CONFERENCE CONNECT HEALTHCARE REFORM COMMERCIALIZATION

A LogiPharma Europe reflection Tapping telehealth gains Challenge from cash pharmacy

JUNE 2024
VOL. 19 NO. 3

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INSTRUMENTAL TO
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EDITORIAL
4 Publisher’s Note INSTRUMENTAL TO
YOUR SUCCESS

5 F rom the Editor

CONFERENCE CONNECT
6 'Maturity' Matters

FEATURE
VALUE & ACCESS
7 Justifying Price Fairness

HEALTHCARE REFORM
8 Making Telehealth
Flexibilities Permanent

BRAND INSIGHTS
9 Value-based Healthcare Delivery
INSTRUMENTAL TO
YOUR SUCCESS

COMMERCIALIZATION CORNER
10 Who Moved My Prescription? Part IV

PATIENT SUPPORT
14 Combining AI and RWE to Bend
the Adherence Curve

SUPPLY CHAIN MANAGEMENT

20 Building Sustainable Pharma Supply Chains

DRUG PRICING
Subscribe to our newsletters for
24  The Value of Dynamic Pricing practical tips and valuable resources

LAST WORD Listen to our latest podcast

episodes with industry experts
26 Prioritizing Patient Centricity
On the cover: Iftikhar alam-stock.adobe.com

©2024 MultiMedia Pharma Sciences LLC All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording, or information storage and retrieval, without
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Alexa Rockenstein, arockenstein@mjhlifesciences.com. MultiMedia Pharma Sciences LLC provides certain customer contact data (such as customers’ names, addresses, phone numbers, and e-mail addresses) to third parties who wish to promote relevant
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pharmaceuticalcommerce.com 3
 PUBLISHER'S NOTE
INSTRUMENTAL TO
YOUR SUCCESS

EDITORIAL AND PRODUCTION

Group Editorial Director
Davy James,
djames@mjhlifesciences.com

Group Managing Editor

Michael Christel,
Contributing Editor
Suzanne Shelley
Editor Emeritus and Founder
Nick Basta,
nbasta@
pharmaceuticalcommerce.com
AI and Patient Behavior
T
mchristel@mjhlifesciences.com

Editor Creative Director, Publishing

Melissa Feinen
he June installment of Pharmaceutical Commerce officially puts us
Nicholas Saraceno,
nsaraceno@mjhlifesciences.com Senior Art Director
halfway through the year, and I could not be any prouder of the
Associate Editor Marie Maresco important topics and business-essential subjects the publication
Donald Tracy, Senior Graphic Designer has explored thus far. Transitioning from earlier coverage dives
dtracy@mjhlifesciences.com Ariana Mexquititla
into such areas as third-party logistics providers to the state of affairs for
Group Social Media Editor
Miranda Schmalfuhs, pharmacy benefit managers, this current issue is headlined by a look at
mschmalfuhs@mjhlifesciences.com the influence of artificial intelligence and real-world evidence/real-world
data on patient behavior and ultimately, the many factors and complex-
ities of medicine adherence (page 14). In the piece, contributing editor
SALES Suzanne Shelley describes how the challenges that patients face when it
Associate Director of Sales Advertising Production comes to starting and staying on therapy can prove detrimental to the
Cheryl Mahon, Nicole Schultz,
646-824-4672 609-716-7777
point of disease progression, along with a rise in morbidity and mortal-
cmahon@mjhlifesciences.com nschultz@mjhlifesciences.com ity. Notable as well is the wider impact on other pharma and healthcare
National Sales Manager stakeholders. For example, as Shelley reports: “Insurance companies end
Cathy Williams,
703-587-7142
up paying for expensive medical interventions that could have been avoid-
cwilliams@ ed by more stringent adherence to therapy; even pharmaceutical brands
pharmaceuticalcommerce.com
INSTRUMENTAL TO fail to recoup the sunk costs associated with drug development and miss
YOUR SUCCESS
the opportunity to achieve competitive success for the brand when their
often life-saving medicines—which were proven to be safe and effective in
CUSTOM PROJECTS clinical trials—fail to deliver on their promise due to adherence lapses.”
Vice President, Content Managing Editor, Custom Projects Sustainable practices in pharma—which consist of implementing
& Special Projects Jeanne Linke Northrop
Christopher Mazzolini,
environmentally-friendly practices into clinical, manufacturing, and
Senior Editors, Custom Projects
CMazzolinl@mjhlifesciences.com
Shannon Stolz, Megan
commercial operations—continues to be a paramount topic as well. In our
Director, Custom Projects Manzano, Terri Somers June issue, Craig Wilson, senior director of strategic planning at Marken,
Robert Alaburda
specifically outlines the value of environmental, social, and governance
practices, including his company’s role in practicing decarbonization
strategies, which are vital when working to conserve resources (page 20).
CORPORATE Examining the drug pricing landscape, Blake Powers, CEO of Medigi
Pharmaceutical Commerce is published by MJH Life Sciences®
and a member of Pharmaceutical Commerce’s Editorial Advisory Board, notes
that new digital solutions and dynamic pricing advantages can have appli-
President & CEO Senior Vice President,
Mike Hennessy Jr Corporate Development cation beyond the generics drug world, trickling into branded and specialty
Brian Haug
Chief Financial Officer lite products, while trending direct; in turn, pharma manufacturers are pro-
Neil Glasser, CPA/CFE Senior Vice President, Content viding unique price points to certain sites of care (page 24).
Silas Inman
Chief Operating Officer In her healthcare reform column this month (page 8), Amy Niles of
Beth Buehler Vice President, Human
Resources & Administration the PAN Foundation suggests that there should be urgency in making
Chief Data Officer
Shari Lundenberg the telehealth flexibilities that were given to Medicare enrollees during
Terric Townsend
SVP, Mergers & Acquisitions, the COVID-19 pandemic a permanent fixture. These flexibilities are
Executive Vice President,
Strategic Innovation
Global Medical Affairs & set to expire Dec. 31, and if Congress doesn't step in, it could result in
Phil Talamo
Corporate Development
Joe Petroziello Executive Creative Director, additional health inequities, Niles contends.
Jeff Brown I hope you enjoy this month’s issue. As always, thanks for reading.

MIKE HENNESSY JR
Founder
Mike Hennessy Sr President and CEO
1960 - 2021 MJH Life Sciences
 FROM THE EDITOR

Content is Indeed King

M
y column in our last issue was focused largely on setting the stage for
Pharma Commerce’s coverage and experience at LogiPharma Europe in mid-
April—and I am happy to report that the show was officially a success.
In my opinion, our “Conference Connect” this month (page 6), along
with May’s Cold Chain Solutions supplement (see bit.ly/44Yg9vT), do a stellar job NICHOLAS SARACENO
at capturing the essence of the conference’s offerings, alongside the editorial content Editor
gathered by our publication. nsaraceno
@mjhlifesciences.com
When I spoke to Will Robinson, LogiPharma’s commercial director, about future plans
for the show—including if it will continue to be held in Lyon, France, and if there were
any talks of switching venues—he noted that “We're definitely here next year; we'll be
here for the 25th anniversary."
Robinson continued: "We don't see any reason to change it. [Centre de Congrès de
Lyon] is on a high-speed rail line, which is certainly where we're trying to drive as many INSTRUMENTAL TO
YOUR SUCCESS

of our attendees to be using. The venue's great. ...For the vast majority of those who
attend, it is actually quite easy to get to. It’s a bit of a break from the office—it takes you
Overcoming Supply
away. It puts you in a different headspace. It makes you engaged in the event for two or
three or four days, or however long you're INSTRUMENTAL
here. TO we're going to stick here for at
I think
Chain Challenges
YOUR SUCCESS
least the next couple of years.” CHIP DAVIS, president
I can only imagine the hype that is expected to surround next year’s milestone show, and CEO of the Healthcare
Distribution Alliance,
especially with 70% of exhibition booths already being booked. recaps its Distribution
Perhaps the limited availability should come as no surprise, given the invaluable benefit Management Conference
that events like these offer. I thoroughly enjoy the “organized chaos” that they present, and discusses current
preparedness levels for
and from an editorial perspective, they always serve as a great reminder that content DSCSA compliance.
continues to be king. Particularly actionable content. Whether in the form of articles,
Q&As, podcasts, videos, you name it, shows such as LogiPharma Europe spotlight the
valuable opportunity to leverage and expand one's Rolodex of KOLs in the industry to
further educate our most valuable asset—our readers—and to help them make sound and
informed decisions in their daily practice. PC

