Postscripts Rx
Conversations Beyond the Prescription. Where pharma, HCPs, life science and digital health solutions meets patients—after the script is written. Conversations on digital health, engagement, and real-world impacts that are re-writing the future of patient engagement.
Postscripts Rx
When MFN Pricing Meets Patient Power: How Digital Support Becomes the Moat
Prices are leveling, but the real story is where competitive edge is moving: from rebates and discounts to experience, trust, and the moments that keep a patient on therapy. We dig into the MFN pricing model and its ripple effects across U.S. pharma, explaining how reference-based pricing compresses margins and forces brands to compete on loyalty, adherence, and the quality of their support programs. When physicians and patients see real-time costs at the point of prescribing, “comparable” options become a head-to-head test of who delivers better help, clearer guidance, and fewer hurdles.
We walk through the new playbook for brand teams: measure what matters (six-to-twelve-month adherence, patient-initiated refills, NPS, and in-app engagement), design push moments that meet patients right when they decide to refill or speak with their doctor, and turn existing content into a living journey. Digital companions are no longer a nice-to-have—they’re loyalty infrastructure. Timely reminders, dose tracking, symptom logs, and doctor discussion guides reduce drop-offs and raise confidence. Layered on top, voice-integrated agents offer scalable, multilingual check-ins that feel personal, follow brand protocols, and escalate to humans when needed, making support available 24/7 without ballooning costs.
At the executive table, the strategy becomes both defensive and offensive. Defensively, protect market share by tightening onboarding, reducing abandonment, and integrating digital support from launch. Offensively, differentiate with patient services, bring engagement and adherence lift into payer negotiations, and broaden KPIs beyond price to lifetime value and experience metrics. As MFN pressures grow, the winners will be those who treat loyalty as a system—measured rigorously, designed intentionally, and delivered consistently. Subscribe, share this with a teammate who owns patient experience, and leave a review with the one metric you think should be on every brand dashboard.
PostScripts Rx is not intended to constitute medical advice, nor is it intended to influence prescribing decisions or any other medical or clinical decision-making. All medical and clinical judgment and decision-making, prescribing decisions, and all related considerations remain exclusively the responsibility of providers and patients.
Welcome to Postscripts, the podcast that explores what happens after those first prescriptions are filled. We cover the latest innovations in patient access, support, digital tools, HCP engagement, and pharma marketing that we all hope drive better outcomes for patients. This podcast is for informational purposes only and does not constitute any medical advice, nor should it be used to influence any clinical decision making. Patients should always consult their healthcare professionals. Welcome to the podcast. My name is Brian Carr. I uh work at MetaSafe, although any opinions expressed here are my own and not necessarily those of MetaSafe or its partners. Hey, we've got a big one today: the pricing power, brand loyalty, and what's happening in this post-stript era. The landscape shifting for pharma companies. More than ever, the pharma executives that we're seeing are really being called to think beyond pricing models and reimagine how patients are really connecting with their patient treatment journeys. The shift is being accelerated here in the U.S. by discussions around this most favored nation, MFN, pricing model. If it's adopted broadly and it's already having its impact here in the U.S., MFN would tie the U.S. drug prices to those paid in other comparably developed nations. This is a radical proposition in what has been a historically free market here pricing environment for pharmaceuticals. But this cost downward pressure then creates this powerful ripple across commercial strategies. What's the fallout? A renewed, urgent focus we are seeing on brand loyalty. For pharma brand marketers, innovation teams, commercial leaders, loyalty could fast become a leading KPI, and the effectiveness of digital patient engagement programs suddenly becomes a differentiator, not a nicety. Today we're exploring that linkage, the rise of the most favored nation pricing, what it means for patient engagement, and brand stickiness and long-term commercial viability. So let's understand the most favored nation model. It was first introduced during the Trump administration, revisited the first Trump administration, and then revisited under President Biden. The most favored nation model is it's about pegging the American drug prices to an index based on prices paid by other wealthy nations like Germany, France, and the UK. The aim is cost containment, particularly in Medicare Part B for U.S. patients and potentially broader payer channels, right? So according to the Centers for Medicare and Medicaid Services, colloquially known as CMS in the U.S., the model was projected to save taxpayers approximately$28 billion over seven years when initially proposed. However, pharma pricing is not just about quantity and cost, it's about perception, value, experience. That's where the conversation turns from cost control into brand strategy. So what are the consequences on pharma commercial strategy? Well, with price convergence between US and XUS market, the historical pricing moat American pharma brands typically enjoyed is starting to shrink. That squeezes margins and dilutes pricing power. So farmer brands are going to need new sources of competitive advantage, and chief among them, brand differentiation, patient