Breaking Point: How 2025 Will Reshape Patient Support Services

Chris Dowd

2024 was a pivotal year for the patient support landscape, as the space underwent a substantial shift shaped by market dynamics, regulatory changes, and the evolving needs of patients.

After a quarter marked by intense discussions at industry conferences and candid conversations with pharmaceutical leaders grappling with unprecedented change, one thing is clear: 2025 will fundamentally transform how drugs are covered, paid for, and filled in America.

Here are five predictions for how the landscape will shift in the year ahead:

1. The dramatic IRA rollback

By mid-2025, we'll witness the most significant healthcare policy battle since the Affordable Care Act. The Republican-controlled Senate, pursuing Trump administration priorities, is likely to substantially challenge key Inflation Reduction Act (IRA) provisions, particularly around drug price negotiations. While the slim Senate and House majorities could make it difficult to institute a full repeal of the IRA, parts of it are vulnerable.

As North Star Opinion Research Vice President Jon McHenry noted in a recent panel discussion, Republicans will likely use unspent IRA funds to help offset the continuation of Trump-era tax cuts expiring in late 2025. However, the $2,000 out-of-pocket cap for Medicare beneficiaries will likely survive, creating an interesting dynamic where manufacturers must navigate a hybrid policy landscape.

To stay ahead of the IRA roller coaster in the coming year, stakeholders in the patient support ecosystem—from providers to hub and patient services teams—need to work overtime to understand the evolving nuances of what’s changing and communicate it effectively. A PDR survey of US healthcare providers (HCPs) reveals that 38% of providers “know nothing” about the pharmaceutical provisions in the IRA, while an additional 55% only know “a little.” This highlights myriad opportunities for pharma manufacturers to also provide welcome education to HCPs about changes in access to their branded drugs.

2. The rise of matrix support programs

The death of the dominance and attention on “traditional” copay programs, the surge in prevalence of accumulator adjustment and maximizer programs, and the continued usage of alternative funding programs will force a complete reimagining of manufacturer support. By Q3 2025, we'll see the emergence of matrix support programs that combine product access, procedure coverage, treatment-journey assistance, and patient success programs in entirely new ways.

Buy-and-bill programs already account for half of specialty product assistance. With the gross-to-net (GTN) pressure on brands to do more with less, including the evolution of copay affordability programs over the last five years, these matrix support programs will only continue to grow in necessity. High-end specialty medications are a prime example: In the same way biologics took the market by storm over the last seven to 10 years despite initial skepticism, cell and gene therapy pipelines and approvals are continuing to escalate—and programs supporting their adoption and adherence will be key.

As the market shifts from traditional copay programs to more sophisticated matrix programs, pharma brands need to seek out best-in-class support options to serve patients. They should consider establishing working groups in their organizations to meet with their field reimbursement managers as well as marketing and managed care teams to stay on top of what patients and providers are expecting (and demanding) in order to build programs that raise the bar.

3. The PBM revolution

Pharmacy benefit managers (PBMs) currently “don’t have any friends in Washington,” as McHenry noted in the recent panel. Pressure on PBMs by both federal and state governments in the form of anti-PBM legislation is unprecedented, and, considering RFK Jr.’s reformist views and the power he could wield, their influence will likely wane in the coming year.

With that in mind, the bipartisan "Patient Before Monopolies Act" will pass in 2025, fundamentally restructuring the PBM industry. As Sens. Elizabeth Warren and Josh Hawley's unlikely alliance pushes the legislation forward, we'll see initial steps to dismantle vertical integration between insurers, PBMs, and pharmacies. This will create immediate market disruption but ultimately lead to more transparent drug pricing models by year's end.

Staying on top of these developments is paramount. Whether through internal or external resources, manufacturers should remain in ongoing contact with state government relations teams to understand how legislation is evolving and how they can react.

4. The rise of ‘anti-abandonment’ programs

Even with a mature patient services model, fewer than half of specialty patients make it through payer controls to fill their prescriptions at 90 days, according to the IQVIA Institute.

With new-to-brand abandonment rates hitting 35% to 40% and the industry losing billions in potential revenue, 2025 will see manufacturers pivot away from traditional adherence programs, toward sophisticated early-intervention models. These programs will leverage predictive analytics to identify at-risk patients before they abandon therapy, combining financial support, behavioral interventions, and digital engagement in novel ways. This shift is particularly crucial as the industry grapples with expanding formulary exclusion lists from major PBMs such as CVS Caremark, Express Scripts, and OptumRx.

Leveraging patient data and AI-driven targeting models can help brands build effective anti-abandonment programs. By scoring key demographic information such as age, drug class, prior experiences, and previous adherence (or lack thereof), early-intervention algorithms can help determine the likelihood of abandonment. From there, brand teams can build tailored programs to improve adherence.

5.The impact of GLP-1 prescriptions

In 2025, GLP-1 agonists will face unprecedented restrictions and rejection rates from payers due to cost, demand, and indication alignment (e.g., trends that include moves by Kaiser, Independence Blue Cross, and Blue Cross Blue Shield of Michigan). While Medicare may expand coverage under the new administration, commercial payers will simultaneously implement a new generation of sophisticated access barriers that go far beyond traditional prior authorization—requiring documented participation in behavioral health programs, mandatory step therapy through lower-cost alternatives, and possibly even time-limited authorizations tied to demonstrable outcomes. And to further complicate the long-term GLP-1 reimbursement landscape, the US Department of Health and Human Services has announced that Ozempic, Rybelsus, and Wegovy will be included in the 2025 round of Medicare drug price negotiations, with adjusted prices becoming effective in 2027. Taken together, these multiple challenges will push pharmaceutical manufacturers to repeatedly reimagine GLP-1 access and support.

Learning from oncology's experience with advanced patient support programs that integrate financial, clinical, and behavioral support, we will see companies move away from traditional copay assistance toward more holistic “lifestyle support hubs” that combine financial assistance with digital coaching, behavioral modification tracking, and outcomes documentation. Traditional support models that “help with copays and prior authorization” will be enhanced by end-to-end patient success programs that help patients navigate increasingly complex payer requirements while supporting long-term therapy success. According to Kevin Herwig, health policy manager at the HIV + Hepatitis Policy Institute, we've already seen this evolution in HIV treatment support programs, where successful adherence increasingly depends on providing comprehensive social, behavioral, and financial support—GLP-1s will accelerate this trend dramatically across all chronic conditions.

The multiple disruptions looming this year will create a clear divide between brands that embrace these changes and those that maintain traditional commercial approaches. For brand leaders, the time to prepare is now, while there's still opportunity to gain first-mover advantage in their therapeutic areas. The future belongs to the bold.

About the Author

Chris Dowd, Senior Vice President, Market Development, at ConnectiveRx, is a new guest columnist for Pharmaceutical Commerce, covering the patient support space. With a nearly 30-year career spanning leadership roles across Big Pharma, healthcare startups, and patient support, Dowd is a preeminent industry voice in patient access and adherence.