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How to optimize prescription coverage at the counter

Guide for Life Sciences Companies

Learn how Life Sciences companies can deliver a responsive consumer experience.

Learn how PHIL delivered seamless adoption of a novel PDT Therapy

How PHIL Delivered High Adoption and Payer Awareness for a novel Ophthalmology Brand Launch.

Providing end-to-end visibility into the prescription life cycle, we unlock coverage and maximize reimbursement for brands while integrating into the lives and workflows of patients and providers.

Phil unlocked access and coverage to enable a successful launch for a novel migraine therapy.

Learn how Phil unlocked payer coverage for 90% of this women's health brands's dispenses with formulary placement transforming their brand trajectory

Editor’s Note: As the cost to bring a drug to market reaches all-time highs and expected returns sink in the life sciences industry, manufacturers commercializing innovative therapies must shake off traditional strategies that are waning in their effectiveness. Gone are the days where clinical differentiation, media buys, and a large sales force is enough to ensure adoption and financial sustainability. In the era of specialty and steep utilization management requirements, an integrated commercial approach that places patient access as a first order priority is essential

Editor’s Note: While each innovative therapy is unique, all brands should make unlocking patient access a top priority. Yet, far too often patient access is relegated behind other commercial objectives like building a sales force or activating the highest possible number of patients. Both of which are necessary, but insufficient strategies for delivering commercial success in an environment where payer coverage has become increasingly hard to come by

Editor’s Note: Over the past two decades, the rise of novel technologies has disrupted industries and radically altered consumer behavior. While the digital transformation of the healthcare industry has historically lagged behind other more tech-forward sectors like entertainment and financial services, the pandemic accelerated its digitization. In return, patients now want and expect to receive a frictionless experience when it comes to accessing and managing their healthcare

Editor’s Note: As the prescription drug pricing policies from the Inflation Reduction Act become a market reality, manufacturers should be prepared. In addition to providing CMS with negotiating power, provisions in the bill will cap annual out of pocket cost expenditures for Medicare beneficiaries at $2,000 annually. The likely result is that additional actions will be taken by payers to shift more financial responsibility to manufacturers in the form of rebates

Pharmacies can significantly impact pharmaceutical manufacturers’ commercial success as crucial players in the prescription fulfillment process. In addition to playing an essential role in the supply chain, pharmacies are the only consumer-facing entities. An ineffective distribution network can diminish a brand’s reputation, patient and provider satisfaction, health outcomes, and gross to net

Editor’s Note: As the Biotech industry faces unprecedented levels of uncertainty in the midst of a trying macroeconomic environment, it’s more critical than ever for commercial stage innovators to deploy effective go-to-market strategies that generate sustainable brand growth. Sustainable growth strategies are those that maximize adoption (amongst patients & HCPs) while also protecting gross-to-net by avoiding free good overutilization. Such strategies can extend cash runways, provide a positive story for investors, and can even position biotechs for a successful acquisition

As life science companies continue to invest in and launch specialty and specialty-lite medications to help patients manage chronic - and sometimes debilitating or life threatening - conditions, they are tasked with developing patient support services programs to help patients access and stay on these therapies. Unfortunately, a poorly utilized program can undermine clinical efficacy and often hinders a brand’s commercial success. Despite pouring $5 billion each year into patient support programs, pharmaceutical manufacturers only get an estimated 3 percent of eligible patients to enroll and use their programs

Editor’s Note: With the lion’s share of R&D investment in the pharmaceutical industry flowing into specialty medications that command high list prices, insurers continue to search for new avenues to reign in prescription drug spending. Aside from enacting utilization requirements that often contribute to significant barriers to patient access, many payers are exploring value-based contracts with life sciences manufacturers that pay based on the positive health outcomes that therapies deliver for patients. The logic is that manufacturers should not pay for therapies that are not efficacious for an individual's health

Strong market access, the ability of a pharmaceutical manufacturer to secure reimbursement and coverage for their products from payers and other decision-makers, does not always translate to covered dispenses at the pharmacy level – particularly for specialty and specialty-lite therapies. Manufacturers must also navigate a complex prescription fulfillment and payer utilization management landscape to overcome barriers to patient access. Here are the three biggest reasons why good market access does not guarantee coverage and what commercialization teams can do to overcome this challenge

