Gerard reframes patient affordability as a clinical issue rather than a purely financial one. He argues that real-time precision, earlier intervention, and coordinated escalation can reduce gross-to-net failures and improve the patient experience.
To learn more about RIS Rx’s approach, request a RIS Rx savings snapshot.
Read on for Gerard’s insights.
The Key to a Better Patient Experience: Improved GTN
By Gerard Rivera, CEO and Co-Founder, RIS Rx
I saw it so often while working as a frontline pharmacist with my co-founder Stephen Hom.
Disruption shows up as interrupted care, delayed starts, and treatment plans that never get off the ground. And despite manufacturers’ efforts with patient affordability programs, unfortunately, billions of those dollars never reach the patients they were meant to support.
That’s why affordability must be understood as a clinical issue, not just a financial one.
How GTN Failures Do Harm
Manufacturers experience GTN challenges as revenue leakage caused by accumulators, maximizers, variable benefit designs and third parties.
Patients experience the same failures differently, usually as confusion, delays, and unexpected out-of-pocket costs.
Common disruption points include:
- A copay card that works on the first fill, then suddenly does not
- A pharmacy pickup that turns into a phone call, then another, then a delay
- A patient being told to contact a third party they’ve never heard of
- Coverage that technically exists but can’t be accessed when it matters most
These aren’t edge cases. They’re patient experience failures. They’re the moments patients remember. They’re also the moments manufacturers often don’t see until it’s too late.
The “Oh No! Moment” for Manufacturers
At some point, many manufacturers have what we call an “oh no! moment.”
It shows up quietly. Call volumes start creeping up. Adherence drops without a clear explanation. Providers complain that access feels too hard.
Someone finally asks the uncomfortable question: are patients actually getting the help we think they are?
That realization can be unsettling, especially if everything looks right from a bird’s eye view. Programs are in place. Vendors are doing what they’re “supposed” to do. And yet patients are dropping off therapy and showing signs of confusion.
That is when patient experience stops being a concept and becomes the most critical signal.
Why Real-Time Precision Is Key for Preventing Clinical Failures—Prior to First Fill
The warning signs of patient disruption are often obvious early in the journey. Coverage complexity, benefit design friction, accumulator and maximizer exposure: these signals appear at enrollment, before a prescription is ever filled.
But identifying risk only at first fill or later does little to restore continuity of care or recover lost copay assistance.
By then, the patient has already disengaged. The therapy has already stalled. The revenue has already leaked.
Here’s why proactive, real-time activation at enrollment consistently outperforms after-the-fact analysis:
- Accuracy when it matters most. Detect and resolve risk before it reaches the patient.
- Reduced noise. Real-time precision limits misclassification, unnecessary escalations, and downstream confusion.
- Operational efficiency. Cleaner workflows and lower call volumes ease strain across hubs, pharmacies, and support teams.
- Better outcomes. Timely intervention protects adherence, patient trust, and program economics—simultaneously.
Real-time precision isn't just about speed and accuracy.
It’s about avoiding preventable breakdowns.
Escalation Is the Moment of Truth in Patient Experience
Even when identification is accurate and real-time, outcomes depend on what happens next.
Good patient experience management is about having a clear, repeatable way to step in when something goes wrong. Calm escalation. Clear guidance. The right handoffs at the right time.
In practice, that means:
- Coordinated action: Working in sync with existing hub and copay partners to avoid duplication or dead ends.
- Simplified communication: Clear, focused guidance that reduces confusion instead of adding noise during a critical moment.
- Intentional escalation timing: Knowing when to intervene, when to hand off, and when to follow up to keep care moving forward.
- Care-first escalation mindset: Treating escalation as part of care delivery, not just a customer service function.
Escalation grounded in pharmacy expertise changes the tone of these moments. Patients feel supported. Providers regain confidence. Potential abandonment turns into continuity.
Aligning Patient Outcomes and GTN Performance
There is still a belief that patient experience and GTN performance pull in different directions. In reality, they move together.
When affordability programs work the way they’re meant to:
- Patients stay on therapy
- Providers spend less time troubleshooting access
- Manufacturers see stronger and more predictable performance
The same system failures that drive GTN leakage are the ones that disrupt care. Addressing one without the other leaves both value and patients behind.
Get Your Savings Snapshot
Manufacturers can’t fix what they can’t see. Too often, patient disruption only becomes visible after the damage is done.
That is why we created the RIS Rx Savings Snapshot. It’s a quick, shareable diagnostic that shows where your affordability programs may be breaking down.
Find new opportunities to optimize GTN. Click here to request your savings snapshot.
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