EDITORIAL ADVISORY BOARD

Shabbir Ahmed Tom Doyle Ela Lourido, MBA Bill Roth
Chief Commercial Officer Vice President, Commercial Sales & Chief Vice President & General Manager Senior Vice President
CareMetx Customer Officer of Biopharma Services McKesson Blue Fin Group, an IntegriChain Company
Cencora
Cheryl Allen, BS Pharm, MBA Rob McMahan Ed Schoonveld
Founding Partner Scott Dulitz, MBA Vice President of Contracts & Reimbursement Value & Access Advisor
Curatio Scientia Advisors Chief Executive Officer Alto Pharmacy Schoonveld Advisory, LLC
Mercalis
Alan Balch, PhD Chris Pierce Edward Vegso
Chief Executive Officer Shaun Jensen Assistant Vice President of Pharmacy Senior Director of Business Development
National Patient Advocate Foundation Founder & Chief Executive Officer Costco Wholesale UBC
JB Consulting
Michael J. Baldzicki, CRCM Will Pih Burt Zweigenhaft, PhD
Chief Commercial Officer Michael Laferrera Principal & EVP of Specialty Executive Vice President, FFF Enterprises;
PolarisRx Specialty Pharmacy President & Chief Executive Officer Commercialization Executive Director & Co-Founder,
Knipper Health Two Labs Association for Value-Based Cancer Care
Ned Bement
Vice President of Sales & Patient Solutions Doug Long Blake Powers
ConcertAI Vice President of Industry Relations Chief Executive Officer
IQVIA Medigi

pharmaceuticalcommerce.com 5
 CONFERENCE CONNECT
'Maturity' Matters:
Fortifying Two Key Cogs
of Pharma Supply Chain
LogiPharma Europe captured many timely topics,
including the importance of next-level approaches
in aligning temperature-controlled transit and visibility.
By Nicholas Saraceno
E
choing the sentiment expressed in our recently published
Cold Chain Solutions eBook (see bit.ly/44Yg9vT) that
explored the trends and highlights thatINSTRUMENTAL
came outTOof
YOUR SUCCESS
LogiPharma Europe, this year's April show provided a
unique forum for discussion and dialogue across the distribution
and healthcare logistics landscape.
The event was again hosted at the Centre de Congrès de Lyon
in Lyon, France, and as Jake Brown, LogiPharma’s sponsorship
director, stated in its recap (see bit.ly/3yFiyji), it “continues
to be the only event globally where you can meet all the key
stakeholders within the life sciences supply chain.”
About 2,000 people attended the show's 24th installment, which
featured numerous sessions revolving around the following themes:
• “Not another dashboard! How to infuse pulse into your supply
chain operation.”
• “How can you transform digital capabilities in your
temperature-controlled supply chain to improve visibility,
quality, and reactivity?”
• “Why must our industry collaborate to reach its most ambitious
sustainability goals by 2030 and what is required to meet them?
• “How can you implement scalable networks to overcome the
challenges of complex supply chains for personalized therapies?”
• “Properly applying diversity, equity, and inclusion initiatives
within the life sciences supply chain.”
One of the above sessions—“How can you transform digital
capabilities in your temperature-controlled supply chain to improve
6 JUNE 2024
visibility, quality, and reactivity?”—particularly piqued my interest
for covering the relationship between two of Pharma Commerce’s
largest topics: product visibility in the supply chain and the cold
chain specifically.
Tony Fonk, president and CEO of SpotSee, moderated the
panel, and was joined by Amy Shortman, a logistics representative
with Despir Logistics; Cesar Gil Martinez, director of procure-
ment logistics, EMEA, Bayer; Tomas Fant, temperature-controlled
logistics project lead, Pfizer; Marie Berranger, cold chain logistics
project and launch manager, Galderma; and Linus Wollentz,
senior manager, Envirotainer.
When asked what "digital maturity" meant to her, especial-
ly in terms of digital capabilities and temperature-controlled
operations, Shortman mentioned that “digital maturity is really
about understanding the value of the data that we’re feeding
through those digital services provides. So it’s making sure that we
understand how we’re using visibility and using that to really drive
down risk and add value to the customer. What we’re seeing in the
market in a general sense is that not all players within the supply
chain ecosystem and logistics ecosystem are at the same level of
digital maturity.”
These were words that truly resonated with me, being that they
served as a reminder to all pharma stakeholders: never lose sight
of adding value to the customer.
Nicholas Saraceno
To read and view all our coverage from LogiPharma Europe—
plus other past shows—including special video interviews, please
visit pharmaceuticalcommerce.com/latest-conference. PC
 VALUE AND ACCESS

G Justifying Price Fairness

lobal price comparisons for
prescription drugs continue to draw
the attention of politicians, medical
groups, and patient organizations.
WHO and lower-income countries advocate The impact of income-based price controls in healthcare.
for income-based pricing to address their
low levels of affordability. However, higher-
income countries systematically use lower
prices around the world to lower their prices ABOUT THE AUTHOR
through international price referencing. Is the Ed Schoonveld is a value & access advisor for Schoonveld
US subsidizing healthcare in other countries Advisory and author of The Price of Global Health.

around the world? What is fair?

Economic perspective
Given different income levels in countries of other countries with a lower income level provided that individual governments pay their
around the world, the question is wheth- without any consideration of differences in fair share and don’t abuse it through price
er adoption of prices adjusted for gross GDP between countries. referencing and authorized importation, as
domestic product (GDP) yields better recently authorized by the FDA for Florida.
commercial results for a drug manufacturer
NATO contributions
than a fixed price across countries (if that Fair government?
NATO countries are bound to contribute
was even feasible given price controls). As Government payers use their monopsony
2% of their GDP to NATO, yet only 11 of
variable production cost of most pharma- INSTRUMENTAL TO powers to demand lower prices. Individual
the 30
YOUR NATO member states contribute the
SUCCESS
ceuticals is relatively low, price adjustments companies usually have no choice other
agreed upon income-adjusted share. Former
to address local affordability tend to lead than either accepting the price or staying
President Trump’s undiplomatic style of
to a higher financial contribution to cover locked out of local sales. Companies are not
raising the issue with European countries was
global infrastructure and fixed organization allowed to coordinate with other companies
not ideal, but it did raise broader awareness
cost. However, the use of international price to break through the government’s
that despite European concerns over
referencing by higher-income countries can purchasing power, as this would be deemed
Vladimir's Putin’s expansion interests beyond
pose serious challenges to this strategy. collusion. Just like with guns, European
Ukraine, they don’t pay their fair share,
even after adjustment for GDP. For drugs, governments don’t pay their fair share
Fair Prescription Drug Prices we don’t accept GDP adjustments for price, for drugs. Many countries demand price
for Americans Act while for guns, we accept that countries pay reductions for drugs when they exceed
Medicare price controls, introduced through less than their GDP adjusted share. budgets that did not adequately fund aging
the Inflation Reduction Act of 2022, did not populations and growing healthcare needs.
satisfy the appetite for US government inter- What is fair?
vention in prescription drug pricing. The Fair One might ask: Why should I pay more for Shifting US policy
Prescription Drug Prices for Americans Act my medications than my friends in London or Rather than attacking the drug industry on
was introduced on April 19, 2023. It includes Rome? Is it fair to not pay the same? What’s its pricing, shouldn’t the US government
regulations that the retail list price in the US the point of working hard for more income if help the industry to fight unfair price
for a drug or a biological product may not each product is priced based on income level? control practices that systematically leech on
exceed the average retail list price for the On the other hand, if patients cannot afford US subsidies, similar to lack of funding of
drug or biological product among Canada, it, then the cost of covering drug company the joint NATO task? PC
France, Germany, Italy, Japan, and the UK. overhead will have to be funded by the ones
This bill proposes to establish maximum US who can, but at even higher prices. For this
For the list of references associated with this
drug prices through the international price reason, it makes economic and social sense to article, please view the online version at www.
referencing principle, using prices in a basket accept “differential pricing” across countries, pharmaceuticalcommerce.com.