Editor’s Note: While there is a patient-centric intent to many prior authorization (PA) practices, they often create a significant operational burden for healthcare providers and disrupt the patient experience. Today, most branded medications witness low HCP PA submission rates which in turn result in high rates of prescription abandonment and manufacturer patient assistance overutilization. Both have negative consequences for pharmaceutical brands that are most commonly felt in the form of reduced brand loyalty and gross to net (GTN)

Editor’s Note: Even casual observers of drug pricing reform would be apt to conclude that change is in the air and more disruptions to standard drug pricing practices are inevitable. As price takers, drug manufacturers are keenly aware that in today’s complex drug channel, even small policy changes can generate ripple effects that impact all stakeholders. With the Inflation Reduction Act of 2022 representing the most significant federal drug pricing legislation in decades and various other measures in play, manufacturers can be sure that tomorrow won’t look like today when it comes to drug pricing policies

Editor’s Note: Innovative therapies that promise to improve the quality of life and/or slow disease state progression for individuals with complex health conditions like ALS remain out of reach for many due to the cost of therapy. While many point the finger at pharmaceutical companies for setting list prices that by all appearances are astronomically high, the cost to bring an innovative therapy to market has never been higher and is complicated even further when the target patient population is small. The bottom line is that all stakeholders can agree that financial barriers shouldn’t prevent patients that can significantly benefit from a life altering therapy from accessing it

Editor's Note: With the increasing prevalence of expensive, branded specialty medications for complex health conditions, drug pricing remains a hot issue in the healthcare industry. Industry stakeholders and the public at large continue to point their fingers at drug manufacturers for the practice reported ON in this article - inflating list prices year over year. What they fail to consider is that drug manufacturers lack substantial pricing power in the drug channel with middlemen extracting more significant concessions year over year that erode manufacturer net revenue

More recently though, as life science companies strive to ensure improved access to their therapies and reduce operational costs, they are turning to disruptive technology platforms that offer the potential to break through barriers to medication. Unfortunately, some companies are still wrapped up in the old paradigm and spend millions of dollars on patient access solutions but get little in return. Here are four ways a technology-driven patient services solution can enable life science companies to achieve more in 2023: Automating workflows From the point of prescribing to driving therapy adherence, automated processes reduce friction across the patient’s medication journey

Editor's Note: The current economic environment has disrupted the playing field for venture backed organizations throughout the life sciences industry. Biopharma companies that were optimistic about their ability to raise capital from investors to fund growth are now responding to a tighter capital environment with defensive financial decisions in hopes of extending their survival. While the maturity of a biopharma’s pipeline will ultimately inform their business strategies, those with late stage pipeline molecules or in-market therapies would be wise to prioritize charting the quickest path to sustainable growth and profitability

SAN FRANCISCO--(BUSINESS WIRE)--Today, Phil Inc., a patient access platform company that revolutionizes life science product commercialization, announced that Duchesnay USA’s Bonjesta® (doxylamine succinate and pyridoxine hydrochloride), a prescription medicine used to treat nausea and vomiting of pregnancy in women who have not improved with change in diet or other non-medicine treatments, is now available to be prescribed via its patient access platform. It is not known if Bonjesta® is safe and effective in women with severe nausea and vomiting of pregnancy, a condition called hyperemesis gravidarum. The most common side effect of Bonjesta® is drowsiness.Phil’s customizable platform helps patients receive and refill medicines quickly, easily and affordably while giving life science companies unprecedented end-to-end visibility into the prescription life cycle

The pharmaceutical industry is one of the most highly regulated industries in the United States. Despite many legal and regulatory obstacles, the U.S. has led the world in the number of new chemical and biological entity launches since the year 2000

Editor’s Note: Digital therapeutics and other digital health technologies have significantly picked up steam in recent years as the entire healthcare ecosystem has raced to meet evolving patient demand to meet them where they are at - in their smartphones. While these technologies and platforms are a new frontier for patients, doctors, and the pharmaceutical industry, many have shown promising results at improving lives and providing additional value to key stakeholders. However, like their pharmacological counterparts, these technologies face issues of access, affordability, and adherence that often prevent patients from using them as prescribed

