that puts brands at a strategic disadvantage. That's where rules-based real-time patient savings come in. When copay support is integrated directly into the RTBC workflow, the prescriber sees not just the list price, but the actual net cost with savings applied, based on the brand's actual program rules and patient eligibility.

When physicians see the complete cost picture, they're able to prescribe based on clinical judgment rather than financial guesswork. That preserves clinical choice. It prevents unnecessary switching. And it ensures patients don't walk out of the office without a therapy they could have afforded.

I have to imagine the decline in rep access is accelerating this shift. Are brands even aware of how significant that change has been?

Many aren't thinking about it strategically yet. Rep access is more limited than it used to be. Hospital systems and private equity are acquiring practices, and when that happens, new rules get put in place—often limiting or eliminating rep visits entirely. The EHR and exam room screens have effectively become the new front door for brand communication.

So point-of-care is no longer a supporting channel—it's a primary one. And what makes it powerful is relevance. Messaging can be tied to therapeutic context, patient characteristics, and the act of prescribing itself, not broad demographic assumptions. It shows up when the decision is happening, not before or after—inside the EHR and pharmacy workflow, where prescribing confidence is formed, not in the waiting room or on a TV screen.

When point-of-care is aligned to affordability transparency, formulary clarity, and support access, we consistently see improvements in first-fill rates and continued therapy. Those aren't soft metrics—they're business outcomes.

Paint me a picture of what failure looks like. What happens when a brand isn't present at that moment?

Here's the most common scenario, and it happens more often than we acknowledge. A physician wants to prescribe your brand and the patient needs the therapy, but the EHR shows a cost that looks too high. So the provider switches to a cheaper option or delays treatment “to see if symptoms improve.” The patient never fills, and the brand never has a chance to demonstrate value.

Meanwhile, your copay program goes unused. Your hub never engages. The patient never learns support was available to make therapy possible. And adherence never starts. That's lost revenue, lost outcomes, and lost trust. All because the brand wasn't present during the moment of choice.

So if I'm a commercial or access leader reading this, where do I even start?

Three places.

First, audit where decisions are actually being influenced today. Not where your brand talks, but where the prescribing decision finalizes.

Second, ask how affordability is communicated in workflow. If the answer is “the website” or “a starter kit,” that's not enough.

Third, make point-of-care part of your annual strategic plan. This is core infrastructure. It belongs beside payer strategy, hubs, and patient support, not downstream from them.

Brands that treat point-of-care as a strategic lever—not a tactical add-on—consistently outperform on both first-fill and continued therapy.

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.

References

1. Understanding the Use of Medicines in the US 2025. IQVIA. April 30, 2025. https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/understanding-the-use-of-medicines-in-the-us-2025

2. Long, M.; Salagna, M.; Pestaina, K. Copay Adjustment Programs: What Are They and What Do They Mean for Consumers? KFF. October 24, 2024. https://www.kff.org/health-costs/copay-adjustment-programs-what-are-they-and-what-do-they-mean-for-consumers/