“In the battle for access, the best tool isn’t just a rebate—it’s real-time intelligence.”

Access Strategy Is Evolving Fast

Payer access has always been a battlefield, but the rules are changing—fast. Traditional formulary strategy—rebate negotiations, tier placement, coverage confirmation—is no longer enough to win.

The new PBM playbook is dynamic, opaque, and engineered to move faster than brand teams can react.

So if your market access strategy ends at the contract stage, you’re playing an old game in a new arena.

The PBM Playbook Is Getting Smarter

Pharmacy Benefit Managers (PBMs) are no longer just administrators—they’re architects of behavior.

• Dynamic exclusions and step edits can appear overnight.
• White-bagging and vertical integration shift dispensing control to specialty partners.
• Rebate traps penalize affordability programs that are “too good.”

The result? Providers are confused. Patients are blocked. Brands are reactive.

Where Data Comes In

To fight smarter, pharma must stop treating access as a quarterly static report and start managing it as a real-time, designable system.

That’s where platforms like Symphony, Surescripts, and payer adjudication feeds come into play.

1. Geo-Specific Payer Intelligence

Identify zip codes triggering the highest PA or rejection rates. Then surface resources to the right HCPs—before the script is written.

2. Real-Time PA Pathways

EHR nudges can simplify prescribing decisions. If Drug A requires a PA but Drug B (your brand) is preferred, make that clear at the point of care.

3. Access-Informed Media Targeting

If a provider’s top plan just dropped coverage, don’t waste ad dollars pushing NBRx messaging. Instead, shift to co-pay tools, bridge programs, or education aligned with what’s possible now.

4. Payer Signal Integration in CRM

Reps shouldn’t rely on 90-day-old access data. Integrating payer favorability + reversal signals into CRM has been shown to drive 2–3x more productive calls.

Design Matters, Too

It’s not enough to have the data. It has to be embedded into workflows—both digital and human.

• SmartPhrase-enabled PA guides for EHRs
• HCP portals that run patient-specific access checks
• Field tools that are intuitive—not made for access specialists

The brands that are winning today? They’re not just spending more. They’re designing for agility—combining insights + access at decision points.

The 609 Perspective

At 609 Health, we help brands decode payer disruption—and turn it into a competitive edge.

Whether it’s:

• Surfacing plan-level pain points directly in the EHR
• Redesigning patient support workflows for clarity
• Building access-aware strategies into your field teams

We don’t just monitor the fight. We help you win it.