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Insight
Today’s medical breakthroughs are more advanced and personalized than ever, but even as new therapies reach the market, many people still face real challenges when it comes to accessing and affording the medications they need.
During the recent Fierce Pharma webinar, CoverMyMeds leaders Megan Wetzel, Vice President of Product, Access and Affordability, Shea Scott, Sr. Director of Product Management and Dimple Patel, PharmaD, Sr. Director of Product Management explored actionable strategies to optimize brand lifecycles and reduce barriers to medication access.
Here are five key takeaways from the conversation:
Despite advances in drug development, medication access remains an ongoing challenge for patients. In 2024, U.S. prescription usage rose to 215 billion days of therapy, with 61% of adults taking at least one medication.[0]IQVIA Institute, The Use of Medicines in the U.S., 2024. Yet, 65% of patients still experience delays in accessing their prescriptions,[0]CoverMyMeds Data on File, 2023. as highlighted in the 2025 CoverMyMeds Medication Access Report.
Rising specialty drug launches, representing 93% of new therapies in 2024,[0]Evaluate Pharma, World Preview 2024, Outlook to 2030. and an aging population projected to reach 63 million Americans over 65 by 2025 are compounding demand.[0]CoverMyMeds Data on File, 2023. As Megan shared, “We’re seeing a clear shift in how we view the patient journey, one that requires more than a one-size-fits-all approach. The rise in specialty medications, aging demographics and fragmented systems means we need to dimensionalize the patient experience and respond with solutions that are proactive, not reactive.”
Industry fragmentation across providers, pharmacies, and health plans and PBMs create data silos and workflow inefficiencies. Providers report that 73% are seeing increased claim denials, and 95% face challenges starting patients on therapy due to prior authorization (PA) complexities.[0]AMA Prior Authorization Physician Survey, 2024. Shea stated, “Providers are managing full workloads. Between prior auth delays, claim denials and fragmented workflows, it’s harder than ever to get patients started on therapy. Our solutions aim to help reduce friction and let care teams focus on what matters most: the patient.”
Pharmacies are similarly impacted, with 1 in 5 patients abandoning prescriptions at the point of sale due to affordability.[0]CoverMyMeds Data on File, 2023. The lack of interoperable systems and cross-stakeholder collaboration is delaying care and burdening patients. Dimple expanded on this by sharing, “Pharmacists are on the front lines of medication access. When affordability tools aren’t integrated, patients walk away without their medications. We need real-time solutions that help streamline the process and empower pharmacists to support long-term adherence, not just dispense.”
Biopharma brands face unique challenges at each stage of the product lifecycle. At launch, gaps in formulary coverage and provider awareness can stall uptake. In mid-to-mature stages, competitive dynamics and label updates require proactive communication. Megan shared, “As brands evolve, so should their access strategies. Whether it’s launch planning or navigating mid-lifecycle pressures, we need scalable solutions that meet stakeholders where they are and adapt to the realities of care delivery.” Flexible solutions, like electronic prior authorization support, field team data tools, and copay programs, can help ease fragmentation and support stakeholders across touchpoints.
Pharmacists and providers need tools that integrate seamlessly into their existing workflows. Solutions from CoverMyMeds—such as automatic copay coupon application, traditional copay programs, and auto-conversion of rejected claims to be paid at the pharmacy—help reduce prescription abandonment and improve claim efficiency. For providers, prospective ePA may enable real-time coverage checks, while retrospective ePA offers streamlined support when claims are rejected because a prior authorization is needed. These tools help streamline care and empower clinicians to focus more on their patients.
AI is increasingly seen as a powerful tool in addressing medication access barriers and optimizing brand lifecycle strategies, but it’s not a silver bullet. As the conversation turned toward technology, Megan, Shea and Dimple emphasized that while AI can analyze complex data and identify patterns, it must be paired with clinical expertise to drive meaningful change and be integrated responsibly and at scale. “AI can help us identify patterns and predict access barriers, but it’s the human insight that drives meaningful action,” said Shea Scott. “The goal isn’t to replace clinical judgment, it’s to support it with smarter, data-driven tools.”
Automation plays a critical role in simplifying structured tasks, but it’s the human insight that ensures interventions are both relevant and effective. Dimple echoed this sentiment, highlighting the importance of seamless integration, “Technology should work for us. When biopharma invests in solutions that fit into pharmacy and provider workflows, it makes a real difference in how quickly and confidently we can deliver care.”
As prescription use continues to grow and therapies become more complex, optimizing medication brand lifecycles is more important than ever. To keep pace, brands need adaptive strategies that prioritize patient affordability and seamless access.
By connecting biopharma, providers, payers, and pharmacies through our extensive network and real-time insights, CoverMyMeds works to reduce barriers and improve the patient access journey. Whether it's ePA, affordability programs or adherence support, CoverMyMeds solutions deliver the right tools at the right stage, making the difference between patients starting and staying on therapy, or getting stuck behind access, cost and adherence barriers.