The 4 Cs, Part Zero: Why Patient Support Starts Here

Coverage, Cost, Care, Compliance... Don't skip strategy and rush into solutions

Boston hit the Bala Boys HARD with a nasty strain of influenza, so my content creation calendar has gone off the rails. Many thanks for your patience!

Speaking of infectious disease....

It's okay, you don't have to groan, because I just did for you.

Back in 2020, everything changed.

Understate much?

Today, I'm going to focus on only one small sliver of the universe impacted by COVID: Patient access to medicines.

And even then, it's going to be a sliver of a sliver.

Sales reps were grounded. Office doors were shut. No more hallway chats, no more detail time. Scripts always mattered, but now each and every one held a different weight, commercially speaking.

Patient Access (once an afterthought tucked behind the brand plan) started getting real airtime in Commercial.

Hello, Access, you sexy beast.

How YOU doin'?

Fast forward five years (yes, it's been five; I first wrote "four" and then corrected myself). Market Access and Patient Support are having a long-overdue moment. But we're still getting in our own way. Because too many conversations start with execution and skip right past strategy.

Everyone wants to jump to how.

• Which hub vendor is best?

• Should we add nurse educators?

• What does a "modern" copay program look like?

• Can you look at our FRM job descriptions?

And I get it. This is the fun part. I genuinely love this work. Clients hire me to either build Patient Support programs from scratch (strategy, design, vendor selection, and team onboarding) or optimize existing programs. We go under the hood and look for gaps, redundancies, inefficiencies, or overlooked needs.

But I can't solve for how until we're clear on why.

As I mentioned in my recent LinkedIn post, I pepper clients and prospects with questions. Not to be annoying (sorry!) but because I want to get to the root of what they're actually trying to solve.

Over the past few years, I've been codifying that upstream diagnostic thinking into something simple, memorable, and practical, because, hello?!? I gotta think about my kid's college fund.

And here's where I've landed:

The 4 Cs of Patient Support Strategy

Most Patient Support challenges boil down to one or more of the following:

Coverage: prior authorization, payer denials, bridge program delays, portal fatigue.

Cost: Copay, deductibles, OOP burden, Medicare coverage gaps.

Care: Route of administration, site of care, self-injection support.

Compliance: Adherence risk, refill reminders, plateau vs. cure, confidence gaps.

(I almost swapped Affordability for Cost, and Adherence for Compliance just so I could use the acronym CACA. I still might. I mean, my Substack's named The POOP fer cryin' out loud. 💩)

What's Getting Overlooked

Manufacturers are investing heavily in Coverage and Cost. Hubs, FRMs, ePAs, Patient portals, copay assistance, and QuickStart are where the budget lives, and sometimes where brand margins lurk. That's where the requests land in my inbox.

And Care and Compliance are overlooked.

They get outsourced to Patient Marketing. Or buried in the channel strategy deck. Or completely deprioritized.

That's a mistake.

Unless this is a one-and-done treatment, you want TotalRx > NewRx, right?
Patients need to be able to follow their Prescribers’ direction.

Because when you ignore the real-life treatment burden or skip the emotional lift required to get someone to believe in their new therapy, you've lost them before they've even started.

I think in many ways, often in response to corporate integrity agreements (CIAs), Access has overcorrected with Patient Support. Let me be clear: I see the line in the sand. I'm not suggesting that Patient Support cross over into promotional activity. But once the decision to treat has been made, I think there is more that Manufacturers can do to enable Patients to start *and stay* on therapy.

Don't Skip the Why

Every vendor RFP, every program redesign, every "can you look at this?" moment should be anchored in a real understanding of the problem you're solving.

Not the tactical deliverable.

So before you build anything, ask:

Which of the 4 Cs are we addressing?

And are we ignoring one that could tank everything else?

Over the next week or so, I’ll take a closer look at each of the 4 Cs, starting with Coverage, and more specifically, what the latest noise around prior authorization reform and Medicaid funding cuts (hi, Big Beautiful Bill) means for Patient Support teams trying to do the right thing with shrinking tools and tighter constraints.

Stay tuned. And stay healthy. This flu is no joke.