Approval Does Not Equal Adoption: Why getting payers to show their cards early is critical to your launch

The Dealer Already Knows You Need the Cards

If you’ve ever played blackjack at a casino, you know the dealer has a built-in advantage: the dealer goes last. Players act first and can bust before the dealer even plays a hand.

In negotiation theory, a similar principle applies. Never Split the Difference author and former FBI negotiator Chris Voss advises against making the first offer because it reveals information and gives the other side the opportunity to anchor the negotiation.

In managed care negotiations, pharmaceutical companies have effectively already made the first offer.

You’ve invested years and hundreds of millions of dollars developing a product. You’ve secured FDA approval. You need access to begin generating revenue — and the payer knows it.

The Commercialization Blind Spot

The challenge is that most commercialization models evaluate a product primarily through the lens of physicians and patients, while payers ultimately shape affordability and access. A product can be clinically compelling yet commercially constrained if reimbursement barriers limit adoption.

That is one of the core problems the RAMPx model was designed to solve.

Getting Payers to “Show Their Cards”

By interviewing payers early and walking them through a product’s Target Product Profile, RAMPx gets payers to “show their cards” before launch. Their feedback is then incorporated alongside physician and patient perspectives to create a more realistic assessment of market potential.

The model evaluates three core dimensions of adoption:

1. How much better the product is perceived to be

2. How easy and affordable it will be to adopt

3. The willingness of customers to act as early adopters

These dimensions are evaluated across twelve underlying drivers of adoption.

When Enthusiasm Meets Access Reality

In a recent RAMPx study, payers viewed a new product favorably from a clinical standpoint. However, because lower-cost alternatives already existed, they indicated the product would likely receive Tier 3 non-preferred status, resulting in commercial co-pays of approximately $80–$90 per month.

Initially, physicians were highly enthusiastic. Many estimated that up to 40% of their patients could benefit from the product, and they were willing both to switch existing patients and use it first-line in new patients.

But when physicians were shown the likely payer restrictions and co-pay implications, projected utilization dropped dramatically — from 40% to roughly 10% of patients. Adoption became largely limited to the sickest new patients and those failing current therapy.

Approval Does Not Equal Adoption

That insight materially changed the client’s launch planning. We are now working with them to reassess rebate strategy, pricing dynamics, and the size and structure of the launch sales force organization.

The lesson is straightforward: approval does not equal adoption.

The RAMPx model helps companies develop a more realistic understanding of commercial potential by integrating the perspectives of physicians, patients, and payers before launch decisions are locked in.

If you have a product in clinical development, I’d welcome the opportunity to discuss how RAMPx can help pressure-test market assumptions earlier — before the market does it for you.