What Novartis Is Testing With Cosentyx Direct

Novartis did not copy Lilly. It ran a structurally similar play in a category where the arithmetic cannot work the same way. That makes Cosentyx the first of these moves that is actually transferable to most of the brands you run.

Lilly and Novo removed the payer from a transaction patients could plausibly fund themselves. A covered specialty biologic does not allow that, and Novartis said so in its own language. The interesting part is what the company is testing instead.

What did Novartis actually do?

Set a cash price for a specialty biologic and called it an experiment.

The media release of 29 September 2025 announced a direct to patient platform effective 1 November, offering Cosentyx to cash paying patients at 55% off list. The company described the price as one that "reflects the average savings that insurers and pharmacy benefit managers receive."

Two phrases in that release are worth more than the platform itself. Novartis called the program a proof of concept for selling specialty medicines directly. Victor Bultó, President US for Novartis, called the launch "a first step."

Note the restraint. Those are the words of a company running a test rather than announcing a solution, and you should read them literally rather than as modesty.

The release also disclosed something easier to miss. Novartis is exploring a direct to business model that would sell Cosentyx, and possibly other medicines, to large employers.

Why does the arithmetic work differently here?

Because 55% off a very large number is still a very large number.

Do the subtraction yourself. Managed Healthcare Executive reported the July 2025 list price at $7,936.48 a month for a self injection package. Take 55% off and you are at roughly $3,600 a month, which is about $43,000 a year.

That is not a consumer price. No patient with a chronic inflammatory condition funds that out of pocket across years, which means the cash channel here is not aimed at the population a GLP-1 cash price reaches.

So who is it for? A narrow slice, and naming it precisely is the whole value of the case. Patients inside a high deductible phase, where $3,600 beats the full list they would otherwise face. Patients between coverage. Then, if the direct to business idea develops, employers who would rather buy at net than through a rebate chain.

Novartis is not deleting the payer. It is testing whether the net price can reach the buyer without the intermediary, which is a different and considerably more ambitious question.

So what is actually being tested?

Net price transparency, not channel convenience.

This is where the Cosentyx move separates from the two before it. LillyDirect shortened a route. Novartis is pricing against the rebate system and saying out loud that the discount approximates what insurers and pharmacy benefit managers already receive.

Read that as a positioning statement about where the money currently goes. Whether it holds commercially is unproven, and the company has not claimed otherwise.

The direct to business thread is the one I would watch. Selling a specialty biologic to a large employer at net price targets the pharmacy benefit manager rather than the pharmacy. If that works it changes more about your market than any patient portal will.

Context from Pharmaceutical Commerce is useful here. Chip Parkinson, CEO of Gifthealth, points out that specialty medicines are more than half of drug spend while reaching only about 2% of patients. That concentration is why specialty is the next place these models go, and why the economics are harder when they arrive.

Which path does this solve?

One seam of one path, and naming the boundary is what makes the case usable to you.

We model the distance between science and patient as three sequential paths. The Path to Prescribe , where a patient is identified, diagnosed, referred and a clinician decides. The Path to Fulfill , where that decision survives coverage, prior authorization, cost and dispensing. The Path to Adhere , where the patient stays on therapy long enough to get the benefit the trial demonstrated.

Cosentyx direct addresses affordability inside the Path to Fulfill, for a defined population. That is a real contribution. It is also a narrow one, and the narrowness is the part you can learn from.

Consider what a specialty biologic actually puts a patient through, and how much of it a cash price leaves untouched. Benefit verification, prior authorization, specialty pharmacy coordination, injection training, refill logistics.

The published burden on that path is heavy. In the American Medical Association's latest survey, 93% of physicians said prior authorization delays care and 82% said it at least sometimes leads patients to abandon treatment.

The Path to Adhere is untouched entirely. For a self injected biologic taken over years, that is where most of the earned value actually sits, which is a statement about the structure of the problem rather than about Novartis.

