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.

Episode Transcript

SPEAKER_00 (00:01):
Welcome to Postscripts, the podcast that
explores what happens afterthose first prescriptions are
filled.
We cover the latest innovationsin patient access, support,
digital tools, HCP engagement,and pharma marketing that we all
hope drive better outcomes forpatients.
This podcast is forinformational purposes only and
does not constitute any medicaladvice, nor should it be used to
influence any clinical decisionmaking.

(00:22):
Patients should always consulttheir healthcare professionals.
Welcome to the podcast.
My name is Brian Carr.
I uh work at MetaSafe, althoughany opinions expressed here are
my own and not necessarily thoseof MetaSafe or its partners.

Hey, we've got a big one today: the pricing power, brand (00:34):
undefined
loyalty, and what's happening inthis post-stript era.
The landscape shifting forpharma companies.
More than ever, the pharmaexecutives that we're seeing are
really being called to thinkbeyond pricing models and
reimagine how patients arereally connecting with their
patient treatment journeys.
The shift is being acceleratedhere in the U.S.
by discussions around this mostfavored nation, MFN, pricing

(00:57):
model.
If it's adopted broadly and it'salready having its impact here
in the U.S., MFN would tie theU.S.
drug prices to those paid inother comparably developed
nations.
This is a radical proposition inwhat has been a historically
free market here pricingenvironment for pharmaceuticals.
But this cost downward pressurethen creates this powerful
ripple across commercialstrategies.

(01:19):
What's the fallout?
A renewed, urgent focus we areseeing on brand loyalty.
For pharma brand marketers,innovation teams, commercial
leaders, loyalty could fastbecome a leading KPI, and the
effectiveness of digital patientengagement programs suddenly
becomes a differentiator, not anicety.
Today we're exploring thatlinkage, the rise of the most

(01:41):
favored nation pricing, what itmeans for patient engagement,
and brand stickiness andlong-term commercial viability.
So let's understand the mostfavored nation model.
It was first introduced duringthe Trump administration,
revisited the first Trumpadministration, and then
revisited under President Biden.
The most favored nation model isit's about pegging the American
drug prices to an index based onprices paid by other wealthy

(02:03):
nations like Germany, France,and the UK.
The aim is cost containment,particularly in Medicare Part B
for U.S.
patients and potentially broaderpayer channels, right?
So according to the Centers forMedicare and Medicaid Services,
colloquially known as CMS in theU.S., the model was projected to
save taxpayers approximately$28billion over seven years when

(02:24):
initially proposed.
However, pharma pricing is notjust about quantity and cost,
it's about perception, value,experience.
That's where the conversationturns from cost control into
brand strategy.
So what are the consequences onpharma commercial strategy?
Well, with price convergencebetween US and XUS market, the
historical pricing moat Americanpharma brands typically enjoyed

(02:48):
is starting to shrink.
That squeezes margins anddilutes pricing power.
So farmer brands are going toneed new sources of competitive
advantage, and chief among them,brand differentiation, patient
loyalty, retention.
That means farmers are going tobe leaning into value-added
services, digital engagement,medication management, real
world support at the tip of yourfingers, right, to earn loyalty

(03:11):
because prices are not going todo it anymore.
So this top strategicimplications include de-emphasis
now on price competition,increased competition on patient
services, right?
Great emphasis on net promoterscore or refill behaviors too,
and other patient experienceKPIs.
Look for procurement and brandteams that will be collaborating

(03:31):
more closely on the downstreamexperience strategies.
Why?
Because that protects marketshare, right?
The idea is simple.
If prices are flat, pharmasuccess depends on stickiness.
Will your patient come back forrefill?
Number two, number three, orquit just quit the therapy
altogether.
Or more likely, the doctors now,it's also kind of gone
unreported, is the doctors noware going to actually see the

(03:54):
pricing as they prescribemedications and more than likely
will be uh seeing what you willpay as a patient based on your
coverage, right?
This is something they've neverseen before.
You go to the doctor now and youask them, you know, do you they
have no idea how much the medscost, right?
Which is probably a good thing.
Some would argue it's a goodthing.
But anyway, now the prices aregoing to be there, but tell part
of the transparency push by theTrump administration, and

(04:16):
they're now using AI models tomake sure the price and
transparency is shown even evenhigher as they're being
prescribed.
So you can imagine the scenario,right?
You know, a doctor looks at twomedications comparable, right?
The PBMs would say, oh, by allmeans, by all means prescribe
the less expensive one, right?
So they can increase theirmargins.
Whereas a doctor may be like,well, you're on the brand of
medication, we're not seeing anybad effects, there's no side

(04:38):
effects, really like it, but youknow, 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'smade in America, because you're
gonna see a lot of that comingin the next couple of years.
I like the fact that Jane is mysupport team rep.
I can tap my engagement devicefor the brand tap.