pharmaceuticalcommerce.com 7
 HEALTHCARE REFORM
The Need to Make Telehealth
Flexibilities Permanent
If Congress doesn't act soon, it could result in more health inequities.
M
illions of people enrolled in
Medicare have benefited from
the telehealth flexibilities
that were granted during the
COVID-19 pandemic, and, subsequently,
extended in 2022. However, without Con-
gressional action, these flexibilities will end
on Dec. 31, 2024—impacting access and
leading to further health inequities.
Demand for telehealth services
Telehealth flexibilities have played a critical
INSTRUMENTAL
role in expanding access to care and main-
taining continuity of care, especially those
living in rural communities and underserved
areas. For individuals requiring access to
advanced specialists, mental health provid-
ers, and those with mobility issues or lack of
transportation, telehealth flexibilities have
served as a much-needed lifeline to care.
According to a national poll conducted
by the PAN Foundation’s Center for Patient
Research,1 nearly one-third of adults who use
telehealth services say they do so to refill their
prescriptions (30%), to address less serious
health issues (28%), and for mental health
support (28%). Clinicians have used telehealth
to expand access to care for patients and to
support strong patient relationships, and they
value the flexibility created by the option
for remote care when clinically appropriate.
Important safety-net providers such as com-
munity health centers and rural health clinics
have depended on these flexibilities, as have
clinicians such as physical, speech, and occu-
pational therapists to extend access to patients.
8 JUNE 2024
How Congress can act
Over the past couple of years, several bills
to permanently extend telehealth flexibilities
for people enrolled in Medicare have
been introduced with bipartisan support.
This includes the Creating Opportunities
Now for Necessary and Effective Care
Technologies (CONNECT) for Health Act
of 2023 (H.R. 4189), introduced by Rep.
Mike Thompson (D-CA). While there are
similarities between various telehealth bills,
it is important
YOUR SUCCESS
TO that a final telehealth bill
that is passed and permanently extends
flexibilities includes the following:
• Expands patient access to telehealth
services by removing geographic and
originating site limitations to enable
patients to communicate remotely with
their providers, regardless of location.
• Removes distant site provider list re-
strictions to allow all Medicare providers
who deliver telehealth-appropriate.
services to provide those through tele-
health. Providers would include physical
and occupational therapists, speech-lan-
guage pathologists, and social workers.
• Ensures that federally qualified health
centers, critical access hospitals, and
rural health clinics can furnish tele-
health in Medicare and be reimbursed
fairly for those services.
• Removes in-person requirements
under Medicare for mental health ser-
vices furnished through telehealth and
telecommunications technology.
• Allows the Centers for Medicare &
Medicaid Services to cover audio-only
telehealth services where necessary
to bridge gaps in access to care.
Audio-only telehealth visits should con-
tinue to be an option for patients who
lack access to the resources needed to
participate in video-based telehealth.
• Allows employers to offer telehealth
benefits for seasonal and part-time
workers. Increasing access to some
telehealth benefits for part-time
employees, seasonal workers, interns,
new employees in a waiting period
can be a meaningful way to support
workers—as long as this access sup-
plements health insurance purchased
by that individual or a family member.
• Drives better and more coordinated
care for those with chronic disease by
ensuring adequate reimbursement for
remote patient monitoring technology.
Since the pandemic, patient and provider
groups have advocated for legislation that
recognizes the value of telehealth services
for Medicare beneficiaries. Congress must
not wait until the end of the year to pass
legislation that already has bipartisan
support. We at PAN urge Congress to act
now2 to pass telehealth legislation that will
positively impact millions of people in the
US and their healthcare journeys. PC
REFERENCES
1.  early Half of Adults Who Use Telehealth Face
N
Barriers to Accessing Services. PAN Foundation.
April 17, 2024. https://www.panfoundation.org/
nearly-half-of-adults-who-use-telehealth-face-bar-
riers-to-accessing-services/
2. Urge Congress to Expand Telehealth Flexibilities
Before it’s too Late! PAN Foundation. https://
www.votervoice.net/PANFoundation/Cam-
paigns/114714/Respond
ABOUT THE AUTHOR
Amy Niles is Chief
Mission Officer at PAN
Foundation.

Navigating the Transition to Value-Based
Healthcare Delivery with Network Approach
A
s healthcare is moving toward the shared goal of improv-
ing patient care more economically, stakeholders across
the spectrum are increasingly aligned with the principles
of value-based care. This paradigm shift is particularly
evident in biopharma, which plays a pivotal role in the American
healthcare system’s transformation. As we navigate this transition, the
complexity of healthcare decision-making escalates, challenging pro-
viders to balance high-quality, cost-effective, and patient-centric care.
Healthcare professionals are often tasked with choosing from a
variety of treatment options, including biopharmaceuticals, medical
devices, and healthcare services. The evaluation of these options is
complex, as they present a broad spectrum of economic and clinical
costs and benefits. Some of these factors are quantifiable, while others,
such as patient-experienced benefits, may not be immediately apparent.
Veradigm stands at the intersection of the healthcare industry’s
INSTRUMENTAL TO
key stakeholders: providers, payers, and biopharma YOUR SUCCESS The
companies.
Veradigm Network enables manufacturers and other key healthcare
stakeholders to unlock value in ways that were previously unattainable.
What is the Veradigm Network?
Some healthcare companies provide clinical data, others deliver
insights through data analysis, while others serve healthcare
providers directly by providing software at the point-of-care.
Veradigm does it all, via the Veradigm Network. Veradigm’s
scale, analytic capabilities, and workflow connectivity drive
efficiencies for its clients and enhance decision-making with insights
derived directly from the point of patient care. Veradigm’s open,
connected network of solutions and partners is well-positioned to
serve life sciences organizations in a way that meets the needs of
today’s connected healthcare ecosystem.
Veradigm Network advantage
Through the Veradigm Network, biopharma and other life sciences
organizations have access to expansive de-identified ambulatory
electronic health record (EHR) data and insights. Veradigm’s
portfolio of connected solutions can help you discover timely,
actionable real-world evidence to demonstrate how your products
can benefit appropriate patient populations.
The Veradigm Network is built upon Veradigm’s comprehensive
BRAND INSIGHTS
SPONSORED CONTENT
healthcare provider footprint, which combines data from both its
owned EHRs and EHR collaborators. Because Veradigm is the
source of the data itself, Veradigm can help you uncover otherwise
hard-to-find insights derived at the point of care.
Connected solutions for biopharma
Veradigm’s solution portfolio designed for biopharma companies
provides expansive de-identified ambulatory patient insights from
the point-of-care and delivers enhanced access to clinical research
opportunities.
• Veradigm Network EHR data: De-dentified real-world data from
an extensive national population of patients drawn from communi-
ty-based physician practice—where most of the care and patient
record generation happens in the US.
• Veradigm cardiology registry: Cardiology’s largest outpatient qual-
ity improvement registry, capturing data on coronary artery disease,
hypertension, heart failure, and atrial fibrillation.
• Veradigm metabolic registry: The first clinical ambulatory
registry aimed at tracking and improving the quality of diabetes and
cardiometabolic care.
• Real-world evidence: Data- and platform-enabled research ser-
vices, capturing the full spectrum of real-world evidence generation,
including prospective and retrospective studies, safety surveillance,
and more.
• Veradigm digital health media: Highly targeted awareness mes-
saging via the practice workflow in the physician’s EHR system.
By integrating data analytics, clinical insights, and a comprehen-
sive network of healthcare providers, Veradigm is uniquely positioned
to support biopharma in its transition toward more patient-cen-
tered, cost-effective care. The Veradigm Network’s ability to provide
de-identified EHR data and real-world evidence empowers stake-
holders to make informed decisions that benefit both patients and the
healthcare system at large.
ABOUT THE AUTHOR
Amanda Cohen, MPH, is a Director of
Marketing at Veradigm.
pharmaceuticalcommerce.com 9
 COMMERCIALIZATION CORNER

Who Moved My Prescription Part IV:

The Rise of Cash Pharmacy INSTRUMENTAL TO
YOUR SUCCESS
An analysis of the general medicine portion of the pharmacy market amid ensuing challenges.
By Bill Roth, IntegriChain

I
n Part I of this series, I covered what
is happening; in Part II, I introduced
why it’s happening; and in Part III, I
unpacked why this is a hard problem for
the pharmacy to solve on their own with
pharmacy benefit managers (PBMs) and
wholesalers bundling their reimbursement
and cost of goods. In this installment, I
open the door to what is likely to occur in
the general medicine (non-specialty) part
of the pharmacy market as a result of
these challenges with pharmacy.
I presented at the National
Community Pharmacy Association
received a standing ovation and even an
“amen” from the back of the room.
Let me explain as I’m sure 99%
of people will think that I’ve lost my
marbles. As noted in prior columns,
retail pharmacy has reached a breaking
point due to sourcing and reimbursement
pressures, with a third of community
pharmacies poised to close by mid-year
and reimbursement rates at all-time lows,
pharmacy deserts on the rise, and stories
of pharmacies struggling to service what
business they have. I was told directly by
community pharmacy leadership to tell our
see it play out in our primary research, and
our manufacturers finally see it in the data.
Pharmacies are actively moving away from
brands and in many cases stop supporting
90-day fills and return to 30-day. The losses
to pharmacy are simply too intense.
Cash pharmacy is nothing new.
We’ve seen this since 2004 when Walmart
announced the first $4 generics and see
it today with Amazon Pharmacy and
Mark Cuban's Cost Plus Drug Company.
Pharmacies are selling product at their
wholesale cost hoping for a $15 mark-up
to cover the cost of operations and their
terovesalainen - stock.adobe.com

Multiple Locations meeting in March
and was asked where I see retail
pharmacy going. My answer was simple:
it’s highly likely that it returns to what
it looked like before the PBMs got
involved—to a cash market. The answer
pharma clients that community pharmacy
is walking away from brands, and we are
moving our pharmacies to cash. Based on
the hundreds of discussions I have with all
flavors of retail pharmacy, I’m confident
this is more than threats and conjecture. We
professional services.
What is rapidly becoming new, though,
is cash pay for brands. My consulting
firm, Blue Fin Group, conducted a project
for a manufacturer opening a direct-to-
patient pharmacy, similar to the recently

