Key market access considerations for long-acting and alternative delivery therapies

In conversations with pharma and biotech teams, we sometimes hear recurring assumptions about what drives payer value. Many believe that convenience or adherence benefits justify premium pricing or access — but when viewed through a payer’s lens, these claims don’t always hold up. Let’s unpack three common misconceptions — and how payers really think.

1. “More convenience” ≠ “more value”

Manufacturers sometimes infer price premiums for products that offer more convenience or better adherence: tablets instead of subcutaneous injections, auto-injectors instead of vials, or extended dosing (e.g., every three months instead of monthly).

The problem? When therapies are described as “more convenient,” U.S. payers will want to see evidence. Convenience is inherently subjective — what’s easier for one patient may not be for another. Payers must rely on objective outcomes to justify pricing premiums.

In short: payers pay for outcomes. Unless convenience demonstrably improves health outcomes, or reduces short-term costs, it won’t support a premium.

2. “Better adherence” must be proven

Many manufacturers position long-acting or alternative delivery products as adherence solutions. However, clinical trials are highly controlled environments that do a poor job of anticipating real-world adherence. Adherence is best measured post-launch using real-world evidence (RWE).

Two common pitfalls emerge:

• Limited baseline opportunity: In some therapeutic areas, adherence with existing therapies is already high, leaving little room for measurable improvement. For instance, Clarivate’s claims data indicate that compliance with daily oral HIV treatment BIKTARVY exceeds 84%, suggesting that adherence may not be a major unmet need in this population.^[1]
• Assuming extended dosing equals better adherence: Longer dosing intervals do not automatically translate into improved adherence. Each patient’s experience is different, and adherence is influenced by numerous behavioral, clinical, and logistical factors. A monthly regimen may not outperform a weekly or daily one, particularly when considering differences in medical versus pharmacy benefit coverage, healthcare professional (HCP) versus self-administration, and other real-world complexities.
• Delays in acquiring data: Another pitfall our consulting team often sees is the timing mismatch between evidence generation and access. RWE is not available at launch and takes time to collect. However, if initial uptake is slow due to restricted coverage, generating real-world adherence or outcomes data takes much longer. This dynamic is especially challenging for niche or rare indications, where patient populations are small and data accumulation is inherently slower.

3. What outcomes do payers actually pay for?

U.S. payers focus on short-term savings, not long-term projections, because members change insurance plans every two to three years. Payers value interventions that prevent costly events within one to two years.

Consider schizophrenia. Oral antipsychotics have 70%–75% adherence^[2], and non-adherence can lead to emergency visits and hospitalizations. Long-acting injectables (LAIs) reduce relapses significantly in the first year, with real-world studies showing hospitalization cost offsets that can approach the added drug expense.^[3]

Here, payers accept a price premium, because outcomes translate into short-term, measurable savings.

Takeaway: Think like a payer

When manufacturers claim “superior adherence” or “greater convenience,” skepticism is natural. Payers will ask:

1. Show me the data. Don’t claim adherence — prove it.
2. Show me the short-term savings. Long-term outcomes sound nice, but I’m accountable for this year’s budget.

If you’re a manufacturer

1. Convenience ≠ adherence. Payers don’t pay premiums without better outcomes in most cases.
2. Check the baseline. If adherence is already high, your opportunity may be limited.
3. Better adherence ≠ better outcomes. Efficacy and duration of effect vary.
4. Quantify near-term impact. Focus on short-term savings and measurable outcomes.

Final thoughts

Do payers pay for “convenience?” Not really. They pay for evidence — and for economic impact they can realize soon. The winning strategies are those that link convenience or adherence improvements directly to measurable, near-term clinical and financial value.

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] Clarivate: HIV Treatment Algorithms Claims Data Analysis, August 2025.

[2] Clarivate Disease Landscape and Forecast reports for Schizophrenia

[3] Cai C. J Managed Care Specialty Pharmacy 2024 (link)

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

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