Matt dives into a specific healthcare topic to help those in the industry, and those outside of it, better understand the market drivers causing today’s healthcare challenges.

That is the share of new specialty prescriptions the original payer rejected outright. IQVIA presented the data at the NASP 2025 Annual Meeting in Denver last October. The numbers track 2024 pharmacy claims for novel medicines launched in 2022 and 2023. Scott Biggs, who runs supplier services at IQVIA, said it from the stage. Over half of new prescriptions for novel medicines go unfilled. Only 29 percent of patients stay on therapy after one year.

Sit with that.

A doctor writes the script. The patient walks into the pharmacy. More than half the time, the answer is no. Of the patients who fight through and start, fewer than a third remain on therapy twelve months later.

So here is the question every commercial team should write at the top of the whiteboard this week. If most patients who try to start your product hear no at the counter, what did you actually launch?

IQVIA tracked the full path of those claims. The original payer rejected 52 percent. Thirteen percent eventually cleared through a different payer after the patient or provider ground through the process. Thirty-nine percent got rejected by every payer they touched. Among the claims that did win approval, another 17 percent of patients walked away before pickup. Net result: 44 percent of the original prescriptions reached the patient.

The tools doing the rejecting carry familiar names. Prior authorization. Step therapy. Coverage exclusions. Quantity limits. Administrative denials. None of these are edge cases. They are standard operating procedure for payers managing specialty spend.

For the patient, the data has a face. You get the diagnosis. You and your doctor pick the therapy. You show up ready. A clerk hands you a denial letter written by someone who never examined you. Now you appeal, or you give up. Thirty to fifty percent of patients give up on the first denial. The sickest patients face the heaviest friction, because their treatments cost the most.

The phrase patient centricity lives in every strategic plan, every investor deck, every town hall. It does not live in the IQVIA data.

Pharma built real infrastructure to help. Copay cards. Hub services. Patient support programs. Foundation grants. Bridge programs. Field reimbursement teams who sit with practices and help them fight denials on a patient's behalf. Every one of those tools matters to the person standing at the counter holding a rejection. Not one of them touches the decision that put the rejection in their hand.

Watch the conversation drift when an advocacy leader brings access data to a pharma partner. It slides toward copay enhancements. It slides toward financial assistance criteria. It slides toward hub workflow fixes. The problem sits upstream. The solutions aim downstream. That gap is the failure.

Most companies still treat advocacy as stakeholder management and access as a market access job. Patients fall through the seam between those two functions.

The best person for your next role might not live near your office — or even in the same country.

And more companies are realizing they don’t need to open entities everywhere just to hire great talent globally.

Instead, teams are using EOR to hire internationally faster, stay compliant, and avoid the operational headache of setting up local infrastructure before they’re ready.

That shift is changing how companies think about growth, hiring, and expansion altogether.

Oyster’s EOR helps companies hire, pay, and support employees in 180+ countries while Oyster handles payroll, compliance, taxes, and local employment requirements.

Talk to experts today

ELAVAY data shows the pattern across the companies we benchmark. The companies with the strongest advocacy organization relationships outperform on access. Measurably.

The difference shows up early. They seat patient advocacy at the commercial planning table before the launch strategy locks. Before formulary conversations harden. Before the payer narrative sets. Before the access barriers become the reality a patient lives with for the next decade of the product.

In practice, that means advocacy insight shapes payer communication strategy. Advocacy leaders see the formulary timelines. The advocacy function helps design the access plan, besides market access, with real authority and real budget. Advocacy organizations get briefed before the strategy ships, not after the denials start.

Advocacy earns that seat because the business depends on what it produces. Not because a values statement promised patient focus. The statement moves nothing. The structural integration moves the numbers.

The companies that skip the structural work keep polishing copay programs and wondering why access stays flat. They commission another patient journey study. They add another hub service. They run another advisory board. The numbers hold still because every tool they add sits downstream of the one decision that matters.

Ask three questions about your next launch.

Does the plan account for the 52 percent? Not the 44 percent who get through. The 52 percent were rejected on first contact. What does your strategy do for them, and when does it start?

Does your internal advocacy function carry enough weight to shape the access decisions that determine what happens at the counter? Or does advocacy get the briefing after the strategy locks?

Are your advocacy organization partners shaping access strategy, or receiving a finished plan with a request to endorse it?

The honest answers usually sting. Good. The companies winning on access answer these differently than the companies stuck on it.

Access is the front door. Persistence is the house. If 52 percent never get through the door, the 29 percent who stay on therapy a year later were never the ceiling. It was the leftover.

The ELAVAY 2026 report shows where your company stands with the advocacy organizations doing this work every day. The Advocacy Influence Diagnostic measures whether your internal advocacy function carries the weight to shape what happens before the counter.

For ELAVAY 2026 report insights, email [email protected].

To understand if your advocacy function is being utilized to the extent that it should be within your organization and gets the level of respect it should, take the Advocacy Influence Diagnostic. For more, and to take the assessment, go to aid.ELAVAY.com.