Market Access

Know where coverage
becomes a barrier to
access

Know what others can’t by connecting payer policy with the patients, providers and treatment activity affected by it.

Coverage is not the same as access. Connect payer policy, prior authorization, prescribing, patient and cost-of-care signals to see where barriers are emerging and what may be driving them before they limit treatment.

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ILLUSTRATIVE PATIENT JOURNEY

Where are eligible patients getting lost?

An illustrative cohort of 47,382 eligible patients. Fifty-three percent reach therapy while forty-seven percent do not. Selecting reveal barriers separates the forty-seven percent into affordability, prior authorization, specialty pharmacy, and unexplained barriers. 47,382 Eligible patients 53% Patients on therapy 47% Patients NOT on therapy Not on therapy 13% Affordability 11% Prior auth. 8% Specialty pharmacy 15% Unexplained
HealthVerity can help identify barriers to care

Why this decision matters

Access barriers rarely affect every patient, payer or market the same way. A policy that appears manageable at the aggregate level can translate into delays, denials or abandonment for specific patient populations.

Understanding where those differences occur, and what is driving them, gives access teams an opportunity to strengthen the evidence, payer strategy and patient support approach before barriers become entrenched.

Know which types of decisions are enabled at this stage

Market Access

Which payer policies deserve the earliest attention?

HEOR

Where does our value story need real-world data in addition to clinical trial evidence?

Medical Affairs

Which prescriber behaviors and outcomes support the case medical affairs makes to payers?

Pricing & Contracting

What is the real cost of standard of care, and which real-world outcomes justify our proposed price to payers?

Government Affairs

How exposed is this program to IRA, formulary consolidation, or 340B pressure?

What a conventional access view may not show you

Aggregate coverage and prior authorization reporting can tell you that an access gap exists. It may not reveal which patients experience it, which payer requirements are driving it, how long treatment is delayed or which providers are successfully navigating the same barriers.

Knowing there is friction is different from knowing where, and why, it happens.

Diagram showing incomplete aggregate access data and an incomplete patient view

How our real-world data ecosystem helps you know what others can’t

Connect payer, patient, prescription, provider and clinical data to understand:

  • Which plans and policies create the greatest access friction;
  • Which patients experience denials, delays or abandonment;
  • How long the path from prescription to therapy varies by payer;
  • Which HCPs successfully navigate more restrictive access environments; and
  • Where access patterns vary by patient population, geography or channel.

Now the access question isn’t simply “Are we covered?” It’s “What happens to patients after the coverage decision?”*

Diagram showing connected access signals creating audit-grade evidence
Bring us your question

Want to see where access is breaking down?

Bring us your market access question and we’ll help connect payer, patient, provider and treatment signals to reveal where barriers occur and what may be driving them.

Find where access breaks down
15-minute conversation with a HealthVerity expert

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Related information

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Discover helpful resources

Publication library Browse peer-reviewed publications generated by clients using HealthVerity data Suggested read Open claims vs. closed payer claims: What’s the difference? Suggested read How pharma can use SDOH to address health equity Suggested read SDOH data analysis for proactive outcome improvement