Editor's Note: The landmark Inflation Reduction Act has caused waves in the life sciences community as it represents the most significant piece of federal drug pricing legislation passed in decades. Key provisions outlined in the law limit drug manufacturers’ ability to raise branded list prices at rates faster than inflation and cap Medicare beneficiary out of pocket spending at $2,000 annually. The consensus among industry analysts and executives is that these measures will result in higher payer utilization management requirements, formulary rebates, and manufacturer subsidies resulting in decreased net revenue

For life science companies, patient support services have become as vital to a brand’s success as efficacy and price. A patient support services program has the potential to help break through barriers to medication access. That’s why it’s crucial to make sure it aligns with your business goals and delivers on your brand objectives while helping patients access their therapy as easily as possible

Downward pressure on net sales is an ongoing problem for pharmaceutical and life sciences companies. It’s crucial to understand the gross-to-net (GNT) challenges that manufacturers are facing and how they can leverage their distribution strategies to optimize GTN. Understanding the challenges surrounding GTN Numerous factors impact a life science company’s GTN, which is the difference between the wholesaler acquisition cost (WAC) – also known as the drug’s list price – and the manufacturer’s net sales

Editor's Note: The consensus amongst healthcare industry experts is that the COVID-19 pandemic accelerated the shift to a more digital and consumer centric healthcare environment. With the shift underway and investment in healthcare technologies booming, many tout this as a silver lining of the pandemic. Despite this well found optimism, rapid technological change always unleashes unintended consequences

Though 2022 has been a down year for the biotechnology sector, notable decisions from the Food and Drug Administration have provided a few bright spots. Two gene therapies came to market, providing a lift for a field that’s been slowed by recent setbacks. The cancer drug Enhertu was approved for a newly defined tumor type known as “HER2-low.” The regulator also cleared a new medicine for ALS and a first-of-its-kind inflammatory disease drug

The seismic changes in consumer behavior and expectations brought on by mobile devices and cloud computing seem to have happened overnight, but they’ve been years in the making. The popularity of user-friendly services offered by the likes of Amazon, Uber, and Apple Pay has driven innovation and disruption across industries. The COVID-19 pandemic further accelerated the shift to digital tools, especially in healthcare

SAN FRANCISCO, Calif. – November 7, 2022 – Today,  Phil Inc., a patient access platform company that revolutionizes life science product commercialization, announced its technology solution now offers expanded functionality for companies developing prescription digital therapeutics (PDTs). Using Phil’s platform, digital health companies can simplify the healthcare journey for patients with their prescription, manage both pharmacy and medical benefits processes and improve access to prescriptions

“Patient access begins at the moment that a drug is prescribed and encompasses everything that goes with getting a drug into a patient’s hand.” said Len Paolillo, CCO of Impel Pharmaceuticals, during last Thursday’s webinar focused on how the right technology can meaningfully improve the chances a therapy will actually be taken as prescribed. As the life sciences industry faces strong access headwinds in 2022 due to evolving consumer expectations and stricter payer utilization management requirements, the conversation was timely and important. Mr

SAN FRANCISCO, Calif. – October 25, 2022 – Phil Inc., a patient access platform company that revolutionizes life science product commercialization with technology to improve patient prescription access, today announced an exclusive partnership with Syneos Health® (Nasdaq:SYNH), the only fully integrated biopharmaceutical solutions organization. Through the strategic partnership, Phil will serve as Syneos Health’s hub partner, creating an end-to-end commercialization solution for life sciences organizations to ensure patients can seamlessly start and adhere to therapy and receive and refill medicines quickly, easily and affordably

Many patients struggle to navigate healthcare effectively, inhibiting access to prescribed therapies. Patrick Leary, Chief Commercial Officer at Phil, shares how technology can break down many of the barriers patients experience, enabling them to better afford and adhere to their medications. Q: What are the most significant challenges patients face today when affording the medications their providers prescribe

Editor's Note: In 2022, Biotechs face a challenging macroeconomic environment that has limited their access to growth capital supplied by investors. As many biotechs have leveraged investor capital to fuel growth, the drying up of available funding will have a material impact on their commercial operations. Biotechs with weaker cash positions will face more pressure to carefully evaluate spend and look for more sustainable growth pathways

Launching a successful pharmaceutical brand is no easy task. It takes significant stakeholder alignment across many strategic fronts to successfully transition from FDA approval to product adoption and growth. And even with a sizable base and formulary placement, it doesn’t necessarily follow that a brand will overcome the “Coverage Hurdle'' that requires a brand to jump through hoops to convert market access to a high % of covered dispenses

