The vocabulary of Patients + Profitability™, defined once, in one place.
Each term below has its own page with a one-sentence definition, a short explanation of why it matters, and links to the articles and programs where it is applied. These are the canonical definitions; where the same term appears on nextgengtn.com or novusproximus.com, it means what it means here.
Terms
- Patients + Profitability™: the philosophy that patient outcomes and sustainable profitability are interdependent rather than opposing, because the patient journey and the economic journey of a therapy are the same journey viewed from opposite sides..
- The Silent Leak™: the population of patients who leave the path to therapy before any system records them: not denied, never counted, gone before a prior authorization, a claim or a support enrollment was ever created..
- The 10 Exits of Therapy™: the ten sequential points at which a patient can delay or discontinue between diagnosis and a sustained start on therapy: Diagnosis, Provider Access, Prescription Creation, Enrollment, Coverage, Authorization, Affordability, Fulfillment, Patient Engagement and Therapy Initiation.. Patients and caregivers can find which exit applies to them at Where did your treatment stop?
- The 5 Layers of GTN™: the five sequential, causal layers through which commercial decisions become the Gross-to-Net number: Layer 1 Clinical and Product Foundation, Layer 2 Access and Policy, Layer 3 Channel and Distribution, Layer 4 Affordability and Patient Support, and Layer 5 Financial Visibility and Enterprise Performance..
- Gross-to-Net: the difference between a pharmaceutical product’s gross sales at list price and the net revenue the manufacturer actually recognizes after rebates, chargebacks, discounts, fees, returns and government program obligations..
- Patient Friction: any barrier, delay, administrative requirement or moment of uncertainty between a prescription and a sustained therapy that causes a patient to stall or stop.
- Commercialization Alignment Labs™: four facilitated executive sessions that take a new product from an unformed commercial position to a launch execution plan, one decision set at a time: Lab 1 Patient Opportunity, Lab 2 Distribution Architecture, Lab 3 Leakage Architecture and Lab 4 Launch Readiness..
- Product Lifecycle Phases: the four phases of the commercialization model used across this work: Phase 1 Pre-Launch and Launch Readiness, Phase 2 Launch and Early Commercialization, Phase 3 In-Market Optimization, and Phase 4 Lifecycle and Loss of Exclusivity..
Terms you will meet as a patient
These are the ordinary words of the system, defined plainly. They are not trademarks and they are not ours. They are the vocabulary you need in order to ask a useful question.
- Differential: the list of conditions a clinician is working through, ruled out in an order set by which are most likely, most dangerous and most testable. Explained in Before Anything Can Be Prescribed.
- Working diagnosis: the clinician’s current best explanation, written in your record before any final answer. Often enough to start a referral. Explained in Before Anything Can Be Prescribed.
- Network: the list of clinicians and facilities your plan has a contract with. A list of contracts, not a list of who is qualified to treat you. Explained in Booked Out, or Out of Network.
- Network adequacy: the requirement that a plan’s network actually contain someone who treats your condition within a reasonable distance or time. When it does not, there is a formal route to ask the plan to cover an out-of-network clinician. Explained in Booked Out, or Out of Network.
- Referral: a separate document from the appointment, sometimes required before a plan will pay for a specialist. It can expire and it can name a specific clinician. Explained in Booked Out, or Out of Network.
- Transmission: the act of sending a prescription to a pharmacy, which is separate from the decision to prescribe and happens after you have left the room. Explained in The Decision Was Made. The Prescription Was Not Sent..
- Patient support program: help attached to a treatment, covering cost, paperwork, delivery or getting started. Almost always opt-in, and nobody is assigned to tell you it exists. Explained in The Form Nobody Mentioned.
- Formulary: the list of medicines your plan covers, sorted into tiers that decide what you pay. A negotiated commercial term, not a clinical finding. Explained in Your Plan Decided Before You Did.
- Step therapy: a plan requirement to try a different medicine first before it will cover the one you were prescribed. Explained in Your Plan Decided Before You Did.
- Formulary exception: a formal request asking a plan to cover a medicine it does not normally cover, or to waive step therapy. Your prescriber files it. Explained in Your Plan Decided Before You Did.
- Prior authorization: a review a plan runs before it will pay. It has a deadline, and the deadline starts when the plan receives the request, not when your prescriber decided. Explained in A Wait With No Clock.
- Deductible: the amount you pay yourself before your plan starts paying. It resets at the start of the benefit year, which is why prices jump in January. Explained in The Number at the Counter.
- Limited distribution: a restriction meaning only a defined set of pharmacies are permitted to dispense a treatment. Different from out of stock and different from not carried. Explained in Three Sentences That Sound the Same.
- Transfer: moving a prescription from one pharmacy to another. Usually a call between the two pharmacies rather than a new prescription. Explained in Three Sentences That Sound the Same.
- Refill: the next fill after the first one. Prescriptions carry a set number, and who initiates the refill varies by treatment and pharmacy. Explained in Nobody Owns the Second Fill.
Definitions by Patrick R. Coyle. Applied across patrickrcoyle.com, NextGen GTN™ and Novus Proximus.