Ashwin Athri, MBA | Executive VP, Strategy, Innovation, & Partnerships
Greg Gregory, PhD | Executive VP, Partner
Eve Jamali, MSc | Senior VP, Managing Director
As drug pricing reforms reshape the pharmaceutical landscape, Patient Support Services (PSS) are emerging as a strategic imperative.
This article builds on the foundational insights from The Price Reckoning Part 1: The Price Convergence, which outlines the structural shifts driven by the Inflation Reduction Act (IRA) and Most Favored Nation (MFN) policy. Read on to understand the strategic role of PSS in navigating the evolving pharmaceutical pricing landscape.
The dual pressures of the IRA's negotiation-based model and the MFN's international reference pricing mandate are creating a "pricing pincer movement" on manufacturer revenue. This is forcing strategic realignment across the industry, characterized by significant challenges, including profound revenue compression for biopharmaceutical companies and an existential viability crisis for independent pharmacies.
A novel and potent feature of the MFN strategy is its integration with U.S. trade policy. The administration has used the threat of imposing 100% tariffs on imported branded and patented pharmaceuticals as a tool to compel manufacturers to adopt MFN pricing voluntarily. This tactic led to special agreements with select biopharma companies, extending MFN pricing to targeted therapies across all state Medicaid programs.
This deal established a clear template: voluntary adherence to MFN principles, particularly through direct-to-patient channels and concessions to Medicaid, in exchange for relief from punitive trade measures.
However, this disruptive environment is also a fertile ground for innovation and strategic repositioning. Key opportunities are emerging at an accelerated pace. Direct-to-Patient (DTP) models, championed by the MFN framework, are disrupting traditional distribution channels and challenging the opaque role of pharmacy benefit managers (PBMs). Patient support services, particularly centralized HUBs, are being strategically elevated from administrative cost centers to essential "revenue protection" engines, critical for navigating increasingly complex access and affordability hurdles. Concurrently, the economic pressures on all stakeholders are forcing a technological revolution in patient support, with artificial intelligence (AI) and automation becoming indispensable tools for delivering personalized care efficiently and at scale.
The modern patient HUB service is no longer a passive administrative function, but an active, strategic engine designed to safeguard brand revenue. The economic pressures of the IRA and MFN, combined with aggressive utilization management tactics from payers, have created a gauntlet of access barriers that can derail a patient's journey to therapy.
Industry data starkly illustrates the scale of this challenge: for every 100 new specialty prescriptions written, as few as 30 are ultimately filled. The majority are lost to coverage denials, prior authorization hurdles, distribution issues, or other restrictions. Each of these abandoned prescriptions represents lost revenue for the manufacturer.
Consequently, forward-thinking organizations are reframing their investment in HUBs not as an expense, but as a critical "revenue protection" strategy. An effective HUB is scalable by proactively managing benefits investigations, expertly navigating PA requirements, and resolving affordability challenges before they lead to abandonment.
In this new landscape, the efficiency and effectiveness of a brand's HUB, its ability to ensure a frictionless journey and accelerate speed-to-therapy, has become a key competitive differentiator, arguably as important as the product's sales force reach.
The dual forces of manufacturer revenue compression and rising patient support needs have intensified the need for more efficient resource allocation. This tension is serving as a powerful catalyst for a technological revolution within patient services.
To maintain service levels amid budget constraints, organizations are aggressively adopting digital tools, AI, and automation to drive efficiency, scale operations, and enhance personalization.
This technological shift is manifesting in several key areas:
This shift is redefining patient support as a tech-enabled, ROI-driven function—no longer a cost center, but a core commercial competency.
The increasing administrative friction and economic pressures on both providers and traditional pharmacies have created a "service gap" between the point of prescription and the point of dispensing. This market failure has catalyzed the growth of an innovative new model: the non-dispensing pharmacy.
These entities do not hold or dispense physical inventory. Instead, they function as specialized intermediaries that focus exclusively on streamlining the front-end of the patient access journey. Upon receiving an e-prescription from a provider, a non-dispensing pharmacy manages the entire pre-fulfillment workflow. This includes conducting benefits verifications (BVs), managing and submitting prior authorizations (PAs), identifying and enrolling patients in applicable copay or patient assistance programs, and then seamlessly transferring the "clean" prescription to the appropriate dispensing pharmacy in the patient's network for fulfillment.
This model provides a powerful value proposition to multiple stakeholders:
In an environment where significant revenue is lost between the prescription being written and the therapy being dispensed, patient support programs from comprehensive hub services to targeted affordability assistance are now on the front lines of revenue protection. This shift is forcing a rapid evolution in how these services are designed, delivered, and justified, with a heavy emphasis on efficiency, technology, and demonstrable return on investment.
The new regulatory landscape is not only compressing drug prices but is restructuring the supply chain. The MFN framework has catalyzed an aggressive push toward Direct-to-Patient (DTP) models, a disruptive force that threatens to disintermediate traditional players like PBMs and pharmacies.
This shift, coupled with the broader economic pressures on the system, is creating a period of intense volatility and strategic realignment for all intermediaries in the drug distribution channel.
The administration’s MFN policy has catalyzed the development of DTP platforms. The launch of TrumpRx.gov and early agreements with biopharma manufacturers signaled a clear policy shift, prompting industry leaders to respond with their own advanced DTP solutions.
These DTP models represent a fundamental strategic gamble on vertical integration. In this model, the manufacturer seeks to orchestrate the entire patient journey, often partnering with telehealth providers for prescribing, digital platforms for benefits verification, and mail-order pharmacies for fulfillment.
Opportunities:
Enhanced Patient Access and Relationships: For uninsured, underinsured, or high-deductible patients, DTP cash-pay options can provide a more affordable pathway to therapy.7 It also allows manufacturers to build direct relationships with patients, gathering valuable data on adherence and outcomes to improve support services.
The U.S. pharmaceutical market is undergoing systemic transformation due to the Inflation Reduction Act and MFN policy. These changes are dismantling legacy pricing models and introducing government-set benchmarks, requiring all stakeholders to rethink strategy around access, pricing, and partnerships.
The following recommendations are offered as a strategic guide for navigating this new landscape:
Precision AQ partners with clients to build forward-looking pricing strategies — integrating policy scenario modeling, innovative contracting, and real-world evidence planning — to protect value from launch through lifecycle. Explore our Value & Access Services to learn more.