Prescribed, but never filled: Why patient access is broken
When she was only weeks old, my daughter was diagnosed with a rare disease. My wife is a patient navigator, and I lead a healthcare AI company. Yet, we nearly fell through the cracks of our own healthcare system.
The endless calls, the forms, the hours on hold, the denials, the re-submissions – my wife essentially supported our daughter full time. We are fortunate that we had the resources, the literacy, and the persistence to fight the system.
Most patients don’t. And while the patient access system is fundamentally broken, I believe we’re finally at a point where technology can help ensure the care that exists arrives to those who need it most.
The crisis hidden in plain sight
We talk a lot about incredible breakthroughs in life sciences, but we don't talk enough about the last mile.
The numbers are stark: estimates suggest roughly 30% of patients do not initiate the therapy their doctor prescribes, with rates even higher in some therapeutic areas. Cost and access frictions are two of the primary reasons.
This isn’t a drug development problem. The science exists. The prescriptions exist. What doesn’t exist is a functional system to connect patients to the therapies meant to save or improve their lives.
Patient access is no longer just an administrative backroom function; it is a core determinant of health outcomes.
"Digital" does not mean fixed
The industry’s knee-jerk reaction to a broken system is to slap a modern CRM or a portal on it, declare it "digitised", and move on.
But behind the glossy language of digital transformation, the underlying workflows remain legacy, batch-based, reactive, and constrained by 9-to-5 business hours. If a patient or provider calls a hub today, they still sit on hold, navigate archaic phone trees, and deal with fragmented data.
The patient journey is riddled with drop-offs at the seams – the handoffs between enrolment, benefits verification, prior authorisation, and pharmacy fulfilment. If a patient has a question at 7pm on a Thursday, they may be stuck until Monday morning. By then, the urgency fades, the momentum is lost, and another patient quietly abandons therapy.
Today, though, with AI we can automate those handoffs – whether they’re between systems, human teams, or AI agents. We can preserve the necessary context while accelerating patient care.
What "always-on" AI actually enables
The broader conversation about AI in healthcare has been highly philosophical: Will AI replace doctors? Can we trust a model with a diagnosis?
While those are valid questions, they’ve crowded out an immediate, massive opportunity: using AI to fix the broken infrastructure that is failing patients right now.
This isn't hypothetical. At Infinitus, for example, we look at this through the lens of operational scale. Today, for instance, a case manager at a patient access programme may spend hours every day calling providers for information that’s missing from enrolment forms (in fact, I know of a programme at one large manufacturer with a team that spends ⅔ of their time making phone calls to collect that missing info).
But when an AI agent can conduct these calls and add the information directly into patient records, it extends the human specialist’s capability. It means the teams hired to help patients during some of the most stressful times of their lives can actually provide that help, instead of spending their time on data entry. It means human staff can be freed up to help make sure patients access – and take – the medications they need.
From measuring inefficiencies to rebuilding
When autonomous vehicles were first tested, the question wasn't just philosophical, it was empirical: how do they perform against human drivers on the same roads? What are the error rates?
Patient access needs that exact same discipline. We need to move past opinions and focus on the data.
The end state isn't an AI that just answers questions or populates another dashboard. It’s AI that proactively manages the system, handling the scale so humans can handle the judgement. The technology to complete this exists.
The time to solve it is now
The patient access system isn't broken because people wanted it to fail. It's broken because it was built for an era where the phone and fax machine were the only universal interfaces, and business hours were a reasonable constraint.
That era is over. Science has given us better drugs. Now our obligation is to ensure those drugs actually reach the people who need them, by reducing the friction that’s getting in the way.
Thankfully, my daughter is doing well today. I constantly think about the families going through that same nightmare without the advantages we had. That is the problem worth solving. It is entirely solvable – and the tools exist today to fix it.
About the author
Ankit Jain is the co-founder and CEO of Infinitus Systems. He is a serial entrepreneur, start-up advisor, and investor with a proven track record of building and supporting numerous technology and AI start-ups.