10 JUNE 2024
 COMMERCIALIZATION CORNER

announced Lilly Direct. The impetus for
this move was data reflecting that when
the product was covered by the insurance
plans, the market was more suppressed
than anything. What was bizarre was that
the demand for the molecule shot up to 3x
the demand for the brand. So the following
notion was considered: As opposed to paying
all these discounts to PBMs, great purchasing
organizations, and distributors, and then
hearing from pharmacies that they still lose
money, why don’t we just sell through the
cash vehicle? The product could rid itself
of prior authorizations and step edits, no
more suppressed pharmacy economics, and
practically complete control of the price to the
patient/consumer. Sounds lovely, doesn’t it?
In my opinion, we have been trying
to put the proverbial genie back in the
bottle for decades. While I personally think
insurance works very well for orphan and
rare disease products, we are seeing states
push back by capping prices. We see cell
and gene therapy products without medical
policy being set. Specialty is set to go
through its transformation for the balance
of the decade, with roughly $240 billion
at risk to conversion to biosimilars and
specialty generics. But with general medicine
already converted to generics for 92% of all
prescriptions and pharmacies declining to
fill brands due to profit loss, this last market
is ripe for disruption back to cash.
PBMs are asking for all-time high
rebates if generics are available in the
drug class, and national drug code blocks
have skyrocketed from about 50 in 2013
to more than 700 in 2024.1-3 And for
the novel science that tries their hand
at the specialty lite price point, they can
expect a rigorous prior authorization and
likely relegation to a third- to fifth-line
therapy. Where brands are not excluded,
patient out-of-pocket (OOP) costs have
grown alongside an expansion in high
deductible plans, which now account for
~30% of commercial lives.4 Given the
sharp increase in abandonment above
$50 copays,5 manufacturers have been
driven to spend ever more, driving down
OOP through copay cards and patient
assistance programs, while battling copay
accumulators and maximizer programs.
Many products in the branded general
medicine space are obsessing on how to
get a $35 OOP to patients while charging
$600 to $800. This game appears to be

INSTRUMENTAL TO
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pharmaceuticalcommerce.com 11
 COMMERCIALIZATION CORNER
nearing its end. And with the Inflation
Reduction Act and most favored pricing,
wholesale acquisition cost reductions,
and more on the way, the message from
government, commercial payers, and plan
sponsors is to stop pricing products high
because that’s how you think the game is
played. The PCSK9 class was the poster
child of that. And it appeared when it
came time to launch the CGRPs for
migraine, the message was received.
Rewinding on PBMs
and pharmacy benefits
As my wife likes to remind me, everything
eventually comes back around. Cash
pharmacy is not a new concept. It’s
the original form of pharmacy and has
continued to exist for at least some portion
INSTRUMENTAL TO
of patients. That portion is growing.
YOUR
It’s good to remind ourselves that the
presence of PBMs and pharmacy benefits is
relatively recent in the scheme of things. The drugs. Reimbursement is going down and
first entities appeared in the 1960s. These
original PBMs were founded by pharmacists
and initially focused on claims processing
while reimbursing pharmacies at their usual
and customary cash price; notable examples
include PAID Prescriptions founded in 1965
and Pharmaceutical Card System (PCS) in
1969. The 1970s and 1980s saw significant
shifts with vertical and horizontal integra-
tions, driven by cost-containment strategies
allowed by the Employee Retirement Income cost reduction,8,9 and pharmacies and
Security Act. In the 1990s, manufacturers
began to acquire PBMs, such as Merck with
Medco and Eli Lilly with PCS. However, this
model was relatively short-lived with both
spinning the PBM back out within 10 years,
and with Eli Lilly recouping only a quarter
of its purchase price.6
The durable, impactful, and now-recog-
nizable model borne out by the 1990s
through the 2000s is the vertical integration
12 JUNE 2024
of PBMs with national pharmacy chains
and insurers, or consolidation among all
three. This began with Rite Aid’s acqui-
sition of PCS from Eli Lilly in 1998 and
Express Scripts’ acquisition of DPS in
1999, but was most notably marked by
consolidation a decade later of CVS and
Caremark, and Express Scripts and Medco.
These moves aligned two of the country’s
largest pharmacies with two of the largest
PBMs. Concurrently, UnitedHealth clawed
back its $11 billion drug benefits business
from Medco and consolidated pharmacy
management into Optum.7
Recall that Medicare was cash up until
2006 when we added Part D via the Medi-
care Modernization Act. But Medicare
is now going through its evolution with a
$2,000 OOP cap that comes in 2025. All
that sounds great if that patient can find a
pharmacy
SUCCESSwilling to dispense the brands
that currently run at $50- to $200-a-month 5. The Use of Medicines in the US 2023. IQVIA. May
losses on a growing number of branded
pharmacy costs of goods are going up.
I, and those in my firm, see the science,
its value, and its demand being challenged.
The GLP-1s are a great example. Great
science. Great clinical profile. Benefits
appear to be building by the day, and with
limited coverage, patients are coming OOP
for $900-$1000/month. A majority of
patients are already willing to situationally
pay cash when it results in short-term
manufacturers are realizing that the future
of retail pharmacy, cash pay, insurance-
ABOUT THE AUTHOR
Bill Roth is the SVP of IntegriChain’s consulting business, which
includes Blue Fin Group, a strategy consulting company he started
in 2001, and the IntegriChain advisory services business.
based coverage for general medicine
brands support is at a crossroads. PC
REFERENCES
1. Performance Drug List - Standard Control for Cli-
ents with Advanced Control Specialty Formulary.
CVS Caremark. January. 2024, www.bsu.edu/-/
media/www/departmentalcontent/payroll/
pdfs/oe-2024/medical---prescirption-plans/
p11---performance-drug-list-2024.pdf?sc_
lang=en&hash=21B89DC77C0880F3E0224F0EF-
3291764427B7CF7.Accessed 28 Apr. 2024.
2. 2024 National Preferred Formulary Exclu-
sions. Express Scripts. April 1, 2024. www.
express-scripts.com/files/hub/pdf/formulary/
NPF_Preferred_Formulary_Exclusions2024.pdf
3. 2024 Premium Standard Formulary. Optum Rx.
January 1, 2024. www.optum.com/content/
dam/o4-dam/resources/pdfs/guides/formular-
ies/Jan2024_Premium_Standard_Abridged_508.
pdf. Accessed 28 Apr. 2024
4. 2023 Employer Health Benefits Survey, Section
5: Market Shares of Health Plans. KFF. December
8, 2023. www.kff.org/report-section/ehbs-2023-
section-5-market-shares-of-health-plans/
2, 2023. www.iqvia.com/insights/the-iqvia-insti-
tute/reports-and-publications/reports/the-use-
of-medicines-in-the-us-2023
6. Cook, A.; Kornfield, T.; Gold, Marsha. The Role of
PBMs in Managing Drug Costs: Implications for a
Medicare Drug Benefit. January 2000. KFF. www.
kff.org/wp-content/uploads/2013/01/the-role-
of-pbms-in-managing-drug-costs-implications-for-
a-medicare-drug-benefit.pdf
7. Overland, D. UnitedHealth Brings Back PBMs in
House. Fierce Healthcare. June 10, 2011, www.
fiercehealthcare.com/payer/unitedhealth-brings-
back-pbms-house
8. Why 'Cash' Pharmacies are Booming—and What
it Means for Health Care. August 24, 20222.
www.advisory.com/daily-briefing/2022/08/24/
cash-pharmacies
9. Rewriting the Script: Independent Pharmacy Trends.
2022 Research Report. Prescryptive, October 10,
2023. prescryptive.com/2022-pharmacy-study/
 Safeguarding Time- and
Temperature-Sensitive
Pharma: Quality Management
for Ground Transport

Register for this free webcast at:

www.pharmaceuticalcommerce.com/pc_p/secured-transformation

Event Overview
Join transportation crime and theft specialist Scott
Cornell, Travelers Insurance, and logistics technology
solutions expert Wes Kerbuski, DeSpir Logistics, as
they share quality management and in-transit security
best practices for critical treatments, medicines, and
devices.
INSTRUMENTAL TO
YOUR SUCCESS

ON-DEMAND WEBCAST Key Learning Objectives

Aired: Thursday, January 11, 2024
Presenters
Scott Cornell
National Practice Leader,
Transportation and Crime &
Theft Specialist
Travelers Inland Marine
Wes Kerbuski
Head of Technology Solutions
DeSpir Logistics
• What to expect from your transportation logistics
providers
• Best practices for pre-transit risk management
• Best practices for in-transit risk management
Who Should Watch
Professionals responsible for supply chain and
procurement for pharmacies and manufacturers in the
life sciences sector.