(04:59):
I can talk to her right away andask 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 thatmy provider or copayer has to
pay, right?
So that's the type of brandloyalty we're actually talking
about in the real world.
You know, we are seeing some ofthe uh pharma companies launch
their own websites, and we sawthe news about Trump RX, where

(05:19):
you could theoretically go to awebsite and, you know, if you've
been prescribed to buy themedications that way.
Let's face it, 80, 85% of the USpopulation is covered from uh in
their health plan from theirwork, right?
So they're paying a$10,$20,$30copay anyway, usually, right?
So it's very rare you're gonnahave someone who is either
uninsured or it's for the GLPones where it's hasn't been

(05:39):
prescribed yet, and they go to awebsite, they have a doctor's
appointment, and they get themedication that way.
That's those are gonna besuccessful.
And as D2C evolves over the nextmonths and years, you're gonna
definitely see that experiencegrow, and I think at the expense
of PVMs.
But anyway, let's get on tothis, what is really gonna be
brand loyalty as a keypharmaceutical KPI.
Loyalty of pharma, it's longlagged behind sectors like

(06:01):
consumer package goods, right?
Largely due to the prescriptivenature of medicine, right?
But as chronic conditiontreatment becomes more
self-managed, patient-informed,loyalty metrics are starting to
surface, right?
So some of the leadingindicators of pharma brand
loyalty include medicationadherence rates over six to 12
month periods.
What's that compliance orpersistent rate, right?
Patient-initiated refills versuspassive HCP-driven continuation,

(06:27):
right?
Engagement during within uhwithin digital therapeutic
platforms, the duration withinthe platform, right?
And theoretically, what othermedications are they taking in
conjunction with your brandedmedication?
Is that affecting how theirtreatment's going, right?
NPS and patient satisfactionsurveys, these are key.
These are one of those some ofour partners absolutely love.

(06:48):
They need to get the NPS, theyreport it internally, others
don't.
But anyway, those patientsatisfaction surveys are
incredibly important.
So according to health affairs,the poor medication adherence
costs the US, yeah, as you as weall have heard this this number,
$300 billion annually, largelydue to complications, hospital
readmissions, et cetera.
You know, it's a public healthfailure to some extent.
It's also a brand failure tosome extent, right?

(07:09):
Because the thesis is a loyalpatient is an engaged patient,
and an engaged patient tends tobe more adherent, producing
better outcomes, fewercomplications, longer lifetime
value for therapy brands, right?
So let's think about the role ofdigital engagement.
So how do you build that loyaltyat a low cost, high ROI?
Well, it's through digitalpatient engagement programs,
right?
You can get a branded medicationapp.

(07:30):
It's no longer a bonus.
It's not a nice-to-have, it's astrategy, right?
Programs that deliver timelyrefill reminders, dose tracking,
symptom monitoring, educationalsupport, videos.
They're not just nice-to-haves.
They're becoming essentialloyalty infrastructure.
And the key point here is mostfarmer and brand teams already
have the assets ready.
They have videos and one pagersand PDFs on, a little bit more

(07:52):
about the medication and quizzesand surveys, right?
Well, you really want to do isdigitally engage patients so
they're not always just going toyour website once, right?
They're being engaged at theright time.
Say they're ready to refill.
That's a great time to hit themup with a survey, what's your
doctor telling you, things likethat, or doctor discussion
guide, right?
But a lot of that, you know, hasto be a push to a patient.

(08:12):
In other words, hey, it's nowyour, you've done your 90 days,
three refills, time to have aconversation with your doctor,
your appointment's coming up.
Here's a doctor discussion guideif you want to get a head start
on some of the questions youmight want answers to, right?
So that's a push.
That's not something someone'stheoretically going to think of
and do on their own in theirbusy life.
Go to the website, you know,search resources, go down and
then download a doctor'sdiscussion guide.

