Optimizing Biopharma Commercial Strategy and Patient Support Programs: Q&A with Dean Erhardt

In a conversation with Pharmaceutical Executive, Dean Erhardt, CEO, D2 Soultions, explores how gaps in communication, coordination, and system design are undermining the patient onboarding experience and delaying therapy initiation.

Erhardt discusses findings from D2 Solutions’ latest survey, which shows that a majority of patients begin their medication journey with uncertainty, limited visibility, and little to no communication. He explains how fragmented processes across providers, payers, and pharmacies leave patients navigating prior authorization, delays, and unclear next steps on their own, ultimately driving disengagement before treatment even begins.

He also highlights generational shifts in patient expectations, noting that younger patients are less tolerant of friction and more likely to abandon therapy when the process feels complex or opaque.

Finally, Erhardt outlines practical, near-term opportunities to improve the experience, including increasing transparency during the prescription-to-fulfillment period, strengthening coordination across stakeholders, and proactively addressing delays before patients disengage. A more connected, patient-centered approach, he argues, is essential not only for improving access, but for ensuring patients actually start and remain on therapy.

A transcript of his conversation with Pharmaceutical Executive can be found below.

Pharmaceutical Executive: According to D2 Solutions new survery, only 20% of patients described their most recent medication start as "strong," while nearly half reported negative emotions like anxiety or feeling "in limbo." What does that tell us about how the industry has fundamentally failed to design the patient onboarding experience around the patient?
Dean Erhardt: What this tells me is that the medication journey is still being designed around systems and transactions, not around the patient experience. When only 20% of patients describe their start as “strong” and nearly half are feeling anxiety, confusion, or like they’re in limbo, that’s not a small signal. That’s telling you the front end of therapy is broken in a very real way. The start of therapy is one of the most important moments in the entire care journey.

Despite this, patients are still left with navigating prior authorization, delays and unclear next steps without real visibility into what’s actually happening or who owns moving it forward. When that happens, engagement drops even before treatment begins. That has a direct impact on adherence and outcomes downstream.

The bottom line is that patients shouldn’t need a degree in healthcare administration just to start a prescribed medication.

PE: With survey results showing that 38% of patients are receiving little or no communication while waiting for their medication, and 46% are unaware that manufacturer support programs even exist, where does the accountability lie and which stakeholder in the ecosystem needs to step up first?
Erhardt: I don’t think this is about any one stakeholder “not doing their job.” Providers, pharmacies, payers and manufacturers are all part of the process. But the patient is the only one experiencing the entire system end-to-end, and right now that system isn’t talking to itself in a coordinated way.

When 38% of patients say they’re getting little or no communication while they wait, and almost half don’t even know manufacturer support programs exist, that’s really a visibility and coordination issue more than anything else. That waiting period is where things fall apart. So if there’s a place to start, it’s that middle space between prescription and fulfillment, because right now, that’s where patients get lost.

PE: The data shows Millennials were more than twice as likely as Baby Boomers to delay starting a medication and more prone to skipping doses or stopping treatment early. What does generational behavior tell us about how access and communication strategies need to evolve, and is the industry paying enough attention to this shift?
Erhardt:Expectations have changed faster than the system has. Younger patients, especially Millennials, are more than twice as likely to delay starting a medication, and they’re more likely to skip doses or stop early.

This isn’t because they're less engaged in their health, but because they’re much less tolerant of friction and ambiguity. If something feels unclear or too hard to navigate, they don’t wait it out the same way. They just disengage.

I don’t think the industry has fully caught up to that yet and a lot of the communication and access infrastructures still assumes patients will persist through confusion. That assumption just doesn’t hold anymore, so the bar has moved, even if the system hasn’t.

PE: As policymakers push for reform, what practical, near-term changes can healthcare companies and technology solutions implement right now without waiting for legislative action?
Erhardt: Prior authorization is one of those areas where everyone agrees there’s a problem, but it still creates friction for patients every day.

Nearly half of patients are going through it, and 22% say it takes longer than expected. Again, it’s not just the delay, it’s the lack of visibility into where things stand.

First, patients and providers need better visibility into status. Most of the frustration comes from not knowing what’s happening. Second, handoffs between systems (provider, payer, pharmacy) need to be more tightly coordinated. There are many delays in those transitions. Lastly, when something is stuck, it needs to be surfaced earlier. Not after the patient has already disengaged or given up.

These are steps that can be executed and coordinated today, rather than sitting around waiting for a policy change.

PE: What does a truly coordinated patient journey look like in practice, and what role should companies play in bridging the gaps between providers, pharmacies, insurers and patients?
Erhardt: A truly coordinated journey is one where the patient isn’t the one trying to piece everything together. It should feel simple to the patient because the patient is being informed along the journey. You get a prescription, you understand what happens next and you’re guided through the process without having to figure out which system to call or what step you’re stuck on.

Right now, that’s not the reality for patients. Instead, they’re trying to interpret information across providers, pharmacies, payers and support programs, and that’s where things break down. But I think the bigger point is this: coordination isn’t just about connecting systems, but also removing effort from the patient experience.

If you do that well, you not only improve access, you change whether people actually start and stay on therapy. For us at D2, the role is to help make that possible, by connecting the operational side of the system in a way that reduces friction for the patient, rather than adding to it. Effectively, capturing the patient at the point of prescribing and guiding them through the process while ensuring they are informed about the process and of the options they have available.