As pharmaceutical manufacturers continue to expand direct-to-patient (DTP) and cash-pay access models, patient support leaders are confronting a new challenge: maintaining visibility into adherence once patients move outside traditional reimbursement channels. UBC thought leaders have identified patient visibility outside traditional channels as a key emerging issue, noting that cash-pay pathways may bypass the data streams hubs have historically relied upon to monitor persistence and adherence.
Traditional patient support programs have depended on claims data, specialty pharmacy dispensing records, prior authorization activity, refill patterns, and payer transactions to understand whether patients initiate and remain on therapy. These data sources create a relatively clear picture of the patient’s journey. However, when patients access therapy through manufacturer-sponsored DTP programs, online pharmacies, telehealth platforms, or direct cash-pay arrangements, some of those visibility signals disappear or become fragmented.
The resulting adherence blind spot can have meaningful operational consequences. A patient who quietly stops therapy after a cash purchase may not generate any of the missed refill alerts, coverage interruptions, or claims-based indicators that would normally prompt outreach from a hub or nurse educator. To close this gap, organizations need to establish alternative engagement and data strategies that incorporate nontraditional outreach when they lack visibility into the patient’s current status. Leading organizations are exploring direct patient engagement tools, digital adherence monitoring, omnichannel communication, patient-reported outcomes, self-service portals, and real-time integration with dispensing partners to replace lost claims-based signals. UBC’s future-state vision similarly emphasizes connected ecosystems, interoperability, and near real-time analytics that can track patient progress across a broader range of access pathways.
Ultimately, the question is not whether DTP and cash-pay programs create adherence blind spots—we know they do. As patient access continues to evolve, successful programs will be those that preserve affordability and convenience while maintaining meaningful insight into patient engagement, persistence, and outcomes across every channel.
Is your program losing sight of patients outside traditional channels? UBC helps manufacturers build connected patient support programs that keep visibility into adherence and persistence across DTP, cash-pay, and traditional access pathways. Connect with our Patient Access team to learn how we can help close your adherence blind spots.
About UBC
United BioSource LLC (UBC) is the leading provider of evidence development solutions with expertise in uniting evidence and access. UBC helps biopharma mitigate risk, address product hurdles, and demonstrate safety, efficacy, and value under real-world conditions. UBC leads the market in providing integrated, comprehensive clinical, safety, and commercialization services and is uniquely positioned to seamlessly integrate best-in-class services throughout the lifecycle of a product.
About the Author
Marci Gott, Executive Director, Patient Services
Marci Gott has more than 25 years of experience in the pharmaceutical and healthcare industry. Her background spans critical care, specialty medicines, direct-to-consumer marketing, and building reimbursement and clinical support centers. She oversees UBC’s Clinical and Reimbursement teams, Site of Care shared services, and a nationwide network of home health agencies and per diem field nursing teams.