(08:33):
It's just presented to them atthe right time, the right port
of their point of their patientjourney.
Like, you know, the MedSafeDigital Companion, we're highly
personalized experience.
We support patients throughoutthe treatment journey,
medication reminders, resources,pill tracking, cross-therapy
insights, all in one place.
We also have VIA, which is thevoice integrated agent, where we

(08:54):
enable brands to acceleratedeployment and customize support
programs around therapies,reducing time to launch while
increasing flexibility and reachof personalization because it's
a voice-activated agent that aperson 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 whenthe program becomes available on
an app, right?

(09:15):
Or checking in this, you know,just a weekly check-in, just
about, you know, not giving outor dispensing any any medical
advice.
It's similar to what you'll seefrom hub systems right now,
right?
But this is all automated withvoice agents that can work 24-7
in MetaSafe multilinguallanguage.
They can be deployed andtriggered based on some app
activity and events that havehappened within the platform.

(09:36):
It's based on the pharmaprotocols.
This is the time to give them acall on this.
This is Brian, he prefers to becalled after 3 o'clock in the
afternoon, but not later than 7o'clock, for example.
Things like that.
This can all be programmed tothe 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 bedthat need that daily support and

(09:57):
really want to have that contactand 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 aquick survey with them, et
cetera.
That can be automated just tocheck in and make sure that
they're staying on brand.
If they have any questions, taphere, right?
So these are automated voiceagents that we've got available
and integrated throughout oursystem, where it can be deployed
in uh, again, to farmerprotocols, and what it really

(10:19):
does is trigger engagement atthe right time for patients in a
way that is very comfortable.
So, you know, it when you'retalking about C-suite
procurement implications aswell, right?
Let's now zoom up to thatexecutive level.
If MFN pressures squeezemargins, the bed, the boardroom
conversation naturally turns tocost efficiencies and innovation
levers, right?
Procurement and user experienceteams and patient teams, the

(10:41):
discussion then becomes bothdefensive and offensive.
Defensive levers, retain thepatient base with richer
experiences, reduce the loss dueto abandonment, discontinuation
by integrated tools like aMetaSafe.
Include digital companions inRFPs for new drug launches early
on.
I could tell you that many SaviPharma execs know they're

(11:01):
launching within a year, andthat's when conversations are
starting for launch brands anddigital companion engagement.
So if you're not doing thatright now, it's your competitors
certainly are.
And pharma brands can go in theoffensive, right?
Deploy support programs ascompetitive differentiators,
drive higher adherence as an ROIlever back to payers, right?
Use engagement data for informedcontract, engagement data for

(11:25):
informed contract rebasing,right?
So pharma execs who broaden theKPIs beyond unit price and uh
and they do move to a moreholistic lifetime value and
experience metrics, they'regonna win under the most favored
nation reimagined markets.
It's already starting to happen.
According to an Accenturesurvey, 73% of pharma companies
are either piloting or scalingtheir digital platform, their
digital engagement platform,64%, 65% now.

(11:48):
I'm sorry, long-term patientloyalty as the critical
objective in brand stewardship.
So finally, you know, inconclusion, loyalty is gonna
lead in the post-pricing wararea.
The MFN model, not just aregulatory shakeup, it's a nudge
to a new area of pharmacompetitiveness built not just
on price, but on connection,engagement, trust, longevity,
brand loyalty.
Those metrics are coming to thefore.

(12:08):
And as markets flatten, marginsget pressed, those who win win
through loyalty.
And loyalty is born fromexperience, support, and
relevance.
That means patient services anddigital companions go from being
supplementary aides to becomingcommercial accelerants.
The winners are those brandsthat A, measure loyalty through
adherence, engagement, surveys,net promoter scores, right?

(12:30):
B, develop scalable platformsfor patient interaction in
trusted, compliant, and securemanners.
And C, partner with serviceinnovators, you know, like
MetaSafe and others that executefast with precision.
So when we look at this MFNpricing looming and patient
power rising, pharma isreframing, and we no longer sell
it to prescribers alone.
We earn the loyalty of humanbeings, prescribers alone,

(12:53):
excuse me.
We are in the loyalty of humanbeings who are managing these
complex diseases every day.
It's going to be a loyalty play.
All right.
Thank you so much for joining ushere at Postscripts.
If you like, please subscribe,and uh, we'll see you next time.