What does the four door problem tell you?

That for a covered biologic the binding constraint has quietly stopped being price and become finding the right door.

Read the affordability routes Novartis lists in its own release, all of them legitimate and well intended. Eligible commercially insured patients may pay as little as $0 through a copay program. Patients appealing an initial coverage denial may receive the medicine at no cost for up to two years. Uninsured or government insured patients meeting income criteria may receive it free through the Novartis Patient Assistance Foundation. Cash paying patients may now buy at 55% off list.

Four doors. Each one solves a real problem for a real population. None of them is the wrong answer.

Now put yourself in the chair of a newly diagnosed patient, or the office manager helping her. Which door applies to you depends on your insurance status, your income, whether you have been denied yet, and where you sit against your deductible. Nobody in the system is accountable for telling you which one you are standing in front of.

That is an unowned problem, it is structural rather than anybody's failing, and it is almost certainly true of your portfolio too. Gartner found 62% of customer service channel transitions are high effort in industries that can watch the transition happen. You cannot watch yours, and you have more doors than they do.

Adding a door improves the menu. It does not reduce the effort of choosing, and effort is what determines whether a decision your science already won turns into therapy.

Did it work?

Nobody has published a number, and nearly a year after launch that absence is the finding.

Be careful what you conclude from it. No uptake figure has been released for Cosentyx direct, which is not evidence of failure and not evidence of success. It is evidence that the category is being run without public measurement, which is exactly the condition in which everyone copies everyone.

The useful independent read is directional. Parkinson describes the industry as "moving past pilot mode" and expects platforms to stop defaulting to cash pay, instead routing each patient down whichever path, cash or insurance, is cheapest and fastest. If that is where this goes, the enduring asset is the routing logic rather than the price.

There is also a regulatory overhang any company in this space inherits. The same reporting notes that the HHS Office of Inspector General has sought public feedback on a full safe harbor for direct to patient arrangements, with rulemaking possibly advancing in 2027. If you are planning one of these, design for a rule that does not exist yet.

What should you take from it?

That price is one seam of one path, and your gate is probably somewhere else.

Three of these moves have now run inside two years, and the industry pattern is clear enough to name. Managed Healthcare Executive records AstraZeneca at up to 70% off list for two products and Bristol Myers Squibb at more than 80% off Sotyktu's list from January 2026. Every one of them is a pricing and channel decision made by commercial leaders. Not one of them began as an experience program.

That is the transferable lesson, and it is the same one the Lilly and Novo cases produced. These companies found the specific structural gate between their science and their patients, then changed the structure rather than improving the experience around it.

Your gate will be different. For most covered specialty brands it is the interval between the prescription and the first dose, and the quiet attrition after it. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7% of initial brand name attempts in 2024. Of those rejected scripts, 48.4% were never followed by a fill of that drug or anything in its class within 90 days.

So find your gate, name the seams, put an owner on each one, and measure what arrives. The money sitting in that interval is value leakage. The share of earned decisions that becomes therapy is your Realization Rate. The bar your patients are already applying is Consumer-Grade, the discipline that recovers the value is Customer Excellence, and the whole argument sits in the future of the pharma commercial model.

Novartis is testing the hardest version of this in the open. The question it leaves on your desk is which of your four doors a patient is standing in front of right now, and who in your company knows.

Key takeaways

Cosentyx direct is a net price experiment rather than a channel convenience play, and Novartis describes it as a proof of concept rather than a solution.
Fifty five percent off a list price Managed Healthcare Executive put at $7,936.48 a month still leaves roughly $43,000 a year, so the cash channel reaches a narrow population rather than a consumer one.
The direct to business thread matters more than the patient platform, because selling at net to large employers targets the pharmacy benefit manager rather than the pharmacy.
It addresses affordability inside the Path to Fulfill and leaves benefit verification, prior authorization, specialty coordination and the entire Path to Adhere where they were.
For a covered biologic with four affordability doors, your binding constraint is orientation rather than price, and no function owns that.