loyalty, retention. That means farmers are going to be leaning into value-added services, digital engagement, medication management, real world support at the tip of your fingers, right, to earn loyalty because prices are not going to do it anymore. So this top strategic implications include de-emphasis now on price competition, increased competition on patient services, right? Great emphasis on net promoter score or refill behaviors too, and other patient experience KPIs. Look for procurement and brand teams that will be collaborating more closely on the downstream experience strategies. Why? Because that protects market share, right? The idea is simple. If prices are flat, pharma success depends on stickiness. Will your patient come back for refill? Number two, number three, or quit just quit the therapy altogether. Or more likely, the doctors now, it's also kind of gone unreported, is the doctors now are going to actually see the pricing as they prescribe medications and more than likely will be uh seeing what you will pay as a patient based on your coverage, right? This is something they've never seen before. You go to the doctor now and you ask them, you know, do you they have no idea how much the meds cost, right? Which is probably a good thing. Some would argue it's a good thing. But anyway, now the prices are going to be there, but tell part of the transparency push by the Trump administration, and they're now using AI models to make sure the price and transparency is shown even even higher as they're being prescribed. So you can imagine the scenario, right? You know, a doctor looks at two medications comparable, right? The PBMs would say, oh, by all means, by all means prescribe the less expensive one, right? So they can increase their margins. Whereas a doctor may be like, well, you're on the brand of medication, we're not seeing any bad effects, there's no side effects, really like it, but you know, do you want me to go for this less expensive one? It's kind of comparable. And I could see patients then, you know, then saying, no, no, no, keep it way it is. I like it. I like knowing the supply chain. I think I like knowing it's it's made in America, because you're gonna see a lot of that coming in the next couple of years. I like the fact that Jane is my support team rep. I can tap my engagement device for the brand tap. I can talk to her right away and ask her a question if I had it. So if you switch off our brand, that brand, I'm not gonna get all those extra experiences. It's worth the extra money that my provider or copayer has to pay, right? So that's the type of brand loyalty we're actually talking about in the real world. You know, we are seeing some of the uh pharma companies launch their own websites, and we saw the news about Trump RX, where you could theoretically go to a website and, you know, if you've been prescribed to buy the medications that way. Let's face it, 80, 85% of the US population is covered from uh in their health plan from their work, right? So they're paying a$10,$20,$30 copay anyway, usually, right? So it's very rare you're gonna have someone who is either uninsured or it's for the GLP ones where it's hasn't been prescribed yet, and they go to a website, they have a doctor's appointment, and they get the medication that way. That's those are gonna be successful. And as D2C evolves over the next months and years, you're gonna definitely see that experience grow, and I think at the expense of PVMs. But anyway, let's get on to this, what is really gonna be brand loyalty as a key pharmaceutical KPI. Loyalty of pharma, it's long lagged behind sectors like consumer package goods, right? Largely due to the prescriptive nature of medicine, right? But as chronic condition treatment becomes more self-managed, patient-informed, loyalty metrics are starting to surface, right? So some of the leading indicators of pharma brand loyalty include medication adherence rates over six to 12 month periods. What's that compliance or persistent rate, right? Patient-initiated refills versus passive HCP-driven continuation, right? Engagement during within uh within digital therapeutic platforms, the duration within the platform, right? And theoretically, what other medications are they taking in conjunction with your branded medication? Is that affecting how their treatment's going, right? NPS and patient satisfaction surveys, these are key. These are one of those some of our partners absolutely love. They need to get the NPS, they report it internally, others don't. But anyway, those patient satisfaction surveys are incredibly important. So according to health affairs, the poor medication adherence costs the US, yeah, as you as we all have heard this this number,$300 billion annually, largely due to complications, hospital readmissions, et cetera. You know, it's a public health failure to some extent. It's also a brand failure to some extent, right? Because the thesis is a loyal patient is an engaged patient, and an engaged patient tends to be more adherent, producing better outcomes, fewer complications, longer lifetime value for therapy brands, right? So let's think about the role of digital engagement. So how do you build that loyalty at a low cost, high ROI? Well, it's through digital patient engagement programs, right? You can get a branded medication app. It's no longer a bonus. It's not a nice-to-have, it's a strategy, right? Programs that deliver timely refill reminders, dose tracking, symptom monitoring, educational support, videos. They're not just nice-to-haves. They're becoming essential loyalty infrastructure. And the key point here is most farmer and brand teams already have the assets ready. They have videos and one pagers and PDFs on, a little bit more about the medication and quizzes and surveys, right? Well, you really want to do is digitally engage patients so they're not always just going to your website