Commerce Is the New Launch Architecture

What you’ll learn:

As our colleagues mapped out in their article “The Launch Foundation: Where Every Trajectory Is Set”, it has never been clearer that decisions made in the pre-commercial phase of launch, and how the brand performs in the first year following approval, set the ultimate peak sales trajectory for the brand. Lost momentum in year 1 can never be regained.

As such, for many years, brands have been promoting to patients more heavily in an effort to accelerate demand and drive uptake—21% increase in Direct-to-Consumer (DTC) spend within 36 months from launch in 2019-2022 vs 2015-2018—and are seeing higher returns as a result. For example, specialty drug launches investing at least $1MM in DTC saw twice as many patients in year 1 as those that didn’t.

However, for many brands, the largest source of launch leakage has increasingly moved downstream, from generating interest to converting qualified demand into treatment. That leakage typically occurs across three areas:

Direct-to-Patient and other digitally enabled models can create new routes into care, but they do not remove the downstream realities of access. To convert demand more reliably, marketing and market access must design the launch as one progression system.

The Launch Model Has a Conversion Problem

Pharma has spent the last decade building more sophisticated demand engines. Media models became more precise. HCP engagement became more targeted and integrated. Patient education became more accessible. Brand experiences became more personalized. In many ways, those investments worked, but adoption did not always follow.

For many brands, the hardest part of commercialization is no longer creating interest; it is converting that interest into a filled prescription through a healthcare system shaped by payer controls, affordability pressure, benefit complexity, channel restrictions, and operational handoffs.

A patient can be motivated. A provider can be willing. A brand can have strong awareness and favorable formulary status. But the journey can still stall between prescription, access approval, fulfillment, and treatment start.

The data is clear. A 2024 AMA survey found that 78% of physicians reported that prior authorization often or sometimes leads patients to abandon a recommended course of treatment. IQVIA analysis of new drug launches found that nearly two-thirds of prescriptions for newly launched drugs go unfilled in the first year on market, with limited coverage persisting for several years after launch. CDC data showed that more than 9.2 million U.S. adults ages 18 to 64 did not take medications as prescribed in 2021 due to cost.

Those are not downstream fulfillment hurdles, but commercial design challenges. And solving them requires marketing and market access teams to jointly design how patients move from demand to treatment.

DTP Is Not a Shortcut. It Is a Connected Commerce Model.

The dominant narrative around DTP often focuses on the front door: the branded destination, the telehealth integration, the checkout-like experience, and the direct relationship with the patient. While those things matter, they are not the entire model.

DTP can shorten time to evaluation, simplify treatment initiation, improve cost visibility, or create an alternate route for patients underserved by traditional care. It does not, however, eliminate coverage barriers, affordability exposure, prior authorization, specialty pharmacy routing, hub enrollment, or provider workflow requirements.

That is why DTP should not be treated as a standalone channel or digital wrapper. It underperforms when the front-end experience is disconnected from the access, support, fulfillment, and clinical infrastructure required to complete the journey.

The opportunity is not simply to create a new entry point. It is to give patients more choice in how they start, navigate, and experience the path to therapy while helping them understand which route is right for them and what happens next.

For a specialty therapy, a patient may enter through a branded experience and receive a prescription, then move through hub enrollment, benefit verification, prior authorization, specialty pharmacy coordination, and financial support. Each step may be necessary. The experience fails when ownership, timing, or next actions remain unclear.

The goal, therefore, is not to select a DTP channel in isolation. It is to determine which entry routes are viable, what downstream access infrastructure each route requires, where demand leaks, and how progression will be measured across different pathways.

Applying Commerce Principles Can Connect the Experience Between Intent and Treatment

Rather than the term “Direct-to-Patient” or “DTP”, we prefer to refer to these solutions as “Commerce” solutions. DTP is confusing, given there is no unified definition of what it is—or what it isn’t—and it often gets equated to cash-only solutions, whereas in reality, the promise and benefits to patients are much more than that.

We define Commerce in pharma as: facilitating frictionless transactional experiences that enhance the value exchange between patients and brands.

“Frictionless” means removing acute friction points in the journey or reducing friction holistically from end to end. “Transactional” means the experience is designed to move patients and providers toward action. “Experiences” means the system must bring human insight and brand relevance into each interaction. “Value exchange” means bringing brands more valuable patients, and bringing patients more value from the brand to drive long-term success.

In pharma, as in the consumer world, Commerce is a set of decisions, supports, handoffs, services, and data signals that help a patient move from interest to therapy start and from therapy start to continuation.

It includes information about a brand, competitor comparisons, the ability to request a specific drug, cost clarity, eligibility support, benefit navigation, channel routing, hub intake, prior authorization enablement, pharmacy coordination, field tools, refill support, and visibility into where the journey slows or breaks.

This is where marketing and market access meet. Marketing drives demand and shapes the experience that surrounds it. Market access defines the viability of the path. Commerce connects both into a system that can move patients and providers forward.

When Commerce is treated as a bolt-on, the journey fragments. Patients are handed from brand experience to access process to support service to pharmacy workflow, often without a clear sense of who is helping or what happens next.