Moderator
Jeanne Linke Northrop
Managing Editor
Pharmaceutical Commerce
Sponsored by Presented by

For questions email

kdunphey@mjhlifesciences.com
 Who Moved My Prescription?
While new forms of pharmacy continue to surface beyond brick-and-mortar retail, a look at what is
driving this shift in perspective—and "pharmacies of the future"—is warranted.
By Bill Roth, IntegriChain

INSTRUMENTAL TO
YOUR SUCCESS

Combining RWE I
t’s widely understood that poor adherence to prescribed
medication regimens has far-reaching clinical and cost
implications for all healthcare stakeholders.
For example, patients who never start or don’t stay

and AI to Bend
on prescribed treatments fail to control their symptoms
and often experience disease progression and increased
morbidity and mortality. Insurance companies end up
paying for expensive medical interventions that could have

the Adherence Curve

been avoided by more stringent adherence to therapy.
Meanwhile, even pharmaceutical brands fail to recoup
the sunk costs associated with drug development and miss
the opportunity to achieve competitive success for the
png-jpeg-vector - stock.adobe.com

By marrying the two, pharma stakeholders can identify new
opportunities to tailor interventions in a way that is most
impactful to patients—helping them overcome roadblocks
in initiating and maintaining therapy.
By Suzanne Shelley, Contributing Editor
brand when their often life-saving medicines—which were
proven to be safe and effective in clinical trials—fail to
deliver on their promise due to adherence lapses.
“Additional tangible and intangible societal costs
arise in terms of job loss and reduced work productivity
for both patients and caregivers,” says Pierantonio

14 JUNE 2024

INSTRUMENTAL TO
Russo, MD, chief medical officer for
EVERSANA.
Considering how many clinical and
financial factors, unmet social needs, mental
health challenges, and comorbidities are
at work, it’s no surprise that patients have
a hard time remaining adherent to one or
more complex therapy regimens as they
struggle to manage one or more chronic
conditions. While the reasons are varied,
there is one thing everyone can agree on:
No single “one-size-fits-all” intervention
will suffice when it comes to helping diverse
patients to overcome the diverse adherence
challenges they face.
Fortunately, two factors are working in
tandem to break the logjam on adherence:
YOUR SUCCESS
• T he collection of real-world data
(RWD) from both established and
novel sources continues to grow
throughout the healthcare arena.
• The number of artificial intelligence (AI)
methodologies—including those based
on machine learning (ML), natural
language processing (NLP), generative
AI, and more—continue to mature,
enabling stakeholders to convert RWD
into real-world evidence (RWE) that
provides actionable insights.
Personalization is the
name of the game
When it comes down to interpreting
patient data, specificity is likely to garner
better outcomes.
IN FOCUS
“THE ABILITY TO ACCESS
MANY SOURCES AND LINK
THEM TO THE SAME
PATIENT IS
EXTRAORDINARY IN
TERMS OF INCREASING
EFFICIENCY AND
HELPING US TO MAKE
CONNECTIONS AND
PREDICTIONS WE COULD
NOT HAVE MADE BEFORE."
“The goal is to use today’s advanced
modeling technology to better understand
the complex relationships between patient-
level characteristics, adherence-related
behaviors, and health outcomes, and then use
the data-driven insights to deliver individual
level outreach, making them patient-specific
(not generalized) to improve outcomes,” says
William Grambley, CEO, AllazoHealth.
In fact, being able to connect the
source of information to one individual
creates a more streamlined process.
“The ability to access many sources
and link them to the same patient is really
extraordinary in terms of increasing effi-
ciency and helping us to make connections
and predictions we could not have made
before,” adds Amanda Bruno, PhD, MPH,
senior vice president in real-world and late
phase at Syneos Health. “It will be exciting
to see how this increased sophistication in
data will impact the pace and integrity of
future evidence generation."
Ensuring quality, accuracy, and reliabil-
ity of insights and predictions generated by
pharmaceuticalcommerce.com 15
 IN FOCUS
INSTRUMENTAL TO
YOUR SUCCESS
today’s AI models is paramount. Stakehold-
ers must prioritize the development of algo-
rithms using credible real-world healthcare
data, while also leveraging expertise from
scientific and medical professionals. Vali-
dating models of predicted results against
real patient outcomes is essential to ensure
confidence and trust in AI-driven healthcare
advancements, notes Christina Mack, chief
scientific officer, real-world solutions, for
IQVIA, adding: “Today’s predictive models
continue to get better in terms of identifying
which patients are at high risk for non-ad-
herence, and that helps stakeholders to
create personalized adherence interventions
that are informed by the patient’s actual
personal choices and barriers.”
Experts believe any opportunity to
build an algorithm that accurately reflects
patient behaviors in the real world can feed
further understanding of the many barriers
patients are facing, and from there, "then
16 JUNE 2024
develop more targeted outreach that helps
to personalize each patient journey based
on predictability,” says Angela Wlodar,
MS, Syneos Health’s senior vice president,
medical affairs in business development.
Complex patients,
complex drug regimens
In the clinical trial setting, safety and effica-
cy is validated in a highly controlled envi-
ronment where drug regimens are adminis-
tered and monitored closely by healthcare
professionals, so adherence lapses are not a
factor that impacts the drug’s performance.
“By contrast, once the drug moves into
the real world, healthcare systems, providers,
and patients become responsible for many of
the factors that impact adherence, so a large
amount of control is lost,” says Mack.
She notes that the types of adherence
challenges patients face can be organized
broadly into the following three buckets:
1. System-related: Challenges
that relate to access to healthcare
resources and communication meth-
odologies and format that may not
be in the patient’s primary language.
2. Treatment-related: Obstacles
such as cost issues, complexity
of the drug-administration
requirements, and the impact of
adverse effects.
3. Patient-related: Challenges
that connect back to comorbidi-
ties, management of side effects,
mental health issues, and other
considerations related to social
determinants of health (SDOH).
“Creating effective interventions requires
us to consider all of the factors we can
modify to make the patient journey more
successful, not just focus on what the patient
is or is not doing,” adds Mack. “We see a
lot of promise in marrying AI and RWE to
meet the challenge, and we are pushing the
envelope and investing in targeting these
capabilities in a robust and validated way.”
One particularly vexing challenge
for brand teams relates to patients who
are prescribed complex drug regimens
to manage potentially life-threatening
conditions that present no real symptoms
or discomfort on a day-to-day basis, such
as cardiovascular disease, hypertension,
high cholesterol, and diabetes.
“Patients are much more likely to
remain adherent to their drug regimens if
they feel their medications are helping to
alleviate symptoms, make them feel better,
and improve the quality of life,” says John
Doyle, DrPH, president of consulting for
Chaman - stock.adobe.com
Fortrea, and adjunct assistant professor at
Columbia University’s Mailman School of
Public Health. “Brand teams can be more
effective in how they engage with patients

