Peter explains that growing pressure on drug pricing is exposing structural inefficiencies in gross-to-net (GTN) across traditional distribution channels. He argues that single-channel ecosystems can better coordinate affordability, coverage, and dispensing, improving both patient outcomes and brand performance.
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Read on for Peter’s insights.
Protecting Gross-to-Net Performance Through Single-Channel Ecosystems
By Peter Darch, SVP, Strategy and Operations, PHIL Inc.
Legacy distribution models, including retail and specialty pharmacies, provide little control over or visibility into how patients experience their brand. In these channels, coverage workflows cannot run in parallel with dispensing, often forcing manufacturers to choose between timely, affordable access for patients and gross-to-net discipline for the brand. More recently, the rise of DTP 1.0 models has improved the intake experience. However, these models tend to lack the coverage-optimizing workflows and end-to-end business rules embedded directly into the platform to effectively balance optimal access pathways with strong commercial performance.
The manufacturers who will successfully protect brand economics in the current landscape are those who recognize that GTN discipline is a channel architecture opportunity, and build towards a model designed to solve this end-to-end: single-channel ecosystems.
Why Single-Channel Ecosystems Support Gross-to-Net Discipline
A single-channel ecosystem, where multiple intake pathways seamlessly flow into an integrated dispense network that offers wholesale capabilities, built-in support, cash-pay and coverage workflows, and pre-determined business rule adherence, to execute one seamless prescription experience. This approach resolves the traditional disjointed and misaligned system often found in traditional channels, both operationally and strategically, by reducing common friction points that often create tension between commercial sustainability and patient access. With a single-channel approach, manufacturers do not choose between timely access and GTN discipline, because the system can pursue both simultaneously to find the right balance between supporting new patient time to therapy and lower out-of-pocket via pursuit of coverage. Additionally, the significant patient experience benefit is an integral component of the compounding economic impact for brands.
In traditional channels, for every $25 increase in patient copay at the point of dispense, 11% of patients abandon at or before first fill (PHIL program data, 2026; varies by therapeutic area and condition). In a single-channel model, an affordable patient copay can be applied while a coverage workflow is initiated in parallel. When coverage is secured, subsequent fills transition into covered claims, protecting manufacturer’s commercial performance. When a prior authorization (PA) is denied or stalled, the system can continue pursuing coverage across refills, applying plan-specific logic and targeted appeals or formulary exceptions selectively on formularies with documented approval history, throughout the patient’s time on therapy. For patients, this removes delays to therapy while waiting for a coverage outcome, and provides transparent, affordable prices so they can start, and stay on, therapy. This single-channel experience creates a snowballing effect, improving patient starts and adherence, while driving covered dispenses, to maximize gross-to-net impact for manufacturers.
Real-World Examples: Quantifying the Commercial Impact of Single-Channel Ecosystems
Two examples from PHIL’s pharma programs illustrate the potential commercial impact that a single-channel ecosystem can deliver in practice for manufacturers.
A branded product launched with a $0 commercial copay for first fills with an immediate PA initiation after a short, defined turnaround time, with continual coverage workflows if denied. The program delivered more than 2x net revenue per new patient compared to retail, driven by approximately 7x first-fill conversion rates and significantly higher adherence.
A different product deployed layered logic that accounted for the payer, offering plan-stated copays within a defined affordability threshold, as well as automated tier exceptions, and structured cash pricing for uncovered patients. With this customized logic, the program delivered more than 1.5x net revenue per new patient, and over 2x total units dispensed vs. retail.
The Case for A Single-Channel Ecosystem
As list price reductions take effect and the gross-to-net bubble deflates, the economic impact of a traditional channel strategy while enduring a shrinking WAC grows increasingly difficult to maintain. Manufacturers who restructure their access architecture to a single-channel ecosystem will be best positioned to maintain gross-to-net performance and experience a multiplicative impact from increased patient starts and adherence.
PHIL's GTN calculator is a self-serve tool for pharma leaders looking to quantify what the commercial potential is of a single-channel ecosystem for their brand, based on real performance data from the field. Calculate your brand’s GTN potential here.
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