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Gross-to-Net is where profitability is won or lost.
Profitability advisory for life sciences.
Patient outcomes and sustainable profitability are not opposing objectives. They are the same objective, seen from two sides. Patient friction creates revenue leakage, and Gross-to-Net is where it shows. We trace every point back to the patient and commercial decisions that set it, then help you design those decisions on purpose.
The philosophy behind the practice
Patients + Profitability™
Patrick R. Coyle came into pharmaceutical finance from IT and finance, which is part of why the patient journey and the general ledger never looked like two subjects to him. Eighteen years inside the industry followed, at Bayer, Novartis, Insmed and Eisai Americas as VP and CFO, then in Gross-to-Net advisory at IQVIA and Baker Tilly.
The same pattern repeated at every stop. Finance saw a number that missed, usually a quarter or more after the decision that moved it. That decision had been made somewhere else entirely: a coverage rule, an authorization queue, an affordability program, a channel choice. By the time it reached the P&L it was arithmetic, and the event behind it was gone.
Patients + Profitability is the conclusion he drew. The patient journey is the center of commercialization, and Gross-to-Net is the financial echo of how well the enterprise executed it. Patient outcomes and sustainable profitability are not opposing objectives. They are the same objective, seen from two sides.
Patient friction creates revenue leakage.
How it shapes the advisory
It sets the order
Patient, then transaction, then number
Every engagement follows the patient first, then the access and channel events, then where those events land in Gross-to-Net. The sequence is not interchangeable.
It sets the standard
A number traced to its cause
An answer is not a variance explained. It is a variance followed back to the exit, the contract or the channel decision that produced it, with an owner named.
It sets the room
Both sides at one table
Commercial counts the patients. Finance prices the same figures. The work is getting them into one room, on one vocabulary, deciding together.
The loop
Break any one link and the loop stops.
Innovation creates possibility, but possibility has little value to a patient who cannot access it. Access turns innovation into treatment, treatment creates the opportunity for outcomes, and sustainability allows innovation to continue. An innovation nobody can reach produces no outcomes, and outcomes nobody can fund produce no next innovation.
- 1InnovationCreates possibility.
- 2AccessTurns innovation into treatment.
- 3OutcomesTreatment creates the opportunity for outcomes.
- 4SustainabilityAllow innovation to continue, for the next patient.
One journey, two sides
The patient journey and the economic journey are the same journey.
They are seen from opposite sides. The 10 Exits of Therapy™ describe where patients leave. The 5 Layers of GTN™ describe where that loss shows up in the economics. Patient friction and revenue leakage are the same problem.
Scroll sideways to follow each exit to its layer.
The Silent Leak™
Not denied. Never counted.
The Silent Leak is revenue lost to patient friction that no single function sees, because each function’s own metrics look acceptable. It is the distance between a product’s approval rate and its access rate, and the 10 Exits of Therapy is how it is measured.
Your approval rate is not your access rate. It describes the prescriptions that survived long enough to be measured.
The application
The philosophy is free. The application is the work.
Four questions beat one answer
“I would rather a team carried these out of the room than carried my conclusion.”Patrick R. Coyle