"CREATING EFFECTIVE INTERVENTIONS REQUIRES US TO CONSIDER ALL
OF THE FACTORS WE CAN MODIFY TO MAKE THE PATIENT JOURNEY MORE
SUCCESSFUL, NOT JUST FOCUS ON WHAT THE PATIENT IS OR IS NOT DOING."
by deploying AI to personalize messaging
and behavior nudges, helping them
connect the dots and really understand
how the medications work, how their
disease will progress, and what risks arise if
they don’t remain adherent to therapy.”
Yet every patient has different needs and
preferences related to this knowledge gap.
“If we’re not finding ways to personalize
outreach to help patients and their
caregivers manage their expectations and
clarify how the health journey will continue
to evolve at every inflection point, we’re
missing a key opportunity to help the
patient remain on therapy over the long
term,” says Wlodar.
As an industry, “we do a lot of great
marketing to physicians to support
prescribing practices,” adds Bruno. “But
not enough of the outreach is directed at
patients to help them truly understand
what’s at stake so they can take control and
become better healthcare advocates for
themselves.”
There’s another often-overlooked aspect
when crafting patient-focused outreach.
“The tech industry and other consumer
brands do a very good job persuading
consumers to believe their products can
really improve their lives and help them
to be their best selves,” says Doyle. “Drug
companies can learn from them and should
make such targeted messaging a bigger
part of their overall health and adherence
intervention campaigns.”
Affordability, or lack there of, is another
major contributor to poor adherence.
Healthcare programs that implement tech-
nology advances on a continuous basis can
help. For example, they can aid in stream-
lining the benefits-verification process or
automating the steps required to onboard
patients into a health plan. This can "help
to instill confidence in access and reduce
the burden for patients and healthcare
providers by removing one more barrier
to therapy,” notes Jordan Armstrong, VP
of business development for AssistRx.
Meanwhile, complex drug-administration
regimens—particularly those associated
with self-injected and infused biologic
therapies—can be daunting, so quickly
identifying which patient needs what type
INSTRUMENTAL
of support TOcan be a benefit.
YOUR SUCCESS
“Whether the patient needs support to
coordinate travel to a doctor’s office or infusion
center, or must learn how to self-administer
these high-cost, high-stakes therapies at home,
both can be difficult—even for the most
motivated patients,” adds Armstrong.
Predicting behaviors,
tailoring the outreach
All of this becomes even more daunting for
patients facing structural health equity issues.
Such SDOHs include challenges related to
healthcare literacy, education level, socioeco-
nomic status, lack of transportation, child-
care challenges, and the inability to take time
off work to manage health conditions. “More
than ever, addressing these multi-faceted
challenges requires tailored interventions, ed-
ucation, and support to enhance adherence
and improve outcomes,” says Russo.
One proven strategy uses modeling and
predictive capabilities to stratify patients
by adherence risk factors as they are being
enrolled into patient-support programs,
IN FOCUS
so that tailored outreach can be offered
based on individualized risk factors and
communication preferences. “Using data-
driven insights into the barriers a given
patient is facing, pharma companies may
choose to provide even more-targeted
interventions, such as transportation,
childcare, or lodging coordination and
services to help them remain on therapy,”
says Armstrong. Similarly, he notes
that providing remote nursing-support
resources is particularly useful to help
patients master self-injection routines
without the hurdles they may face in
traveling to a provider’s office.
Deciding what to send
to patients at what time
Pharma brand teams have a lot of
options when it comes to how and when
to influence and engage the patient, in
terms of phone calls, email, and SMS
text campaigns that provide reminders,
information about adverse effects, access to
nurses for clinical information, and benefits
counselors. All of these avenues reduce the
administrative burden for coverage.
But knowing exactly what to offer at
what point in the patient journey so that a
given touchpoint will be most effective is still
a mystery to most brand teams, contends
Grambley, whose company uses AI to make
predictions on specific patients in order to
tailor their results.
“By optimizing communications for
patients at the right time, on the right
channels, at scale, we have proven that
we can get them on therapy sooner, stay
on therapy longer, and get more benefit
pharmaceuticalcommerce.com 17
 IN FOCUS
from the medication,” he says. “For the
most part, we do not change the branded
program offerings and messaging that the
pharma company has already developed.
Rather, by studying and modeling more
than 500 different variables related to their
preferences and behaviors in the past,
we can deliver decision intelligence that
allows the brand team to proactively target
the timing and fine-tune which program
elements reach which patients at what time.” RWD sources that provide
In one example working with a pharma
brand that offers a therapy for a major
depressive disorder (MDD), AllazoHealth’s
AI platform was used to predict which
patients were at risk of non-adherence
to their MDD medication, determine
the most impactful email content to
address that risk, and personalize the
communications for each patient.
According to Grambley, doing so boosted
INSTRUMENTAL TO
first-fill rates by 8.4%, while average time a YOURBy
patient remained on therapy rose by 13%.
Also, emails sent to MDD patients were
2.5 to 4.2 times more effective with AI
optimization than those without.
Meanwhile, AllazoHealth is also
piloting an advanced approach to
personalize “dynamic modular content”
with pharma clients. Consider a matrix
that involves different versions of the
approved subset line, headlines, email
content message, and images that may
resonate differently with different people,
and specific calls to action that relate to
different challenges patients may be facing.
“Using our data-driven intelligence, we
are able to drive the optimal combination
of elements from the matrix that will
provide the most personalized and impactful Nathan. “This provides a superior approach
outreach for any given patient," says
Grambley. AllazoHealth plans to roll out
this feature more broadly later this year.
Mack adds that having patients on the
correct treatment pathway to begin with
18 JUNE 2024
is a key component to adherence, and a
place where leveraging AI and RWE can
drive improvements. In a recent study in
Germany, IQVIA leveraged local RWD to
identify and profile unmet needs among
asthma patients, based on demographics
and other clinical drivers, leading to a 17%
reduction in uncontrolled asthma in six
months following new treatment initiation.
insights into patients’ lives
Traditionally, identifying non-adherent
patients has relied on direct inquiries,
surveys, and analysis of pharmacy data for
missed refills, notes Ramaa Nathan, PhD,
VP of data science and RWE insights,
EVERSANA. However, both approaches
are costly and time-consuming; frequently,
they do not allow for the discovery of all
non-adherence contributing factors.
contrast, today’s AI methodologies
SUCCESS
are able to produce sophisticated pattern
recognition and build models based
not only on EHR data, lab tests, and
phenotypes and genotypes associated
with the disease, but can identify relevant
patterns and make predictions related to
patient demographic data and SDOH.
“We know these factors play a direct
impact on drug adherence and clinical
outcomes,” says Doyle.
“Today, we are able to build ML
predictive models with inputs from
extensive datasets, including clinical
notes, administrative claims, behavioral
health profiles, SDOH, patient-reported
data, and social media listening for early
identification of at-risk individuals,” adds
over traditional regression methods, as it
recognizes complex, non-linear patterns and
its predictive accuracy improves over time
with the input of new data.”
According to Nathan, classifying patients
into different clusters and recognizing those
patient sets that are most likely to encounter
adherence issues can help when developing
personalized outreach methods.
IQVIA is working to use NLP to
simplify medical terminology for patients
(removing a common adherence barrier),
and has developed an AI-powered patient-
relationship management tool, which, Mack
says, is being used by several pharma brands.
“The chatbot can digest the patient’s
input and route them to the most
appropriate person or resource to triage the
situation in a personalized and accurate way,
allowing both patients and physicians to
overcome barriers in access and affordability
to promote adherence,” she adds.
Meanwhile, AssistRx’s patient-support
programs currently use voice/tonal
recognition technology to identify, address,
and report on access and affordability
challenges patients are facing that can
reduce adherence. “As AI becomes
more sophisticated, we’re excited for the
opportunity to be able to flag patient
behaviors and interactions—live during calls
with our representatives—that are barriers
to access and adherence, then proactively
address those challenges,” says Jordan.
Success in this department, however, will
ultimately come down to continuity.
“Once we as an industry put these life-
saving therapies out into the world, sustained
patient adherence is one of the most critical
factors to ensure these products can deliver
on their promise and potential,” says Mack.
The ability to implement AI, catered to
specific patient needs, as detailed, will be a
major catalyst in these efforts.
“Any given patient program will always
help some people but not all of the people,”
notes Grambley. “But when you can apply AI
to really tailor the options and help patients
to get exactly the type of support they need at
the right time, it’s kind of magical.” PC
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INSTRUMENTAL TO
YOUR SUCCESS

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 FEATURE

Medicine for the Planet: Building a INSTRUMENTAL TO

Sustainable Legacy in Pharma Supply Chains

YOUR SUCCESS

New innovations that are contributing to industry environmental efforts.

By Craig Wilson, Marken

A
s the benchmark of a successful business, sustainability
and being environmentally focused is more than
a symbol of advancement and efficiency; it is an
absolute necessity for a world facing growing ecological
concerns. Modern organizations must remain cognizant of
their inefficiencies and their peripheral effects on our planet. To
immediate performance indicators, but after years of research
and catastrophic climate events, ESG is now a major criterion for
weighing a company’s longevity.
The pharmaceutical industry is a global powerhouse, delivering
healthcare and life-saving treatments to billions of people around the
world. As such, this vital sector must contend with making a signifi-
Anutha - stock.adobe.com

bring sustainability to the forefront, environmental, social, and cant carbon footprint. According to one study, the pharma industry
governance (ESG) initiatives are the measures for which modern puts out 13% more pollution than the automotive industry—at a
organizations achieve functional success. Only years ago, many market size less than 30% pharma’s value.1 In the same study, it
companies would consider sustainability extraneous to more was determined pharma manufacturing’s annual carbon dioxide

20 JUNE 2024

emissions were 48.55 tons of CO2e (carbon
dioxide equivalent) per million dollars of
revenue—55% greater than auto manufac-
turing in that same year.2 The supply chains
for life sciences and healthcare are estimated
to contribute 70% of the overall emissions
pharma companies expend, highlighting an
imperative for change.2
Recent scientific evidence suggests
climate change is rapidly accelerating,
placing ESG initiatives in the spotlight as
an inherent component of business.3 In the
race to curb further damage from pollution,
pharma and its supply chains are position-
ing themselves to lead the way. Fortunately,
awareness of environmental degradation
has accelerated along with the adoption of
new innovations, and this confluence could
not arrive at a better time.
Accelerating sustainable
INSTRUMENTAL
solutions through technology YOUR
At every level in the pharma industry,
innovative technologies are being integrated
to improve and assist in developing complex,
ground-breaking novel therapies. These
same technologies are also capable of
analyzing big data and developing processes
for sustainability. While the supply chain is
integrating these technologies to optimize
processes and elevate the movement of
ultrasensitive drugs, it simultaneously offers
the opportunity to improve sustainability
initiatives through advanced data analysis
and improved efficiencies. Digitalization
for this new age of healthcare, in the form
of automation, artificial intelligence (AI),
blockchain, and the internet of things or
more specifically, the internet of supply
chains (IoSC) (also referred to as a connected
supply chain), is shaping new processes and
daily operations, presenting opportunities to
greatly influence directives for ESG. 4
IoSC offers a major uptick in control,
efficacy, and optimization by fully integrating trips and fewer carbon emissions.
FEATURE
components of the supply chain with the Closed loop and reverse
internet. This allows operations a robust set logistics solutions
of informed solutions combined with faster,
possibly instantaneous, decision-making. The World Health Organization estimates
that the pharma industry produces over 300
When combined with data analysis from
million tons of plastic waste annually—with
other developing technologies, it will lead to
single-use plastics estimated to represent
a smarter, more intuitive supply chain with
half this number.5 To circumvent this
endless applications for determining ESG
enormous amount of waste, supply chains
initiatives. By elevating the supply chain’s
use strategies to maximize the lifecycle and
connection to the internet, we take a major
reuse of packaging assets.
step toward the next industrial revolution—
Through collaborative efforts with
Pharma 4.0—optimized visibility, traceability,
partners, an ESG initiative to return this
predictive maintenance, streamlined
packaging by taking steps to track, return,
transport operations, and increased cross-
and recondition in a process of reverse
organizational communication.
logistics not only saves resources, but
AI joins IoSC to open even more opportu-
prevents these containers from remaining
nities for sustainability. It assesses big data sets
indefinitely at a partner’s facility and
to define processes, like analyzing routes and
potentially the landfill. By bringing all
carriers to determine best practices to limit
stakeholders together through a closed loop
emissions, simulated clinical trials, or other
process, we maximize savings on transport
virtual simulations,
TO thus eliminating product
SUCCESS expenditures and CO2 emissions while
loss and unnecessary lengthy studies. Also,
keeping partners supplied with packaging
AI will cut out laborious manual processes
and returning assets to their original
impacting traditional systems that churn out
destination.
paper waste. It promises to bring many other
To enhance this process, radio frequency
technologies together as the computational
identification tags (RFID) have been incor-
power of standard systems is elevated to new
porated into packaging for tracking and
heights through machine learning.
data collection, assisting managers by pro-
Blockchain, in tandem with these other
viding a robust view on regional quantities
technologies, has the potential to create
that perpetually drive this cyclical process.
some of the most balanced and well-kept
The smoothness of a well-maintained,
supply chains. Blockchain acts as a digital
closed-loop system is an orchestration of
ledger made infallible by connectivity across
operations teams and sensors collecting
multiple channels to provide a deeper,
copious data on assets that, when enhanced
impeccable look at inventory, status, and
with other technology, such as AI and block-
integrity of medical products across the
chain, organize, manage, and alert when an
entire supply chain.
asset is nearing the end of its lifecycle.
Blockchain logs every step, preventing
deficiencies in stock products and where
Human insight fueling
they are available for relocation in times of
processes and accountability
demand. These elevated records facilitate
sustainability by preventing oversupply and The data for climate change has reached
stockouts, maximizing accuracy of quan- a pinnacle in recent years, after elevated
tities for transport, which translates to less media coverage and the release of extensive
research from the Intergovernmental Panel
pharmaceuticalcommerce.com 21
 FEATURE

