Q&A: How Direct Access and Transparency Close the Patient Gap

Market access has become one of the most operationally complex and financially consequential functions in pharmaceutical commercialization. Gross-to-net pressure (GTN), formulary restrictions, and prior authorization burdens continue to demand attention from commercial teams, and survey data suggest the industry is actively reconsidering how it approaches access models and distribution.

To understand where those priorities are focused, Pharmaceutical Commerce and Pharmaceutical Executive surveyed readers across commercial, market access, and patient support functions on the pressures, structural barriers, and strategic pivots defining their near-term outlook. Gross-to-net economics and affordability ranked among the top concerns, and nearly 40% of pharma respondents indicated they expect to pursue direct-to-patient access and fulfillment models within the next 24 to 36 months.

To explore what that shift requires in practice, Pharmaceutical Commerce spoke with Cameron Olig, chief commercial officer at Prescryptive Health, who offered a candid assessment of why awareness of what needs to change has not yet translated into action, and what pharmaceutical companies that move decisively stand to gain.

PC: Managing GTN economics was the top market access pressure in our survey, and nearly 40% of pharma respondents expect to pursue direct-to-patient models in the next 24–36 months. How does Prescryptive see those two trends as connected?

Olig: GTN pressure is exposing the limits of the current system, and the move toward direct models reconnects price, access, and the patient. I think what we’re seeing, and what we hear from pharma here, is a shift from trying to optimize within a complex system to exploring approaches that simplify the path to the patient.

Direct models have the potential to reduce friction in how therapies are accessed while creating more alignment between financial outcomes and patient outcomes.

Coverage and authorization delays topped the list of access friction points, followed by onboarding abandonment driven by administrative and economic barriers. Where does technology have the most immediate impact?

Technology can move a reactive model to a proactive one, where the patient sees their price, options, pharmacy choice, and more, while they are still at the point of prescribing. That supports timely, informed choice, rather than a process that happens at the pharmacy counter or even after the medication is picked up.

Removing uncertainty at the point of prescribing is our approach, and that offers value downstream.

Respondents cited technology limitations as the top constraint on scaling patient support, and siloed data and lack of real-time visibility as their biggest data challenges. What does end-to-end real-time visibility actually look like in practice, and what decisions does it unlock?

When we talk about end-to-end, real-time visibility, it’s easy to think about it as just a data problem. It’s also a consumer experience problem.

Today, most patients are navigating access without the basic information they need to act: What will this cost me? Where can I get it? Real-time visibility means that just after the provider writes the prescription, the patient can navigate through their prescription workflow – seeing their actual price and pharmacy options, available support programs and services – and immediately take action. That’s what turns a patient into a healthcare consumer, someone who can make informed decisions in real time.

A benefit of this integrated consumer experience is the availability of data and information for employers and payers and pharma manufacturers to help them understand what drives abandonment and where we lose patients in the journey toward therapy.

Nearly 40% said limited channel transparency is a fundamental structural barrier to improving access and affordability. How does Prescryptive's model address that gap — and how do you see the role of intermediaries evolving?

Historically, transparency has been difficult because the current system wasn’t designed to provide meaningful information in real time. It was designed around a series of negotiated and sequential processes.

What we’re seeing now is a shift toward models where transparency is embedded in how the system works, not added on through reporting or reconciliation. It’s built in.

At Prescryptive, we think about this in an approach that creates connectivity and alignment through technology and infrastructure. Our model is designed to bring pricing, access, and fulfillment together in a direct access approach that's a system redesign rather than a service layer.

Intermediaries aren't going away, but their role will evolve as part of the market shift we're seeing toward direct access.

Some respondents plan to increase use of specialized HUB partners, while others want to use technology to fundamentally reevaluate the HUB model entirely. Those feel like two different bets. Where does Prescryptive sit in that spectrum?

We are on the technology side of the spectrum.

Prescryptive’s platform serves as the orchestration layer supporting pharma manufacturer’s direct channel strategies. We believe that the patient experience, from prescription through fulfillment, should provide people with the choices and information to more quickly navigate to better outcomes and therapy.

Through our modular approach we find that pharma can optimize what they are already doing well while helping to quickly get more patients on therapy. And we are just beginning to understand the value for pharma of having an enduring consumer engagement strategy upstream of the PBM and pharmacies.

The survey shows the industry knows it needs to change — more direct contracting, better data, less reliance on legacy intermediaries — but progress has been slow. What's the biggest internal barrier pharma companies need to overcome, and what does success look like for those that get it right?

The strategies being considered are challenging – and new.

From the discussions we have been in, pharma has identified internal talent challenges and decision speed as potential barriers to change. We believe it takes a new approach and cross functional alignment to effectively move forward.