When the Commerce ecosystem is designed from the ground up, patients understand what comes next, providers know what is required, support services are easier to enter, field teams can answer practical questions, and data can reveal where intervention is needed. That is the difference between generating demand and converting it.

Commerce is built on three connected capabilities.

Together, they create an adoption engine designed not only to create demand, but to convert it.

Different Products Require Different Commerce Architectures

One of the most expensive mistakes in pharma Commerce is applying one model across fundamentally different products, markets, and access environments. Architecture should be selected based on access mechanics, not simply product category.

A consumer-influenced retail product may prioritize cost clarity, prescribing access, and retail fulfillment. A specialty pharmacy product may require hub integration, prior authorization enablement, limited-distribution routing, and onboarding support. A medical benefit product may depend on benefit verification, coding, product acquisition, site economics, and provider readiness. Hybrid products may require multiple pathways by patient, payer, site of care, or channel.

The right Commerce architecture depends on how patients enter care, how access is managed, and who controls therapy initiation.

Marketing and Market Access Need One Operating Model

The traditional launch model treated marketing and market access as parallel tracks. Marketing builds awareness and demand. Market access informed payer strategy. Patient services supported patients after the prescription was written. Channel partners managed fulfillment. Data teams measured what they could see.

That model breaks down because patients and providers do not experience commercialization as a set of separate functions. They experience every message, requirement, delay, and handoff as part of the treatment journey.

The treatment journey is also becoming more complex. Patients may enter through multiple routes, compare treatment options, use digital health platforms, seek manufacturer support, switch providers, or abandon treatment when the journey becomes too difficult. At each point, confidence can be strengthened or lost.

In an access-driven Commerce model, marketing and market access work together from the start. Marketing must understand which patient segments can realistically progress through the access system, which entry points are viable, and what patients and providers need to act with confidence. Market access must understand how demand will be created, experienced, and routed across those pathways. Patient support and channel design must be built into the experience, not added after launch.

This expands the role of both functions.

Marketing now owns more than demand generation. It must set credible expectations around cost, access, support, fulfillment, and follow-up while making available treatment routes clear to patients and providers.

Market access now owns more than payer strategy. Coverage, affordability, channel requirements, provider workflow, site economics, and fulfillment constraints must shape how demand is activated before launch and how the model evolves after launch.

This does not require merging functions. It requires shared decision rights at the points where demand, access, and fulfillment intersect. Three connected Commerce workflows can help marketing and market access begin operating more cohesively:

Together, these workflows create a Commerce operating model grounded in the realities patients and providers experience while giving commercial teams a shared way to improve progression over time.

Progression Is the New Shared Commercial Operating Metric

If marketing and market access are to operate as one commercial system, they need a shared definition of success.

Traditional commercial metrics measure individual activities such as awareness, engagement, coverage, prescriptions, and paid fills. Each is important, but each reflects only one stage of the journey. What they do not show is whether patients continue progressing toward treatment.

Progression measures that movement across the entire journey. It follows qualified demand from awareness to provider engagement, prescription, paid fill, and continued therapy.

More importantly, progression creates a shared operating framework across marketing, market access, patient services, field teams, and analytics. It helps teams identify where patients are advancing, where they are stalling, and where intervention is needed to keep them moving toward treatment.

The Klick Perspective

DTP has exposed what was always true: demand creation and access conversion cannot be designed separately.

The next era of launch will not be won by brands that simply create more awareness, drive more traffic, or build the most sophisticated DTP front door. It will be won by brands that design the right Commerce architecture for their product, patient, provider, payer, and channel reality.

That is the strategic shift: from demand generation to demand conversion, from access as a downstream function to access as a launch design principle, and from fragmented execution to connected commercialization.

We begin with Commerce Intelligence to understand where qualified demand can realistically convert. We design the Commerce Architecture that aligns patient pathways, access, fulfillment, and support. We then build the Commerce Experience that helps patients and providers continue progressing toward treatment.

In the next era of commercialization, competitive advantage will come less from creating more demand than from converting more qualified demand into sustained treatment.

That is the role of Commerce. It connects demand generation, access, fulfillment, and patient support into one progression system designed around the realities of healthcare.

Demand creates opportunity. Commerce enables progression. Progression creates growth.

References

Klick Health. The Launch Trajectory: Where Every Trajectory is Set, May 2026. Available at https://idx.klick.com/articles/the-launch-foundation-where-every-trajectory-is-set

IQVIA. Engaging Consumers at Launch: Maximizing Value in a Transforming Market, December 1, 2025. Available at: https://www.iqvia.com/locations/united-states/blogs/2025/11/engaging-consumers-at-launch-maximizing-value-in-a-transforming-market

American Medical Association. 2024 AMA Prior Authorization Physician Survey. Available at: ama-assn.org/practice-management/prior-authorization/exhausted-prior-auth-many-patients-abandon-care-ama-survey

https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/us-medicine-use-trends-2026

CDC/NCHS. Characteristics of Adults Aged 18–64 Who Did Not Take Medication as Prescribed to Reduce Costs: United States, 2021. NCHS Data Brief No. 470, June 2023. Available at: www.cdc.gov/nchs/products/databriefs/db470.htm