Questions to ask your leadership team

How many affordability routes does your lead brand have, and who tells a patient which one applies to her?
If you set a cash price at the average rebate you currently give away, what would it be, and who would object internally?
Would a large self insured employer buy your brand at net, and has anyone in your company ever asked one?
Of the barriers on your Path to Fulfill, how many are price and how many are paperwork and coordination?
What share of earned decisions on your brand becomes therapy at twelve months, and when did you last look?

About the author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related reading: The future of the pharma commercial model, What is Realization Rate? and How to measure customer experience in pharma

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[PRACTICE NOTE] Your Call Plan Isn’t the Problem. Your Customer Context Is.

March 15, 2026

Why healthcare professionals now judge pharmaceutical engagement against the best experiences in their lives, and what that means for the future of commercial leadership. When commercial performance falters, the reflex inside many pharmaceutical organizations is to adjust the machinery of field execution. Leaders revisit call plans, recalibrate targeting models, and increase the volume of activity in the hope that more precision or more frequency will restore momentum. For decades this system has been treated as the central instrument of commercial performance, determining which physicians are prioritized, how frequently representatives engage, and how resources are deployed across territories. Yet the growing gap between commercial effort and commercial impact suggests a deeper issue. T he problem is rarely the design of the call plan itself. It is the context in which healthcare professionals now operate. Physicians are navigating increasingly complex clinical, administrative, and informational environments, and that evolving reality now shapes prescribing behavior far more than the cadence of promotional interactions. What many organizations are experiencing is a widening Customer Context Gap. Commercial systems were designed for a time when prescribing decisions could be influenced primarily through promotional interaction and product information. Today physicians operate inside a far more complex reality shaped by administrative burden, reimbursement constraints, digital information overload, and growing expectations for seamless support across the entire care journey. In this environment the physician’s decision is influenced not only by clinical evidence but also by how easily a therapy fits into the practical realities of care delivery. When commercial models remain anchored in promotional activity while the customer’s context has fundamentally changed, even the most disciplined call plan struggles to deliver the outcomes it was designed to produce. Closing this gap requires a different way of thinking about commercial performance. The question is no longer how to optimize promotional activity but how to align the organization around the real journeys through which physicians help patients receive therapy. Prescribing decisions unfold within complex sequences of clinical evaluation, reimbursement navigation, patient readiness, and ongoing support. When commercial strategy is designed around these journeys rather than isolated interactions, the role of the field force begins to evolve. Representatives are no longer positioned primarily as messengers of information but as partners in removing barriers that slow care. Organizations that recognize this shift begin redesigning their commercial systems accordingly, aligning field engagement, digital support, access programs, and patient services around the same goal: helping healthcare professionals help patients move from clinical intent to successful treatment. From Promotional Activity to Customer Journeys The pharmaceutical industry has historically organized commercial activity around the moment of promotion. Call plans, targeting models, and message sequencing were designed to influence prescribing behavior primarily through informational engagement with healthcare professionals. While this model brought structure and scale to commercial operations, it reflects an earlier era in which the path from clinical awareness to prescribing action was comparatively linear. Today the journey is far more complex. Physicians must navigate an intricate landscape of clinical evidence, treatment guidelines, payer requirements, prior authorization processes, patient affordability concerns, and adherence challenges. Prescribing a therapy is no longer a single decision point. It is the beginning of a chain of events that determines whether a patient ultimately receives and remains on treatment. This is why the commercial conversation must expand beyond the traditional moment of prescription to encompass three interconnected journeys. The first is the Path-to-Prescribe , where scientific evidence, clinical education, and confidence in the therapy shape the physician’s willingness to recommend treatment. The second is the Path-to-Fulfill, where access, affordability, patient readiness, and operational support determine whether that recommendation ultimately becomes therapy in