Many companies developing alternative drug delivery systems start with a common question: “If our therapy improves adherence or convenience, will payers reward it with a price premium or better access?”
It’s an appealing idea — better convenience should lead to better adherence, which should mean better outcomes, right? In practice, however, payers rarely pay for convenience. They pay for outcomes that can be measured as cost savings within their budget horizon, typically one to two years.
Two case examples illustrate the difference between the “adherence premium” and the “outcome premium.”
Case Study 1: NEULASTA on-body device —adherence and outcomes drive advantage in a highly competitive, rebate-driven market
NEULASTA Onpro, an on-body device (OBD), automatically releases pegfilgrastim around 27 hours after chemotherapy, eliminating a return clinic visit for administration.[1] The Onpro kit has an Average Sales Price (ASP; the list price exclusive of rebates, discounts, and other factors) of $1,072.[2] There are multiple branded and biosimilar pegfilgrastim products available as HCP-administered subcutaneous (SC) injections. The lowest cost option is biosimilar pegfilgrastim ZIEXTENZO with an ASP of $283 per dose.[3]
Will payers offer comparable access to the NEULASTA on-body device when a biosimilar SC injection is available with a ~70% lower ASP? Despite the higher Average Sales Price, most commercial and Medicare payers advantage access to the on-body device compared to the lowest cost biosimilar.
- NEULASTA On-Body Device: 50% preferred tier for commercial, 71% preferred tier for Medicare Advantage medical benefit
- ZIEXTENZO SC: 4% preferred tier across the board[4]
While substantial payer rebate competition exists among Neulasta, Neulasta Onpro, and biosimilars, real-world outcomes data offer compelling evidence to support Neulasta Onpro’s value in payer engagements.
Real-world studies show:
- Better adherence: 94% for NEULASTA Onpro vs. 58% for clinic-based SC injections[5]
- Lower neutropenia incidence: 6.4% vs. 9.4% over 12-16 weeks5
- Avoided hospitalizations: 93% reduction in neutropenia admissions, which cost an average $47K per episode1
Those are short-term, measurable outcomes. Payers can directly link the higher upfront drug cost to fewer expensive hospital admissions within the same fiscal cycle.
Case Study 2: CABENUVA — when high adherence leaves no room to improve
CABENUVA, the (bi-)monthly long-acting injectable combination of cabotegravir and rilpivirine for HIV treatment, entered the market with the promise of better adherence through less frequent dosing.
In pivotal clinical trials, CABENUVA demonstrated non-inferiority to daily oral antiretroviral therapy (ART).[6] CABENUVA’s post-launch real-world study confirmed this: patients switching to CABENUVA had similar virologic outcomes to those who switched to another oral regimen, with no statistically significant difference in failure rates.[7]
The issue is that while some sub-populations of people with HIV have adherence challenges with daily orals, many patients do not. Clarivate real-world data analysis indicates that average compliance for daily orals in the US was over 80% in 2024.[8] Patients taking daily oral ART maintained viral suppression rates of 91% versus 95% for CABENUVA in the real-world OPERA study.
CABENUVA’s launch price was higher than its daily oral competitor BIKTARVY when it launched in January 2021 and was significantly more expensive than generic daily orals.2
- Cabenuva’s new-to-market block (NTMB) period exceeded the typical market average of 6–12 months; it took approximately 17 months for more than 95% of state and managed Medicaid health plans to provide coverage4
- Over three years after approval, only 18 (37%) state Medicaid plans provided uniform coverage of CABENUVA with no prior authorization[9]
When adherence is already high, the “better adherence” argument simply doesn’t translate into incremental value.
The Takeaway: Payers Pay for Outcomes, Not Intentions
Payers don’t pay for “convenience”: they pay for evidence of clinical and economic impact in 1-2 years. In short, the “adherence premium” only becomes an “outcome premium” when the data prove it saves money – fast.
Clarivate’s experienced market access and pricing experts can help you analyze, optimize, and tailor your strategy to maximize commercial success. Visit us to learn more or connect with our experts: Healthcare Commercial Consulting Services | Clarivate
[1] NEULASTA Onpro website for healthcare providers, accessed October 2025[2] NAVLIN pricing database
[3] Samsung Bioepis Biosimilar Market Report, 10th edition Q3 2025
[4] Clarivate Fingertip Formulary, accessed in October 2025
[5] Rifkin R, Crawford J, Mahtani R et al. (2022). A prospective study to evaluate febrile neutropenia incidence in patients receiving pegfilgrastim on-body injector vs other choices. Support Care Cancer. 30 (10). 1-10
[6] CABENUVA ATLAS and FLAIR clinical trials as described in Highlights of Prescribing Information
[7] CABENUVA website for healthcare providers, accessed October 2025
[8] Clarivate HIV Treatment Algorithms: Claims Data Analysis published March 2025
[9] Zalla LC, Horn T, Lujintanon S, Lesko CR (2025). State-level variation in access to long-acting injectable antiretroviral therapy for HIV in the United States. Health Aff Sch. Jan 29;3(2)
Related insights
The latest news, technologies, and resources from our team.
