If there's anyone particularly qualified to provide a balanced look at the swirling tides of access to prescription drugs—from funding to technological advances—perhaps it's Harry Totonis, CEO and chairman of ConnectiveRx.
The long-time leader and entrepreneur (he cut his teeth during a 15-year stint at Booz Allen Hamilton) returned to the executive role at ConnectiveRx in January 2023 after moving to CEO two years earlier. In collaboration with Genstar Capital, where Totonis is still a member of the advisory board, he founded ConnectiveRx in 2015. The technology-focused services organization (today with approximately 1,400 employees) helps biopharma manufacturers, healthcare providers and patients manage the complexities of the prescribing process.
This complexity has of course increased significantly in recent years and months – with branded and specialty drugs currently being particularly hard hit by fluctuations in market access and the political landscape. ConnectiveRx focuses on both areas of care, namely patient support, affordability, awareness and adherence.
In the following interview with Pharm ExecTotonis shares his thoughts on the evolving dynamics of healthcare access – and how he is focusing his company on his vision for the future, including the need to pursue new strategic opportunities that he believes will arise from the current disruption.
Notably, prior to ConnectiveRx, Totonis served as President and CEO of Surescripts, where he helped grow the company into the largest e-prescription and clinical information network in the United States. He also held leadership positions at MasterCard and Kinexus.
Pharm Exec: Specialty medications now account for a significant portion of pharmaceutical spending and are becoming increasingly complex to manage along the supply chain as they continue to evolve. How has this challenged traditional patient hub services, multiple touchpoints and broader healthcare efforts around affordability and adherence?
Totonis: The access landscape is changing as specialty medications dominate pharma spending and hub services have evolved from supporting functions to central to brand success. We are managing exponentially more complex coordination requirements – logistics, specialized fulfillment, limited distribution networks and specialty pharmacy coordination – which require streamlined capabilities.
According to a 2024 AMA study, pre-authorization requirements have tightened, with 80% of providers reporting an increase, adding strain to an already slow process. This makes automating labor-intensive processes essential.
Cost remains the biggest barrier, and the data is clear: IQVIA shows that out-of-pocket costs of $250 result in abandonment rates of 50%. We are seeing more direct-to-patient solutions and greater awareness at the point of care to address this issue.
Managing specialty medications requires real-time visibility across the entire patient journey, allowing us to help customers optimize programs for their patient populations through constant data analysis.
Our mission is simple: We want to make it easier and faster for providers to prescribe the best therapy and give patients easy access to it. As medication complexity increases, we simplify the process through technology combined with skilled teams that deliver the full value of patient support services. Without it, patients lose access and the commercial success of the brand is at risk.
Pharm Exec: With the rise of DTC pharmacy models, particularly in Big Pharma, how are companies like yours advising or assisting healthcare providers in navigating this terrain? Are the benefits obvious?
Totonis: The emergence of DTC pharmacy models represents a significant opportunity for pharmaceutical companies to build direct relationships with patients while cutting out middlemen. Instead of the money the pharmaceutical industry spends with intermediaries, it can now be passed on directly to patients in the form of better prices, more savings and improved support services.
These models offer clear benefits – optimized access, reduced administrative burden and often better patient outcomes through direct engagement. The most successful implementations we've seen maintain the personal touch and comprehensive support that patients need while delivering the cost savings and efficiencies that come from direct relationships. When done right, eliminating the middleman creates a win-win situation: better access and transparency for patients and more sustainable economics for brands.
Pharm Exec: Where do you see this trend going? Do you think we are essentially entering a new era of DTC Rx care?
Totonis: For years, the industry has been talking about patient centricity – “putting the patient at the center of everything we do.” With DTC models, this vision is actually becoming a reality, and I think that is a fundamentally positive change. We see easier access for patients, the ability to pass more cost savings directly to them, and it helps the pharmaceutical industry build true trust through direct relationships rather than through multiple layers of intermediaries.