once, right? They're being engaged at the right time. Say they're ready to refill. That's a great time to hit them up with a survey, what's your doctor telling you, things like that, or doctor discussion guide, right? But a lot of that, you know, has to be a push to a patient. In other words, hey, it's now your, you've done your 90 days, three refills, time to have a conversation with your doctor, your appointment's coming up. Here's a doctor discussion guide if you want to get a head start on some of the questions you might want answers to, right? So that's a push. That's not something someone's theoretically going to think of and do on their own in their busy life. Go to the website, you know, search resources, go down and then download a doctor's discussion guide. It's just presented to them at the right time, the right port of their point of their patient journey. Like, you know, the MedSafe Digital Companion, we're highly personalized experience. We support patients throughout the treatment journey, medication reminders, resources, pill tracking, cross-therapy insights, all in one place. We also have VIA, which is the voice integrated agent, where we enable brands to accelerate deployment and customize support programs around therapies, reducing time to launch while increasing flexibility and reach of personalization because it's a voice-activated agent that a person joining a pharma program would have opted into for, hey, I need a call for a weekly symptom check. Or I want to get reminded when the program becomes available on an app, right? Or checking in this, you know, just a weekly check-in, just about, you know, not giving out or dispensing any any medical advice. It's similar to what you'll see from hub systems right now, right? But this is all automated with voice agents that can work 24-7 in MetaSafe multilingual language. They can be deployed and triggered based on some app activity and events that have happened within the platform. It's based on the pharma protocols. This is the time to give them a call on this. This is Brian, he prefers to be called after 3 o'clock in the afternoon, but not later than 7 o'clock, for example. Things like that. This can all be programmed to the pharma protocols and deployed at scale. And part of that is also, yes, you know, say there's 20% of your patients on a branded bed that need that daily support and really want to have that contact and you want to keep them on board. And the other 80% doing okay, but you might still want to have a check-in with them or do a quick survey with them, et cetera. That can be automated just to check in and make sure that they're staying on brand. If they have any questions, tap here, right? So these are automated voice agents that we've got available and integrated throughout our system, where it can be deployed in uh, again, to farmer protocols, and what it really does is trigger engagement at the right time for patients in a way that is very comfortable. So, you know, it when you're talking about C-suite procurement implications as well, right? Let's now zoom up to that executive level. If MFN pressures squeeze margins, the bed, the boardroom conversation naturally turns to cost efficiencies and innovation levers, right? Procurement and user experience teams and patient teams, the discussion then becomes both defensive and offensive. Defensive levers, retain the patient base with richer experiences, reduce the loss due to abandonment, discontinuation by integrated tools like a MetaSafe. Include digital companions in RFPs for new drug launches early on. I could tell you that many Savi Pharma execs know they're launching within a year, and that's when conversations are starting for launch brands and digital companion engagement. So if you're not doing that right now, it's your competitors certainly are. And pharma brands can go in the offensive, right? Deploy support programs as competitive differentiators, drive higher adherence as an ROI lever back to payers, right? Use engagement data for informed contract, engagement data for informed contract rebasing, right? So pharma execs who broaden the KPIs beyond unit price and uh and they do move to a more holistic lifetime value and experience metrics, they're gonna win under the most favored nation reimagined markets. It's already starting to happen. According to an Accenture survey, 73% of pharma companies are either piloting or scaling their digital platform, their digital engagement platform, 64%, 65% now. I'm sorry, long-term patient loyalty as the critical objective in brand stewardship. So finally, you know, in conclusion, loyalty is gonna lead in the post-pricing war area. The MFN model, not just a regulatory shakeup, it's a nudge to a new area of pharma competitiveness built not just on price, but on connection, engagement, trust, longevity, brand loyalty. Those metrics are coming to the fore. And as markets flatten, margins get pressed, those who win win through loyalty. And loyalty is born from experience, support, and relevance. That means patient services and digital companions go from being supplementary aides to becoming commercial accelerants. The winners are those brands that A, measure loyalty through adherence, engagement, surveys, net promoter scores, right? B, develop scalable platforms for patient interaction in trusted, compliant, and secure manners. And C, partner with service innovators, you know, like MetaSafe and others that execute fast with precision. So when we look at this MFN pricing looming and patient power rising, pharma is reframing, and we no longer sell it to prescribers alone. We earn the loyalty of human beings, prescribers alone, excuse me. We are in the loyalty of human beings who are managing these complex diseases every day. It's going to be a loyalty play. All right. Thank you so much for joining us here at Postscripts. If you like, please subscribe, and uh, we'll see you next time.
