Briefing 02 · Patient Access Thesis · 5 min read
Reimbursement continuity through plan year transitions.
Thesis
Plan year transitions expose the structural fragility of access programs built for steady state. Continuity is not a benefits question — it is a governance question about who owns the patient experience when coverage, channel, and benefit design shift simultaneously.
"Continuity is the truest measure of whether your access infrastructure was designed, or merely assembled."
Plan year transitions concentrate every weakness in an access program into a four-week window. Formularies move, deductibles reset, copay assistance recalibrates, and patients who were stable in December become at-risk in January — not because anything about their disease changed, but because the infrastructure around them did.
Most programs treat this as a benefits problem to be solved with messaging. The organizations that protect adherence treat it as a governance problem: who owns the patient experience when coverage, channel, and benefit design all shift in the same week?
Continuity governance assigns that ownership in advance, instruments the transition with leading indicators, and gives the field, the hub, and the specialty pharmacy a single playbook for the moments where the patient is most likely to be lost.
Bring this lens into a working session with your commercialization team.