Channel strategy underpins the deployment of a life science company’s overall commercialization strategy. A company’s channel strategy is the tie that binds the market access, patient access, marketing, trade, and sales strategies to meet brand goals effectively. Ideally, it tightly integrates the processes for managing the logistics of getting products from the manufacturer to patients, implementing services to support patient access and medication adherence, and capturing channel data to measure success and inform decision-making

One of the most significant burdens on the U.S. healthcare system is nonadherence to drug therapy. Not only does this issue exact a severe toll on patients’ health and quality of life, but the related healthcare costs are also staggering

What matters most for life sciences companies is not the amount of data but knowing how to use it. A Forrester report revealed that data-driven companies experience an annual average growth rate of over 30%. Pharma companies that invest in capabilities to capture and analyze the best data to make informed commercialization decisions will realize better business outcomes and a competitive advantage

Developing a new drug is an incredibly costly, time-consuming, and high-risk venture. In the 21st century, it typically takes ten years and over $2.6 billion for a pharmaceutical manufacturer to move a drug from its initial discovery into the marketplace. While getting an innovative treatment approved for patient use is a major milestone, it’s just the beginning and certainly does not ensure the brand’s commercial success

The primary objective of a drug distribution model is to ensure patients receive the medications they need when they need them. A manufacturer’s strategy for getting their product from manufacturer to patient – effectively and efficiently – is crucial to the success of a therapy. The complexity of the distribution process has been exacerbated as a result of the pandemic

In this on-demand webinar, Patrick Leary, Phil’s Chief Commercial Officer, discusses challenges pharmaceutical brands are facing and how a well-thought-out channel strategy is essential to these key success factors: - Speed-to-therapy - Payer Coverage (Approvals of Rx) - Pull-through to First Fill - Adherence to Therapy - Reimbursement A fragmented commercialization strategy poses significant risks to brand growth and threatens things like the patient and prescriber experience, rates of prescription coverage and pull through, medication adherence, and ultimately, profit margins and commercial success. In this webinar, you’ll learn some of the market factors impacting channel strategy, such as payer cost control measures, out-of-pocket costs, and patient consumerization, along with seven important channel strategy considerations and eight components of channel partner evaluation. You will also see a case study on one brand’s successful launch where they exceeded their commercial and access targets with: A 95% enrollment rate 50% of Trx covered in the first month 3x average adherence vs other channels 4x + net sales vs other channels

Due to its highly regulated, high-risk environment, the pharmaceutical industry has traditionally been slow to adopt new technologies. A conservative approach to technology implementation means that pharma companies may be missing out on the advantages digital technologies offer and have lagged behind other industries in creating rich customer experiences; however, the Covid-19 pandemic significantly accelerated digital transformation throughout the industry. The latest healthcare technologies promise to transform the development and delivery of innovative pharmaceutical therapies and elevate the experience for patients and providers

Migraine is a neurological disorder that affects approximately 1 in 6 Americans and leads to over 1 million emergency department visits in the US annually. Just like many neurological conditions, the treatment landscape of triptans, opioids and NSAIDs has fallen short of providing a sustainable solution for migraine patients with drugs that have subpar efficacy and intolerable side-effects. The condition has been difficult to study and characterize due to varying levels of severity, causes and symptoms and traditional therapies have not specifically addressed the disease pathology of migraines

A recent survey by Boston Consulting Group, exploring what patients want from pharma companies and how well companies are meeting those needs, revealed a deficiency in patient engagement. The growing demand for improved and more efficient communication between patients and healthcare entities has created an opportunity for pharmaceutical manufacturers to promote patient engagement through digital tools. However, three common myths may be holding them back

What commercialization strategies should life sciences companies focus on as they look ahead. It’s crucial to monitor trends closely to navigate the evolving healthcare landscape better and build winning strategies. Here are the top six healthcare trends affecting pharma commercialization today: 1

The pharmaceutical industry generates immense volumes of data, so it would make sense that pharma companies are ahead of the curve by leveraging the latest technologies to transform their operations across the value chain. However, historically, the pharmaceutical sector has been slow to embrace digital technologies. In a highly regulated, high-risk environment, it is no surprise that pharma companies tend to be risk averse

Catherine Hill Catherine Hill is the Vice President of Marketing at Phil. She joined the company at a pivotal time of growth. In this article Catherine shares what attracted her to Phil as a healthcare outsider and how her personal connection to healthcare drew her to the mission to get patients on life saving therapies