Pharm Exec: How do you assess the potential impact of other planned policy changes in the US, such as MFN drug pricing and continued implementation of the Inflation Reduction Act (IRA)? Do you see any unintended consequences arising from this and do you envision significant adjustments to the Access playbook?
Totonis: We continually assess the political and regulatory landscape, particularly as new administrations take office, and bring in outside experts to help us truly understand the impact on our business and the overall healthcare ecosystem, as everything is interconnected. Overall, the research conducted into the current situation concluded that the scope of federal drug pricing reform, whether the IRA or the MFN, is predominantly limited to Medicare patients and non-commercially insured patients whom we serve primarily on behalf of our pharmaceutical clients.
While the MFN pricing regulation is not limited to Medicare and does place some pressure on the pharmaceutical industry, research suggests that the impact on commercial pricing is relatively small and could potentially be limited to Medicaid and new drug introductions, giving the pharmaceutical industry more time to strategically plan its pricing strategies.
However, the access playbook should continue to evolve, and the earlier access strategies are developed in the commercialization process, particularly given some uncertainty around policy implications and pricing, the better.
Pharm Exec: How do advances in AI/predictive analytics fit into this equation – and how do they also shape your company’s future strategy?
Totonis: AI has been and continues to be a focus of investment for ConnectiveRx. Almost every RFP we receive now includes AI questions, especially as brand budgets come under greater scrutiny.
But for us, AI should mean more than just cost savings for brands – that's really a game-changer at this point. We focus on when and where AI integration makes sense to ensure it continually delivers and maximizes value. There is a crucial difference between cost-driven automation and results-driven automation. We think beyond how AI leads to better quality and faster output and look at how AI helps us and our customers achieve better results. These efficiencies should result in better brand performance, not just cost savings.
Healthcare will always be a very human experience, which is why we are incorporating AI that strengthens patient engagement and relationships rather than replacing it. Our customers trust us not only with the integrity of their brand, but also with the care of their patients. AI can pave the way for our human team to do what they do best: provide great care and solve problems with empathy.
Pharm Exec: You returned to the role of CEO in January 2023 after serving as Chairman. What prompted this decision and how have your strategic priorities changed since then?
Totonis: The opportunity that excited me in 2015 when I founded ConnectiveRx is still there and growing. There is tremendous potential to transform the way the pharmaceutical industry markets specialty medications, and while we have made significant progress at ConnectiveRx, I believe our greatest impact is still ahead of us. I wanted to come back to our team to fully realize this vision.
“Market changes, regulatory changes, new technologies – they all push us out of our comfort zone and force us to think differently.”
Our priorities have not changed – we remain focused on providing an exceptional experience for our customers, healthcare providers and patients. This happens in three key areas: first, by executing everything we do with precision and striving for flawlessness; second, knowing when technology is enough or when technology needs to be paired with the human touch; and third, to act as a strategic ally for our customers. Our job is to make the work of our partners easier. If we do these three things well, we are successful.
Pharm Exec: What leadership lessons stand out after transitioning between CEO and Chairman roles?
Totonis: Surround yourself with the right people. For me it always depends on the team, because at the end of the day I can't and don't know everything. I have to rely on the experts around me to make informed decisions. Therefore, building and maintaining a trustworthy team is absolutely critical to success.
Pharm Exec: What keeps you personally current despite industry changes? Or guiding principles for your career path?
Totonis: As a student of history, when I look at the last 100+ years, there is only one constant – and that is change. Momentary changes always look disruptive, but if you take a step back and assess where we are, we are all better off for the changes that have taken place. We have better medicines, better treatments and overall better outcomes.
Change forces innovation. When the status quo is disrupted, it pushes us to find better solutions. Market changes, regulatory changes, new technologies – they all push us out of our comfort zone and force us to think differently, solve problems creatively and ultimately deliver better results. Embrace change and do what we humans do best: innovation.