Angelica Norrell, PharmD, BCOP, CSP | Senior Director, Access Experience Team
For years, pharma market access strategy has had one primary target: get payer coverage. That still matters. But especially for specialty and oncology therapies, coverage isn't the finish line anymore. The real question now is whether the health system will actually adopt your product.
That's why Integrated Delivery Networks (IDNs) and large health systems matter more than ever. Payers still decide whether a product gets covered, but systems increasingly decide whether it gets used. Internal formularies, treatment pathways, site-of-care restrictions, and operational realities can make or break a therapy's transition from approval to patient care.
Too many manufacturers assume that favorable reimbursement will automatically lead to uptake. That’s usually not the case. Here's what we're seeing more often:
This disconnect is happening more because large systems are standardizing decision-making across entire physician networks. Enterprise P&T committees, service-line leaders, and pathway teams can shape prescribing behavior at scale, often more effectively than any individual physician. Coverage opens the door, but system adoption determines who walks through it.
For manufacturers, this changes everything. Traditional payer strategy is necessary but not sufficient. If your launch plan ends at coverage, you're missing one of the biggest barriers to access.
Several market forces are accelerating the influence of IDNs and large health systems.
Put it all together, and manufacturers need a broader definition of "market access" than they've historically used. Payer wins still matter, but they're not enough to guarantee commercial success.
The new question to ask is: “Will this product be adopted by the systems that now control so much of care delivery?”
Health systems are making deliberate choices about which products fit their pathways, workflows, economics, and care models. When a therapy creates friction inside the system, it struggles to gain traction, even when it's clinically compelling and reimbursed.
This is where manufacturers get caught off guard. Teams invest heavily in payer strategy, account planning, and clinical differentiation, yet still face slower-than-expected uptake because they underestimated enterprise decision-making inside health systems.
The manufacturers adapting best to this environment are broadening their access strategies beyond reimbursement. They're building plans that account for how systems evaluate therapies in practice, not just how payers cover them on paper.
That means asking questions such as:
Answering those questions requires a deeper understanding of how health systems make enterprise decisions and how access, operations, clinical governance, and economics increasingly intersect.
At Precision AQ, we think manufacturers need to assess more than payer access at launch. They need to assess adoption readiness inside the system. That includes understanding whether a therapy is positioned to align with the realities of modern health-system decision-making: clinical governance, operational feasibility, economic fitness, and pathway relevance. This is where many launches either accelerate or quietly stall.
The companies that get ahead of this shift are better positioned to:
Precision AQ helps pharmaceutical manufacturers evaluate where system-level barriers may be limiting adoption and where access strategy needs to evolve beyond coverage alone. If you would like to discuss an IDN Adoption Readiness Assessment for your brand or portfolio, let’s talk.