Why ease of administration in new drugs sometimes draws a yawn from payers

Everyone wins when a provider-administered drug can be given less often or requires less time in the chair. Patients value fewer needle sticks and more free time. Busy health systems value freeing up infusion chairs and staff time to administer more infusions. And payers should love lower administration costs… right?

Unfortunately, patients, providers and innovators oftentimes aren’t feeling the love when products delivering greater ease-of-administration come to market. Let’s dig into two real-world examples of why less needle sticks rarely move the needle on access or pricing.

Case study 1: Long-acting injectables for eye diseases

EYLEA (aflibercept) is an intravitreal injection for wet AMD and other eye diseases.  For patients in the maintenance phase of dosing, the market now includes:

• EYLEA (every 8 weeks)
• EYLEA HD (every 8–16 weeks)
• PAVBLU, an EYLEA biosimilar (every 8 weeks)^[1]

On paper, EYLEA HD should be the payer favorite. It delivers similar efficacy to EYLEA, but with potentially half the injection frequency. That means fewer procedures, fewer patient visits, and lower overall admin burden.

Even better: EYLEA HD has the lowest WAC and ASP price when dosed every 16 weeks.^[2] So you’d expect EYLEA HD to enjoy premium access with fewer restrictions.

But that’s not what happens.

Across most major plans, all three aflibercept products are covered with the same prior authorization criteria.^[3],[4] In other words, despite clear convenience and cost-of-administration advantages for EYLEA HD, payers treat them all the same. Eliminating 3-4 intravitreal injection procedure fees per year saves Medicare less than $600, and doesn’t meaningfully compare to five-figure ophthalmology drug spend.

Let’s look at another example in a different therapeutic area that demonstrates a different dynamic.

Case study 2: Subcutaneous vs IV injections in oncology

PHESGO (a subcutaneous combo of the active ingredients in HERCEPTIN and PERJETA) is another “convenience superstar.” It turns one or two lengthy IV infusions—often 60–150 minutes—into a 5-minute SC injection.¹

Because net prices (based on ASP) are similar to the IV versions,² you might think payers would be eager to shift use toward PHESGO to save chair time and staffing costs. But again, the reality is less exciting. Payers give PHESGO similar access as the IV products because it is not worth it to disadvantage access to the individual IV products.

And it’s not just PHESGO. The same pattern pops up with other IV-to-SC oncology products with hyaluronidase like Opdivo QVANTIG, Herceptin HYLECTA, and Tecentriq HYBREZA. Annual costs are similar, and so is access.^3,4 These are viewed by payers as treatment alternatives, not premium products, despite savings on admin costs.

The payer calculus on administrative burden

The blunt truth is that less frequent or shorter administration for providers or patients rarely translates into better coverage or premium pricing.

Why?

• Administration costs are tiny compared to specialty drug costs.[5]
  • IV infusion (60 minutes): $50-$80
  • Subcutaneous injection by healthcare provider: $10-$20
  • Intravitreal injection: $100-$140
• Operational efficiencies accrue to the health system, not the payer, unless the health system is owned by the payer (e.g., Kaiser Permanente). It is, in most cases, someone else’s concern and someone else’s dime.
• The manufacturer often has long established contracts with the payers which may be unfavorable for either side to disrupt when a product reformulation enters the market. Better to ‘duke it out’ with prescribers and patients on market share.

In short: convenience is a clinical and operational win, but not (yet) a lever that shifts payer behavior.

The takeaway for manufacturers

If you’re bringing a new formulation, route, or dosing schedule to market, don’t assume convenience will unlock premium access. It may strengthen your payer value story, but net cost, contracting flexibility, and plan economics still dominate payer decision-making.

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] Highlights of Prescribing Information available on each product’s HCP website and FDA.gov

[2] NAVLIN pricing database accessed October 2025

[3] DRG Fingertip Formulary accessed October 2025

[4] Medical policies for United Health, Aetna, Cigna, and Anthem commercial health plans, accessed November 2025

[5] Non-facility fee taken from Physician Fee Lookup Tool; CMS.gov

Biopharma Commercialization FDA HMO Launch Managed care Market Access MCO North America Payer PBM pricing Route of administration U.S.

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