Pull-Through Strategy: Why Approval Alone No Longer Guarantees Access
- Jul 10
- 4 min read
Updated: 5 days ago
Want the downloadable brief? Get the full Signal 4 PDF and webinar replay resources from our Access Inflection resource page.
Approval is no longer the final access hurdle.
For pharmaceutical and biotech manufacturers, a favorable coverage decision can feel like the finish line. But in today’s access environment, coverage does not always translate into real-world uptake.
Even when a product is covered, operational mechanics such as coding, NDC mapping, prior authorization, claims adjudication, dosing requirements, and provider workflow can delay or limit patient starts.
During eMAX Health Systems’ webinar, The Access Inflection: When the 2025 Playbook Stops Working, a live panel of senior payer and market access leaders discussed five signals reshaping 2026 access planning.
Signal 4 focuses on The Pull-Through Trap.
The key takeaway: manufacturers cannot assume approval will translate into pull-through. Launch readiness now requires a clearer understanding of how payers, providers, coding systems, and benefit processes will handle the product once it enters the market.
Pull-Through Friction Can Be Intentional, Operational, or Both
Access barriers are not always designed as hard exclusions.
Sometimes they reflect appropriate-use controls, sequencing logic, or administrative processes intended to ensure the right product reaches the right patient.
One panelist explained:
“I think there are concrete reasons why there’s unique NDCs and steps and so forth… to make sure that the right product is going to the right patient.”
For manufacturers, the implication is important. Payer friction should not always be interpreted as resistance. It may reflect how the plan is trying to operationalize appropriate use.
The access challenge is understanding those mechanics early enough to prepare providers, field teams, hub partners, and support programs before friction slows uptake.
Coding and Claims Systems Can Create Unintended Access Barriers
Even when a payer intends to cover a product, coding mismatches can create delays.
That is especially true for products with new dosage forms, administration changes, unusual billing pathways, site-of-care considerations, or benefit complexity.
One payer panelist described the issue directly:
“We are intending to cover the drug, but we’re having friction.”
That distinction matters.
A product may have favorable coverage, but if it does not map cleanly into payer systems, providers may still struggle to get patients started. GPI, NDC, billing, PA logic, medical benefit requirements, and claims workflows can all influence whether coverage turns into treatment.
For launch teams, this means pull-through planning needs to begin before the field starts reporting barriers.
Novel Administration or Dosing Does Not Automatically Create Access Advantage
Manufacturers often view a novel administration method, unique dosing schedule, or differentiated delivery model as a competitive advantage.
Payers may view those same features differently.
As one panelist put it:
“Just because you have a novel administration or unusual dose, it doesn’t necessarily mean best in class.”
That does not mean innovation is unimportant. It means operational complexity needs to be justified by meaningful value.
If a product introduces new coding, dosing, billing, monitoring, or provider workflow requirements, the access strategy should clearly explain why those differences matter clinically, operationally, or economically.
Otherwise, what the manufacturer sees as differentiation may be viewed by payers and providers as added friction.
Provider and Payer Friction Need to Be Planned Together
Pull-through barriers often sit between the payer and provider.
A product may be approved, but questions around billing, PA approval, claims submission, documentation, and policy interpretation can still slow or disrupt patient starts.
One panelist described the dynamic as two connected funnels:
“I kind of see 2 funnels here. So one is sort of the payer friction and one is the provider friction and what they’re experiencing.”
This creates a planning challenge for manufacturers.
Payer strategy and provider support cannot be developed in separate lanes. Teams need to understand where the two workflows intersect, where breakdowns are most likely to occur, and how to reduce friction before it affects real-world adoption.
Manufacturers can also play an important bridge role by helping payers understand how the product will be used and helping providers understand what will be required to navigate access successfully.
What Manufacturers Should Pressure-Test in Their Pull-Through Strategy
For teams preparing for 2026 and 2027 planning, Signal 4 raises several important questions:
Have we mapped how the product will be coded, billed, and adjudicated across payer systems?
Do we understand where PA, step edits, documentation, or reauthorization requirements may create friction?
Have we tested whether providers can realistically navigate the access pathway?
Are payer-facing and provider-facing teams aligned around the same pull-through risks?
Have we identified where benefit design, site of care, or dosing complexity could delay patient starts?
Do we have a plan to respond quickly when post-launch friction appears?
These questions matter because the pull-through trap often becomes visible only after launch, when teams are already trying to diagnose why uptake is slower than expected.
By then, valuable time may already be lost.
Where MAVA® Fits in Pull-Through Strategy
MAVA® helps pharmaceutical and biotech teams bring current payer and healthcare decision-maker insight into high-stakes access planning before market conditions shift.
For pull-through planning, MAVA can help teams understand how payers and healthcare decision-makers may evaluate coding, billing, PA requirements, provider workflow, evidence alignment, and operational barriers before they slow real-world adoption.
MAVA can help teams:
Validate how payers may operationalize coverage after approval
Understand likely prior authorization, step edit, coding, and documentation requirements
Pressure-test whether evidence maps to payer UM criteria
Explore payer and provider friction before launch
Identify where provider workflow barriers may delay patient starts
Align Commercial, Medical, HEOR, Pricing, and Access teams around a more realistic pull-through strategy
The goal is to help teams move from launch assumptions to payer- and provider-informed pull-through planning.
The Takeaway
Approval alone does not guarantee access.
Increasingly, the real barrier may appear after coverage decisions are made, in the operational details that determine whether a patient can actually start therapy.
Manufacturers that wait until post-launch to diagnose pull-through issues may lose valuable time. Teams that pressure-test coding, billing, PA, provider workflow, and payer policy assumptions earlier will be better positioned to reduce friction and support real-world uptake.
The 2026 playbook needs to account for the full path from approval to patient start.
Now is the time to pressure-test pull-through strategy before operational barriers slow access.
