Access USA 2025: Uncovering Patient Access Complexities

Image Credit: Nicholas Saraceno

Informa’s Access USA conference leveraged its KOL base with a roundtable on “Unravelling the Complexities of Patient Access and Affordability.”¹ Featuring Ian Ocilka, ConnectiveRx’s chief strategy officer as moderator, he was accompanied by Nancy Bell, vice president and head of market access at Celcuity; Shannon Ashmon, lead, patient services–oncology, US market access at Eisai, US; and Larry Bressler, Disc Medicine’s vice president of marketing.

With the help of real-world strategies and emerging trends, the goal of the roundtable was to dive deep into how patient access needs are being assessed, along with the value of affordability when it comes to impacting healthcare decisions from a leadership perspective.

The development of market access tools and strategies

Ocilka kicked things off by raising the question of how market access tools and strategies have changed over the past five years, along with what panelists believe to be the most important emerging trends in market access in 2025, beginning with perspective.

“I think no one would be surprised to hear that vertical and horizontal integration and consolidation across the continuum are some of the most prevalent things in our industry today,” Bell said. “You look at that as well as the federal policies are coming out, whether it be pertaining to 340B or PBMs, and I think those are some of the biggest things that are impacting manufacturers today— and I think the biggest change I've seen—is how we look at the business.

“A lot of times, patient services was patient services. Payers were payers, and never the two shall meet or discuss. Now, if you're making decisions without understanding what each part of the business is doing, then you're going to have some significant impact on the brand, and potentially, sustainability. When I look at strategies, when I look at the different tools that are at our disposal—whether it's predictive analytics or real-world evidence—those are the things I have to think about. How is the business changing? And if this one domino gets pushed down, is it going to set an entire cascade? And how do I manage that to best help the brand perform and protect its integrity?”

The speedy development of tech has also been essential, as it has allowed for getting more patients on therapy.

“I think back five years ago, we were in the midst of a global pandemic, and if there was a silver lining around COVID, it’s the rapid adoption of new technologies,” Ashmon pointed out. “We all remember those HCP portals to get patients enrolled in therapy, but now, what I'm really excited about is predictive AI, so we can identify patients who might need financial support earlier in that treatment journey, and when we think about adherence, identifying how patients would prefer to be contacted to ensure adherence, whether it's text every other day, phone calls—those are some of the things that we've seen over the last five years come to pass. I would say a micro trend that we're noticing is the engagement with our market access colleagues and our government affairs team and pharma. We even have a policy expert embedded in our patient services program.”

How drug provisions in the IRA are impacting market and patient access

When it comes to the Inflation Reduction Act (IRA)’s effects on outpatient pharmacies and PAP programs—along with hub and copay programs—industry is ranging in terms of initial sentiments.

“It’s yet to be determined. We think it's going to be a great thing for patients as it relates to our PAP program, but it's still early,” said Ashmon. It's March. I haven't seen any clean data from our team to support whether patients are enrolling in an M3P [Medicare Prescription Payment Plan], but what we have heard, Nancy, anecdotally from medical pharmacies, integrated pharmacies, is that they're pleased with hearing that foundation support is going much further with the redesign to Medicare Part D, so that's exciting to hear.”

In Bell’s opinion, IRA only scratches the surface in terms of concerns.

“This stuff keeps me up at night, and I think it's easy to point a finger at the IRA because it was just so monumental. But it's not the only thing. We have to worry about the continued expansion of 340B in the state's overruling previous judgments when it comes to managing the distribution, the tariffs that just were put in place on importing from ex-US countries. There is so much pressure coming down that I think our ability to hear it, take it in, understand it, and then apply it—[pushes us] to raise the bar in ourselves. In order to be successful, those types of things are not going to go in.

“To Shannon's point, we put everything on the side. We're like, this is what we think is going to happen. This is what everyone's telling us, but we just don't know yet, because a lot of it is really just going into effect this year. We still need true data to make accurate assumptions versus hypotheses. If I could give a piece of advice on this, sometimes it's so easy to put things on a slide and say, no, there's smoothing. Even if patients have to pay the $2000, it's going to be fine. Smoothing is a lot harder than people realize. Let’s be realistic about it, and let's make sure that the people in our in our companies, understand that, yes, there're options, but it doesn't mean it’s guaranteed, and let's really put that effort into making sure we do try to get things across the finish line, and we do really support them.”

Improving patient support programs in response to personnel

Bressler, who operates in the marketing sector but also has experience leading market access in the rare disease space, pointed to the value of the economic side of the equation. What factors impact one’s program?

“First of all, understanding the cost of drivers for your gross-to-net, understanding your rebates, your chargebacks, the patient support program, every aspect of your program [is key]. If you don't understand the costs and everything that's cutting into your profitability, it’s kind of hard to maximize your programs, to make sure that you're actually achieving the optimal profitability that you can. That's my first piece of advice. Also, understanding your segment mix, your payer mix, that is a huge component of your first event. Understanding what percentage of your population is coming from 340B and coming from commercial payers.

“Ensuring that the patients who are in your programs are not leaking out [is also important] … What components do you need to put into your program to ensure that the revenue’s coming in, that you're supporting them, that you have things that are keeping people on therapy, as well as matching up with the cost piece that's actually pulling away some of your revenue? It's looking at it as a top-line and then a bottom-line sort of approach, and looking at all the different drivers that can impact the profitability of the drugs.”

When pulling key thoughts from this presentation, Bell urged the audience to keep in mind that these insights are all from a leadership perspective; the ideas should be adjusted to suit one’s particular situation.

“I hope you can come out of this session understanding how leadership is looking at it and what they're thinking about, which might help you,” she said. “Adapt your approach, because the way as a leader looks at it today is not the same as we looked at it five or 10 years ago. I think really understanding that is important.”

Reference

1. Ocilka I, Bell N, Neff S, Ashmon S. Leaders Council Insight—Unravelling the Complexities of Patient Access and Affordability. March 18, 2025. Access USA (general session). Philadelphia.