Pharmaceutical companies are losing commercial momentum at a critical moment in the patient journey, according to a new analysis by Flora Health’s chief growth officer.
Karina Castagna argues that most practical barriers to therapy initiation emerge not before a prescription is written, but after it.
Every additional step between a prescription and a patient actually starting therapy creates a fresh opportunity for delay, abandonment, or a breakdown in confidence.
Patients often leave their appointments without a clear understanding of what happens next, placing additional administrative pressure on already stretched care teams.
For pharmaceutical manufacturers, this friction means that well-designed commercial strategies can lose momentum precisely when they matter most, at the point of care.
Castagna identifies a structural solution: bringing patient access support closer to prescribing by connecting it within electronic health record systems and aligning it with health system workflows.
The urgency of this shift is underscored by the rapid consolidation of physician employment, with 82.0% of U.S. physicians now employed by hospitals or corporate entities as of January 1, 2026, according to data from the Physicians Advocacy Institute and Avalere Health.
Health systems operate on centralised workflows and EHR structures, meaning field and access teams must understand that infrastructure directly to function effectively within it.
Castagna frames the central question plainly: whether the right person can use the right resource at the right time, with minimal disruption to the system’s existing workflow.
To address this, she outlines a four-step operating framework designed to close the gap between prescribing and therapy initiation in a measurable way.
The first step calls for understanding where healthcare professionals sit organisationally and how the health system around them operates on a practical level.
The second step involves earlier coordination among brand, access, patient services, and analytics teams, linking commercial messaging directly to real-world barriers patients face.
The third step focuses on workflow-connected post-prescription execution, ensuring access support is embedded naturally rather than bolted on as an afterthought.
The fourth step centres on data-driven optimisation, using signals around friction points and time-to-therapy to continuously improve where and how access support is deployed.
Castagna argues that measurement only gains real value when tied directly to health system workflows, revealing where access support reaches patients and where process redesign should be prioritised.
A more connected model, she contends, helps providers, patients, hubs, and manufacturers work from better information, with fewer manual steps and clearer next actions available to all parties.
The ultimate goal is to reduce the steps, time, and effort involved so that patients move one step closer to starting therapy before they even leave the care setting.