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One of the things I’ve learned over the years conducting qualitative research with physicians is that some of the most important barriers to new product adoption are rarely stated directly. They emerge indirectly. Subtley. Almost philosophically.
A prime example is the concept of “cost.”
On the surface, this seems straightforward enough. Physicians will often comment or suspect that a therapy might be, or is, “expensive” or that “cost could be an issue.” But increasingly, I’ve come to believe that when physicians raise the issue of cost, they are often talking about something much deeper than its price alone.
Recently, I was discussing this with a highly experienced professional in pharmaceutical insights and analytics. We were reflecting on how frequently this issue surfaces in research, especially in discussions around newer, high-value therapies, and how challenging it can be to unpack what physicians actually mean when they talk about “cost.”
A few nights later, during dinner with a close friend who is an infectious disease specialist at a major Ivy League institution, the topic resurfaced in a more clinical context. He explained that in infectious disease, physicians are constantly balancing not only what is best for the individual patient, but also the broader implications for the healthcare system. Decisions often involve ID pharmacy, stewardship teams, and discussions about resource utilization and system-wide impact.
That struck me because it clarified something important. When physicians talk about cost, they are not always referring to the acquisition price of a medication.
Sometimes they are referring to the moral weight of using it.
This is where things become psychologically, and strategically, intriguing.
In qualitative research interviews, I’ll probe physicians when they describe a therapy as “too expensive.” What exactly do they mean?
Do they know the actual cost of the product, like the WAC price or AWP? For the most part, they do not. They may have only a vague sense of it. Few know the price precisely.
Instead, their perception of expense is frequently assumed through contextual cues: prior authorizations, reimbursement hurdles, payer scrutiny, specialty pharmacy involvement, or the need for office staff to spend significant time navigating access.
In other words, the friction surrounding the product becomes a signal. A signal that says: this intervention carries significant cost to the system.
And that signal is important.
Because most physicians still view themselves not only as advocates for individual patients, but also as stewards of finite healthcare resources. Even if they never explicitly frame it this way, there is often an underlying moral calculus taking place.
These are not merely economic questions. They are ethical ones.
This creates an important challenge for pharmaceutical companies launching innovative therapies. Commercial teams tend to focus heavily on clinical differentiation: efficacy, safety, convenience, biomarkers, outcomes. All of which matter enormously.
But in some categories, particularly those involving very high-cost therapies, the true barrier may sit elsewhere.
The physician may understand the product’s value proposition perfectly well. The issue is that the therapy may not align cleanly with the physician’s internal sense of obligation, fairness, or societal value.
That distinction is critical.
Because when a physician hesitates, the hesitation may not stem from skepticism about the data. It may stem from discomfort about the broader implications of prescribing the product.
And unless we probe deeply enough in research, we may completely overlook that dynamic.
This is why I’ve increasingly come to believe that we need to listen much more carefully to (and probe more extensively about) how physicians discuss cost in qualitative interviews.
When respondents raise affordability concerns, we should not assume we understand what they mean. We need to unpack the underlying psychology.
Those are very different barriers, requiring very different strategic responses.
Too often, we collapse or conflate them together.
One clear implication of this is that our industry may need to do a better job illuminating the human cost of disease: not just the clinical burden, but the societal and personal consequences of under-treatment.
Because if physicians are weighing cost to the system, then part of the responsibility of brand strategy is to demonstrate the cost of not treating. Things like:
These are not abstract concepts. They are real forms of societal cost.
And in many cases, they far exceed the cost of intervention itself.
This is particularly important in unbranded disease education, where the goal is often not simply awareness, but reframing the perceived urgency and legitimacy of treatment.
In the I&A field, we often talk about “drivers and barriers” as though they are primarily product-centric. But some of the most consequential drivers and barriers exist outside the product entirely.
They exist in belief systems. In moral frameworks. In perceptions of responsibility and stewardship.
And increasingly, I suspect these dynamics will become even more important as therapies become more expensive, as our healthcare system become more constrained, and as physicians face greater pressure to justify the choices they make.
Which means that understanding physician psychology requires us to go well beyond traditional attribute testing.
Sometimes the real question is not whether a physician believes a product works.
It is whether they believe using it is the right thing to do.
