Realizing the value of convenience: payer engagement strategies for pharmas

It’s one of those industry mantras that’s been around for years — a quiet warning to manufacturers that a simpler, faster, or less frequent treatment with similar efficacy and safety probably won’t move the needle on coverage or access.

Maybe it’s time we start questioning that.

Route and frequency of administration are an essential part of competitive product strategy for patients and providers. However, payers have very different attitudes, preferences, and incentives, and require distinct engagement strategies.

In this series of posts, we’ll explore examples where payers are rewarding new routes/frequencies of administration with premium access or pricing. Because what we’ve long dismissed as “convenience” — fewer clinic visits, simpler administration, better adherence — may represent value by another name.

The challenge lies in how new routes and frequency of administration are positioned — and perceived — by payers.

Case study 1:  Long-acting injectables versus daily orals in schizophrenia

INVEGA HAFYERA, UZEDY, and ABILIFY ASTIMTUFII are long-acting injectable (LAI) therapies for schizophrenia that contain the same active ingredient as commonly prescribed generic oral therapies. These LAIs are administered 2-6 times per year by a healthcare provider and are substantially more expensive than their oral counterparts. There is no direct evidence in pivotal clinical trials that INVEGA HAFYERA, UZEDY, and ABILIFY ASTIMTUFII are superior to daily orals with with the same active ingredient,^[1] yet payers widely cover these drugs.

• INVEGA HAFYERA, UZEDY, and ABILIFY ASTIMTUFII are covered by > 95% of commercial and Medicaid plans^[2]
• No prior authorization requirement is in place for over two-thirds of these plans

How did manufacturers make the case that the price premium was justified, particularly for budget-sensitive Medicaid plans? They skipped past convenience = adherence arguments and demonstrated better real-world outcomes and 43% lower overall health costs over 2 years.^[3]

But what happens in therapeutic areas where cost savings are more difficult to demonstrate? The migraine prophylaxis market presents a different perspective on how payers respond to new routes and dosing schedules.

Case study 2: Daily orals vs. long-acting injectables in migraine prevention

QULIPTA is a daily oral treatment for migraine prophylaxis that was launched as an alternative treatment option to long-acting IV or subcutaneous injections that target the same pathway. QULIPTA had similar reductions in monthly migraine days to AIMOVIG, AJOVY, and EMGALITY in pivotal clinical trials.^[4]

Here’s the striking part: QULIPTA’s list price is roughly 50% higher than AIMOVIG, AJOVY, and EMGALITY,^[5] yet it enjoys the highest coverage rate among Medicare Advantage plans and comparable coverage in commercial plans.

At first glance, this seems counterintuitive. Adherence to daily oral migraine prophylaxis is known to be among the lowest across treatment options, according to recent real-world data from Clarivate.^[6]

So, what’s driving coverage here? Likely factors include market dynamics, plan design, rebates and discounts, and the flexibility that daily orals offer in managing the overall benefit mix.

Therapies with new routes/frequency of administration have multiple options to demonstrate payer value beyond clinical outcomes and cost savings. Understanding the implications to benefit design can be critical to success. However, not every case rewards convenience.

Case study 3: When convenience doesn’t command a premium

ENTYVIO, for ulcerative colitis and Crohn’s disease, is available as a monthly IV and a bi-monthly autoinjector. IV and autoinjector have similar efficacy and safety profiles, but the autoinjector’s list price is 40% higher than the IV.

Coverage tells a clear story:

• Autoinjector: 23% in Medicare Advantage and Medicare Employer Group Waiver Plans, 85% in commercial plans
• IV: >99% across the board

Here, payers do not appear willing to pay for convenience alone. However, the difference between Medicare Advantage and commercial coverage hints that patient population and benefit design still influence access decisions. Convenience interacts with other factors, but it isn’t sufficient on its own to drive premium coverage.

The takeaway

Payer acceptance of a route or frequency of administration is context-dependent. At Clarivate, we’ve identified four factors that can support premium pricing or access for products offering new routes or frequencies of administration:

1. Demonstrably improved outcomes or cost savings via significantly better adherence.
2. Shift in benefit coverage that lowers the plan’s financial responsibility.
3. Statutory or policy mandates requiring coverage.
4. Rebate optimization, particularly in markets disrupted by biosimilars or generics.

In the coming posts, we’ll take a closer look at each of these dynamics — and explore when and how “convenience” becomes something payers really do pay for.

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: Pharma Market Access Consulting | Clarivate

This post was written by Moira Ringo, Director, Commercial Consulting, and Leyla Jiang, Senior Consultant, Commercial Consulting

[1] Unless otherwise indicated, efficacy and safety data can be found in the FDA label (i.e., Highlights of Prescribing Information) for each therapy

[2] DRG Fingertip Formulary accessed October 2025

[3] Fu, A.Z., Pesa, J.A., Lakey, S. et al. Healthcare resource utilization and costs before and after long-acting injectable antipsychotic initiation in commercially insured young adults with schizophrenia. BMC Psychiatry 22, 250 (2022). https://doi.org/10.1186/s12888-022-03895-2

[4] Highlights of Prescribing Information for QULIPTA, AIMOVIG, AJOVY, and EMGALITY

[5] NAVLIN pricing database accessed October 2025

[6] Clarivate Migraine Prophylaxis Treatment Algorithms: Claims Data Analysis published Sept 2025

Biopharma Commercialization Launch Lifecycle management Managed care Market Access MCO Patient Payer PBM Pharma pricing Route of administration U.S.

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