on Climate Change in 2021 and the World with a robust communication program the efficient processes, the pharma industry
Meteorological Organization’s State of the first year to alert and educate employees and and its supply chains are reaching a new
Global Climate Report from 2022 showing external service providers of our initiatives era of sustainable practices. Likewise, by
overwhelming evidence that global tempera- and their roles in them. This was followed focusing on ESG factors throughout the
tures have reached an extreme level and our by increased involvement the following year pharma supply chain, companies ensure
current processes are inadequate. Acknowl- with targeted areas and metric goals. In the medications we rely on are produced
edging the severity of the issue is the first the final stages, we implemented solutions responsibly. This translates to a healthier
step to bringing about change, and while our for areas that did not achieve objectives. planet and a more sustainable industry
advancing technology will play a significant By following this strategy, Marken met the with better access for patients. While
role in our future, human insight defines the specifications for its EcoVadis reporting and challenges remain, the growing focus
direction, purpose, and adaptability needed adopted additional strategies to move from on ESG initiatives presents a significant
to create a truly sustainable industry. a bronze to silver status within a few years, opportunity for the pharma and its supply
The best ESG practices are designed a unique designation only the top 25% of chains to become leaders in responsible
by experts familiar with the frontlines—sci- reporting companies achieve. manufacturing and distribution. PC
entists, logisticians, and project managers A transparent approach with elevated
using detailed understanding for designing communication to stakeholders is crucial
strategies to address inefficiencies. For our for allowing outside processing to also REFERENCES
part in the supply chain, decarbonization become familiar with ESG initiatives and 1. L otfi, B. Big Pharma Emits More Greenhouse
strategies are important to conserving processes, building on the collaboration Gases than the Automotive Industry. May 27,
2019. https://theconversation.com/big-
resources, and we take every chance to necessary to create change on a large scale. pharma-emits-more-greenhouse-gases-than-the-
consolidate shipments and reduce fuel It is important to keep in mind as a global automotive-industry-115285
consumption whenever possible. Internal INSTRUMENTAL
organization,
TO different countries have 2. Heim, M.; Entrup, C.; Miranda, W.
YOUR SUCCESS Making Biopharma’s Supply Chains More
initiatives play a large part in implementing various approaches to sustainability.
Environmentally Sustainable. Deloitte.
ESG into daily activities, such as eliminating With so many touchpoints in the supply September 20, 2023. https://www2.deloitte.
waste, recycling programs, choosing reus- chain for different projects and regions, an com/us/en/insights/industry/health-
care/scaling-pharmaceutical-supply-chain-
able materials, and ensuring we get the most individual company’s initiatives and ability
sustainability-efforts.html
out of a product. to lower waste is often only as good as the 3. Evidence. NASA. 2019. https://science.nasa.
As headway in ESG is made through next player in the process. This is why a gov/climate-change/evidence/
these areas and record keeping is formalized, well-informed and staged approach brings 4. Seethamariah, S. The Power of a Smart,
Connected Supply Chain. Forbes. February
global organizations are in place to create teams together with a common mission— 17, 2023. https://www.forbes.com/sites/
standards, judge progress, and assess a busi- eliminating unnecessary events and building forbesbusinesscouncil/2023/02/17/
ness’s ESG actions to determine success. reciprocal services to deliver the most out the-power-of-a-smart-connected-supply-
chain/?sh=172929691b18
Founded in 2011, EcoVadis is an of resources.
5. The Pharmaceutical Industry is Prescribing More
innovative solution that empowers To address the inefficiencies in the Sustainable Practices. OWL ESG. November 22,
businesses with assessments and scores pursuit of optimizing sustainability, we 2022. https://owlesg.com/2022/11/22/the-
pharmaceutical-industry-is-prescribing-more-
to award sustainability status. It offers a must master our individual roles throughout
sustainable-practices
novel approach by collaborating to adopt pharma, revealing where there is room
new standards, implementing plans for for improvement and taking action to
controlling waste, cutting emissions, and implement changes to make a difference in
keeping track of all sustainability initiatives. concern of our environment.
Savvy organizations are assessed by their
plan of action and the resulting data Focusing resources ABOUT THE AUTHOR
Craig Wilson is Senior
collected from their ESG efforts. on sustainability Director of Strategic
At Marken, we view ESG as a long game Planning at Marken.
and are in the late stages of a five-year By strategically combining human
campaign assessed by EcoVadis. We began expertise, cutting-edge technology, and

22 JUNE 2024
 ®

Cold Chain
Solutions A SU PP LE M EN T TO

Supplement: INSTRUMEN

Further
TA
YOUR SUCCL TO
ESS

Exploration
of Pharma’s
Temperature
Controlled
Sector
Post LogiPharma, the editors
INSTRUMENTAL TO
YOUR SUCCESS
of Pharmaceutical Commerce
examine the trends and
highlights that came out of
the conference, specifically
surrounding the cold
TE MP ER AT UR E-
CO NT RO LL ED SO
chain solutions segment. LU TIO NS
This digital supplement
offers an overview of this
niche sector’s value to
COLD CHAIN
the industry, and through
exclusive video interviews
with key opinion leaders
EXPLORATION
and session coverage, A SE CTOR
OV ER VI EW SU STAI NA BL E
provides perspectives from CO LL AB OR AT IO
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LO GI ST IC S
& CGTs
subject matter leaders on
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most relevant, including
matters pertaining to
third-party logistics (3PL)
providers/day-to-day logistics, supply
DOWNLOAD
chain management, and packaging & monitoring. THE EBOOK

To learn more, visit PharmaceuticalCommerce.com

 FEATURE
Dynamic Pricing: What Pharma Needs?
With pharmacies under pressure to lower drug-acquisition costs, a look at how digital
formats can help manufacturers better manage price based on real-time data.
By Blake Powers, Medigi
W
e’ve all witnessed the retail,
transportation, and travel industries
undergo a transformation based
on new digital models. Outcomes
include lower cost, improved safety, more consumer
choice, and ecosystems that serve as a haven for a
ABOUT THE AUTHOR variety of market players to coexist and compete
Blake Powers is
on price, quality,INSTRUMENTAL
demand, TO
and
YOUR SUCCESS reputation. These
the CEO of Medigi,
and a member of dynamic pricing models leverage data analytics to
Pharmaceutical make pricing decisions that benefit both businesses
Commerce’s Editorial
and customers through timely, market-aligned
Advisory Board.
adjustments. Yet, with all the innovation applied to
pharmaceuticals, e-commerce has yet to gain traction
in the space. Pharmaceuticals stand to benefit with
the same outcomes as other industries embracing
digital approaches to their pricing models.
The recent US Department of Health and
Human Services (HHS) white paper, “Policy
Considerations to Prevent Drug Shortages and
Mitigate Supply Chain Vulnerabilities in the United
States,” published in April, suggests it’s time to
reevaluate, noting that “Incentives throughout the
supply chain must be reimagined to ensure the
resilience and supplier redundancy required to
prevent drug shortages from occurring.”
We habitually use dynamic pricing models in our
daily lives, whether it’s travel reservations, ride hailing
apps, or online marketplaces to stock our pantries
or to find the perfect gift. Still, the pharmaceutical
industry, by and large, has yet to adapt. It still
depends on older models that rely on long-term price
negotiations that lock in prices.
24 JUNE 2024
Online marketplaces and aggregators have a
historic track record for debuting new business
models, amplifying transparency, fixating on source
suppliers’ unmet needs, and obsessing about the
perfect user experience for the buyers engaged
with their applications. Something that would have
required either the services of a travel agent or hours
of comparative research now only takes 10 minutes.
Up-and-coming creators and artists don’t need to
invest in the overhead of a gallery or peddle their wares
on the street anymore; they simply list their pieces online
for greater customer reach. So many aspects of our lives
have changed in the last 20 years, yet what’s fascinating
is how within the ecosystem of healthcare providers
(HCPs) sourcing drugs, it hasn’t really changed at all.
Take, for example, the 90% volume that generic
drugs represent in the US pharmaceutical market. For
HCPs, 80% to 90% of their medication purchases are
negotiated on their behalf by their group purchasing
organization (GPO) as “contracted products.” The
philosophy is that when you combine a GPO member-
ship’s total purchasing power (representing one-third
of the hospital beds in the country), each hospital
member will have the most competitive price. It’s one
less detail for HCPs to worry about, and with multiyear
awards from drug manufacturers committing to a price
for five to seven years, the argument is that it helps
pharmaceutical companies better plan for market
demands while ultimately, creating more stable supply.
However, this model has its flaws.
A F rom the reliability perspective, outcomes of the
status quo static-pricing model are concerning,