Commercial launch is an expensive and risky endeavor, especially for small life science companies. According to a recent report, about half of all the drugs launched in the last fifteen years underperformed market expectations by more than 20%. In fact, over half failed to reach $250 million in peak U.S

Experts have called for major reform to the existing prior authorization processes with suggestions such as:  Streamlining of administrative steps Tighter turnaround times for prescription authorization Widespread automation and digitization of processes  Integration of health and administrative systems Nationwide coverage    The lack of standardization among current approval processes are resulting in treatment delays, poor patient and physician experiences, low adherence rates, script abandonment, and in many cases, increased healthcare spending as disease progression worsens. Below are some examples that illustrate the burden of prior authorizations within specific therapeutic areas. Cardiology The cardiovascular treatment landscape significantly expanded in 2015 with a new game-changing class of drugs, PCSK9 inhibitors, which are intended to manage cholesterol-related cardiovascular disease

One of the most important considerations for any pharmaceutical manufacturer is determining the internal capabilities and capital needed to support drug commercialization. The reality is that small- and medium-sized life sciences companies lack the resources to match the commercialization strategies of big pharma. Fortunately, today, there are opportunities for small pharmaceutical companies to execute a go-to-market strategy through outsourcing

Drug formularies are a driving force for patient access to prescribed medication. A pharmaceutical brand’s inclusion and positioning on drug formularies are often reflective of the market access strategy’s level of success. To remain competitive, pharma manufacturers must understand how formulary management and the influence of payers are evolving and take steps to optimize market access

According to the National Diabetes Statistics Report from the CDC, around 37.3 million people have diabetes in the US, while 96 million have prediabetes. Type 2 diabetes remains the most prevalent in the US (90-95% of diagnosis), while both subtypes represent chronic illnesses that require rigorous self management of therapies for effective disease control. The increased prevalence of diabetes over the last 20 years unleashed a multibillion dollar pharmaceutical market that has pushed drug developers to aggressively pursue life-saving treatments for both type 1 and type 2 diabetes

The traditional route to pharmaceutical market access focuses on successful clinical trials and meeting regulators' safety and efficacy data requirements. In the past, this same data was sufficient for payers to determine that the drug was worth covering at the price point set by the manufacturer. But times have changed

Antiviral drug approvals over the last decade have been dominated by drugs aimed at treating Hepatitis C (HCV) and human immunodeficiency virus (HIV). An estimated 2.4 million to 4.7 million people are living with HCV in the US, while about 1.2 million people in the US live with HIV. While these are both huge markets that continue to attract big pharma development efforts, the competitive landscape has become multi-layered and complex with long-standing therapies being evaluated alongside newly approved combinations

Specialty drugs comprise a growing share of the pharmaceutical market. According to an industry report by Drug Channels, total prescription revenues surpassed $500 billion in 2021, with specialty drugs accounting for almost 40 percent of outpatient prescription revenues and an even larger share of payers’ net prescription costs. Over the next five years, these therapies are projected to account for at least half of all revenue generated by the pharmacy industry

There was a time when the path from a physician prescribing to the patient starting drug therapy was straightforward. With the rise of value-based healthcare and novel specialty treatments, that’s no longer the case. Today, rigorous payer requirements and increasing out-of-pocket obligations frequently hinder patient access

Is a pharmaceutical hub the best solution for commercializing your therapies. For well over a decade, pharmaceutical hub services have played a pivotal role in supporting patient access to life-saving and life-altering advanced drug therapies. Unfortunately, hubs tend to be a partner with low customer satisfaction rates and lower than ideal coverage and adherence

Mid-cycle specialty products often face challenges when it comes to reaching patients several years after launch. Case Study: Women’s Health Product Phil was able to assist our client with turning around a tumultuous post-approval journey. Reimbursement challenges led to poor uptake and the pharma manufacturer brought on a telemedicine company to help with the prescribing and authorization process

Deepak Thomas is the founder and CEO of Phil. He started the company as patient zero after being diagnosed with a chronic illness in the late 90s and struggled to navigate his own care within the complex US healthcare system. Several years later, he applied his experience in tech to build a solution that expands and simplifies patient access to specialty drugs, while aligning economic incentives for therapy manufacturers