the patient’s hands. The third is the Path-to-Adhere , where ongoing patient support, monitoring, and engagement determine whether patients remain on therapy long enough to realize the intended clinical benefit. Science drives the Path to Prescribe, where evidence, clinical education, and confidence in the therapy shape the physician’s willingness to recommend treatment. Experience shapes the Path to Fulfill, where access, affordability, and patient readiness determine whether that recommendation becomes therapy in the patient’s hands. Sustained outcomes depend on the Path to Adhere, where ongoing support, monitoring, and engagement ensure patients remain on therapy long enough to realize its intended clinical benefit. When commercial organizations focus almost exclusively on the first while leaving the latter journeys fragmented and burdened, a significant portion of therapeutic value is lost between intention and impact. In many therapeutic areas, the result appears in the persistent gap between prescriptions written, prescriptions filled, and therapies sustained—gaps that reflect not a failure of science but a failure of system design. Recognizing these three journeys shifts the unit of focus from promotional activity to the real-world pathways through which care is delivered. It reframes the role of the field force, the purpose of digital engagement, and the design of patient support programs around a single objective: reducing the friction that stands between clinical intent, treatment initiation, and sustained patient outcomes. Customer Context Is the New Commercial Variable For much of the pharmaceutical industry’s history, commercial performance was largely explained by a familiar set of variables. Product efficacy, clinical differentiation, promotional reach, and sales force execution determined the trajectory of most brands. When performance lagged, leaders adjusted those levers by refining segmentation, optimizing targeting, and recalibrating call plans. Today those traditional levers still matter, but they no longer explain commercial outcomes on their own. A far more powerful variable has entered the equation: customer context. HCPs now operate within an environment defined not only by clinical complexity and administrative burden but also by rising expectations shaped by their experiences outside healthcare. Physicians are also consumers. In their personal lives they interact daily with companies such as Apple, Amazon, Tesla, and Netflix that anticipate their needs, remove friction, and simplify complex processes through thoughtful design. These experiences quietly reset the benchmark for competence, responsiveness, and respect for their time. When those same physicians step into their clinical roles, they do not shed those expectations. They carry them with them. The contrast between the seamless orchestration of their consumer experiences and the fragmented systems surrounding many healthcare interactions becomes difficult to ignore. What once felt acceptable now feels unnecessarily burdensome. This dynamic represents the Consumer-Grade Imperative. Healthcare professionals increasingly evaluate pharmaceutical engagement not against other pharmaceutical companies but against the best experiences they encounter anywhere in their lives. In this environment even a clinically superior therapy can struggle if the surrounding system makes it difficult to initiate treatment, navigate reimbursement, or support patient adherence. Customer context therefore becomes the new commercial variable. It determines whether scientific differentiation translates into practical adoption. It shapes whether prescribing intent becomes therapy initiation and whether therapy initiation becomes sustained patient outcomes. Call plans were designed to manage activity. Customer context requires organizations to manage journeys. The Field Force in the Era of Customer Context Recognizing customer context as the defining commercial variable inevitably reshapes how the role of the field force is understood. For decades the pharmaceutical sales representative has been positioned primarily as the carrier of scientific information. Call plans optimized the frequency and sequencing of these interactions to ensure that physicians received consistent messaging. That role does not disappear, but the environment surrounding it has changed profoundly. Physicians today are navigating administrative burden, payer complexity, digital information overload, and increasing time pressure. In this environment they are not simply seeking more information. They are seeking clarity, simplicity, and support that helps them navigate the complexity surrounding treatment decisions. This shift transforms the representative from a messenger of information into something far more valuable: a partner in removing friction from the care journey. Conversations move beyond repeating clinical claims toward understanding the practical barriers that physicians and their teams face as they attempt to initiate and sustain therapy for patients. The most effective field forces are therefore supported by commercial systems designed around journeys rather than activities. Representatives are equipped not only with scientific messaging but with the insight and coordination required to address