with drug shortages reaching a report- creating overstocks, and ironically, phar-
ed two-decade high.
B I t assumes that the sole (or dual)
manufacturer(s) awarded will have
uninterrupted supply of the product
for five to seven years. Are the lowest
bidders always the most reliable?
C The model doesn’t encourage other
players to be ready to serve the market
in situations where a hurricane shuts
down the island of Puerto Rico, or FDA
suspends the operations of a produc-
tion plant due to a failed inspection.
D W
 ith the trend of M&A, it leaves the
number of major national hospital GPOs
to three. This means, as a drug company,
if you don’t win the award of a particular
GPO, you are boxed out of the market
until the time rolls around where the
other two major GPOs have a bid cycle.
E I t discriminates against emerging/
midsized pharmaceutical companies
because the sheer volume of the bid re-
quires enormous production capacity.
F L ong-term prescription demand is tough
to forecast and often the expected vol-
ume of the awarded product does not
match up with the actual pull-through
(creating excess supply, risk of waste
for manufacturers, or shortages).
Artificially setting fixed price points
insulates the pharmaceutical supply chain
from the basic economic law of supply and
demand. If the price is set too low, only the
largest players (or those with the thinnest
margin tolerance) can compete with the
economies of scale necessary to make the
math work, and such concentration only
leaves the supply chain more vulnerable to
shortages. It doesn’t entice other manufac-
turers to stay or enter into the space.
If the contracted price is set too high,
you’ll have too many manufacturers
producing the same product in the market,
macy acquisition cost (at a fixed contracted
price) would be greater than what it would
be in a free-market environment. With static
pricing set by long-term GPO bid cycles, it
removes the ability for price points to float
into its real-time equilibrium price guided
by current supply and demand conditions.
How dynamic pricing is
starting to unfold for pharma
New digital solutions and dynamic pricing
advantages extend beyond the generic drug
world. With more branded and specialty-lite
products trending direct, drugmakers often
offer unique price points to certain sites of
care. For instance, pharmacy-specific prices
can be adjusted by the supplier based on
the precommitted or historic pull-through
volumes of the pharmacy customer.
INSTRUMENTAL TO
YOURModern
SUCCESS technology now provides pro-
curement professionals with real-time optics
into what’s available at the manufacturer level
and allows for more convenient, open trade.
Would a free-market
system create price erosion?
By its very nature, dynamic pricing does not
discriminate. In moments of abundance,
prices tend to decrease, and in situations of
scarcity, prices most always bounce up. The
price equilibrium in a dynamic pricing model
is discovered immediately. With prenegotiated
long-term pricing models, it delays where the
market price should really be at.
Considering the number of backorders
and the influx of volatility in medication
supply, drug manufacturers who can deliver
reliable supply at fair market prices should
be the ones positioned for success. The
aforementioned HHS white paper states,
“hospitals can spend at least $600 million
per year managing shortages and diverting
essential personnel who are needed for direct
FEATURE
patient care to find alternative treatments for
patients.” Contrary to the common assump-
tion that pharmacy buyers always go for the
cheapest available product, procurement
teams do indeed make restrictions/soft blocks
on certain national drug codes/manufac-
turers because of physician preference; ease
of patient administration; reimbursement
implications; shipment turnaround; lack of
historic reliability; and even the coloring of
the label/vial cap. Price is certainly a major
dimension of the purchasing decision, but it’s
not the only factor. A platform that provides
the freedom of direct dynamic pricing offers
a new approach to a supply chain that is
experiencing no shortages of new challenges.
The gross-to-net economics of what the
product sells for versus what is retained by the
manufacturer at the end of the day is begin-
ning to have a negative impact. It starts with
the drug company trying to sustain a product
line where 40% to 65% of gross sales are be-
ing consumed by pharmacy benefit manager
rebates, higher distribution fees, chargebacks,
340B penny pricing, and GPO administra-
tion fees. After all the upfront expense of
R&D and manufacturing capabilities, the
costs of the active pharmaceutical ingredient
and labor, and obtaining FDA approval, it’s
becoming a greater challenge to forecast the
viability of a product once pharma compa-
nies analyze the bottom line of what it takes
to also launch and distribute the product.
Arguably, the costs should be lower for
manufacturers to digitally price and distribute
their drugs to HCPs and their patients. Having
the ability to manage price based on real-time
market data puts companies in control, pre-
venting unstainable erosion, and allowing for a
more rapid response to any unmet needs.
Is it time to contemplate medications as
we do other commodities, embrace digital
formats, and allow for more dynamic pricing
to occur? Perhaps this shift in thinking is just
the remedy the drug supply chain needs. PC
pharmaceuticalcommerce.com 25
 LAST WORD
How Serious Are You INSTRUMENTAL TO
YOUR SUCCESS
About Patient Centricity?
Companies need to alter their thinking to better prioritize patients.
R 3
ising cost pressures demand
more efficient operations.
Micro-launches are creating
shorter go-to-market runways.
The continued rise of specialty drugs with
small patient populations puts increased
pressure on companies’ promotional
efforts. In this landscape, there are many
ideas for how to improve commercial focus
and effectiveness. However, maximizing
the impact of commercial efforts starts
with putting patients first. In addition to
being the right choice ethically, it has also
become strategically imperative (hence,
the widespread discussion in the industry
about patient centricity).
Now, believing is one thing, but living
the belief is another. Companies need to
think differently to truly place patients
26 JUNE 2024
at the forefront of their commercial
strategies. One of the keys to making
this shift is for a company to broaden its
perspective on promotional tactics. Even
if its current tactics—such as robust social
media campaigns or healthcare provider
education initiatives—are highly effective
individually, they often optimize local
impact rather than overall effectiveness.
Therefore, instead of focusing solely on
tactics, a company should adopt a holistic
“customer engagement model.” Since
patient-centric decisions involve multiple
stakeholders, companies need to engage
them comprehensively and strategically.
Here are three key elements for developing
impactful customer engagement models,
which will go a long way toward helping
companies achieve patient-centricity.
1
DESIGN AND ENABLE
Too often, customer engagement models
that are well-designed end up being
unsuccessful because they run contrary
to existing organizational structures.
Competing priorities across teams,
misaligned corporate objectives, and a lack of senior
leadership vision are the main reasons these
initiatives fail. Therefore, enablement is as important
as the design of the customer engagement model. To
successfully deploy these models, companies may
have to break through the internal silos that were
built for a different, brand-driven era. An ideal model
must truly cut across teams, and a company must
put in place the proper incentives to facilitate this
unified approach. In the end, companies should
ensure that all practitioners engaged in the effort
work toward the common, patient-centered goal.
2
PRIORITIZE PATIENTS, BUT
CONSIDER ALL INVOLVED
Companies should prioritize patients as
the North Star of their commercial
efforts but also address all the players
that surround them in the treatment
ecosystem—from their physicians to pharmacists, to
nurses to regulators, to payers. To succeed, commercial
teams must ensure they understand the treatment
and emotional/decision journeys of all stakeholders,
the different needs they have, and the barriers they
need to overcome in order to best serve the patient.
GO ALL IN (I.E.,
DON’T PHASE IT)
A company should ensure it does not
fall into the slippery slope of having the
right design and enablement model for
customer engagement but then
pivoting around short-term, brand-focused objectives.
Too often, drugmakers end up in this situation because
at the time of enablement of the model, they start
characterizing it as a big initiative with a large price
tag, are unwilling to garner rank-and-file support for it,
or feel overwhelmed by the need to continue investing
in the model’s evolution. Therefore, companies need to
think in a bit more like a purist and ensure they see the
model right through to the end. PC
wladimir1804 - stock.adobe.com
ABOUT THE AUTHOR
Rohit Gupta is a
partner at Beghou
Consulting.
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