obstacles across prescribing, reimbursement, and patient support. Field engagement becomes a catalyst for problem solving rather than simply a vehicle for promotion. From Call Plans to Customer-Aligned Commercial Systems If customer context has become the defining commercial variable, then the systems designed to support the field must evolve accordingly. The traditional call plan was built to manage activity. It provided structure for how frequently physicians were engaged, how territories were covered, and how resources were deployed. Yet activity alone does not determine whether therapies ultimately reach patients. What determines impact is whether the commercial system surrounding the physician reduces or increases the burden of delivering care. A customer-aligned commercial system begins with the journeys through which physicians help patients move from diagnosis to treatment and beyond. Marketing clarifies the scientific story. Sales provides trusted relationships and real-time understanding of physician needs. Access teams simplify reimbursement pathways. Patient support programs reduce administrative burden. Digital engagement reinforces and extends human interaction. The result is a commercial system that operates less like disconnected functions and more like an integrated network designed to help physicians help patients. This is the essence of Customer Excellence. It aligns the entire commercial enterprise around the real-world context in which care is delivered. The problem was never the call plan. The problem was the context. Key Takeaways Commercial performance in pharma organizations has traditionally been managed through field execution mechanics, yet the effectiveness of those mechanics increasingly depends on how well they reflect the real-world context in which physicians operate. Customer context has become the most pivotal commercial variable as administrative burden, payer complexity, and consumer-grade expectations reshape how prescribing decisions are made. HCPs now evaluate pharmaceutical engagement against the best experiences they encounter anywhere in their lives, raising the standard for clarity, responsiveness, and ease. Optimizing promotional activity alone is no longer sufficient. Commercial success depends on reducing friction across the journeys physicians navigate as they move patients from diagnosis to treatment. Customer Excellence represents the structural response, aligning marketing, sales, access, digital engagement, and patient support around the real journeys of care delivery . Diagnostic Questions to Consider Are we optimizing the activity of our field force, or designing commercial systems that support the real journeys physicians navigate to help patients receive therapy? How well do we understand the administrative, reimbursement, and operational barriers physicians encounter after they decide to prescribe a therapy? Do our commercial systems reduce the burden placed on physicians and their staff , or unintentionally add to the complexity of care delivery? Are we benchmarking our engagement against other pharma companies , or against the best experiences physicians encounter in their lives as consumers? Have our investments in digital platforms simplified the physician’s experience, or multiplied the number of disconnected interactions they must manage? Are we still managing performance through activity metrics alone , or beginning to understand the context that ultimately determines whether therapies reach patients? Closing Reflection The pharma and life sciences industry has spent decades refining the mechanics of field execution. Call plans, segmentation models, and targeting systems brought structure and discipline to commercial organizations. Yet the environment surrounding physicians has evolved far more rapidly than the systems built to support them. Healthcare professionals now operate in a world defined by consumer-grade expectations for clarity, responsiveness, and ease. When the experience of engaging with a pharmaceutical company fails to reflect those expectations, the contrast becomes impossible to ignore. Organizations that recognize this shift will redesign their commercial systems around the realities of modern care delivery. They will move beyond managing activity and toward understanding the context in which physicians help patients receive treatment. In doing so they will close the gap between scientific innovation and real-world impact. Your breakthrough science deserves experiences worthy of it. Together, we turn customer excellence into real-world impact. About the Author Wayne Simmons is a hands-on commercial excellence architect and founder of The Customer Excellence Agency, where he partners with pharmaceutical and life sciences leaders to turn customer-centric ambition into durable commercial advantage. He previously served as Global Customer Excellence Lead within Pfizer’s Chief Marketing Organization and has held leadership roles with Bayer Pharmaceuticals and The Ritz-Carlton Leadership Center. Wayne writes The Customer-Centric Marketer newsletter and is the author of The Customer Excellence Enterprise: A Playbook for Creating Customers for Life. The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

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