Why Site of Care Is the Hidden Barrier in Neurology’s Bright Pipeline

Neurology is entering a period of real progress. After years of slow movement, therapies for conditions like Parkinson’s disease, Alzheimer’s disease, and multiple sclerosis are advancing through late-stage trials and toward approval. As of January 2025, there are 182 clinical trials assessing 138 distinct drugs in Alzheimer’s disease alone, including 48 trials in Phase 3.  

Upwards of 60% of these novel treatments are delivered through infusion.  For manufacturers preparing to bring them to market, this raises an urgent consideration: the path from prescription to infusion remains fragmented, with multiple fail points where patients often disengage, never receiving the first dose.  

The Referral-to-Infusion Gap 

Consider Luisa, a 52-year-old woman living with multiple sclerosis. For years she has relied on a self-injected therapy that generally keeps her symptoms under control, and she has grown comfortable with this care routine. But when her condition begins to worsen, her neurologist points to a newly approved infused therapy that could offer greater relief. He writes the prescription, sends the referral, and explains that she should expect to begin soon. Luisa wants to feel better and is open to the change, but she feels nervous about what it might mean: the cost, travel to an infusion center, possible time away from work. Still, she trusts her doctor and agrees to move forward. 

A week later, her neurologist’s office calls to say her insurer denied coverage. Before they will approve the infusion, the plan requires Luisa to try a lower-cost therapy first. The provider files an appeal. 

During that time, she begins filling out financial forms for the new therapy. She learns that even with insurance, her share of the cost could reach several thousand dollars. She applies for manufacturer assistance, but approval is not immediate, and she does not know if it will be enough. 

When the appeal is finally approved, Luisa learns her insurance will only cover the infusion if she goes to a designated center. She calls the location closest to her, only to be told they do not carry the therapy. The next option is more than an hour away. After weeks of denials, paperwork, and uncertainty, Luisa feels worn down. She calls her neurologist and explains that she has decided not to move forward. Her flare is starting to ease, and she would rather stay with the treatment she knows. 

Where Breakdowns Occur 

Luisa’s experience is only one example of how the referral-to-infusion process can falter. Therapies administered at an alternate site of care are especially exposed because treatment depends on coordination across multiple offices and systems. In practice, the most common breakdowns fall into a few predictable patterns that manufacturers should anticipate:  

Referral routing is fragile. Most neurology practices do not infuse in-office, so patients must be sent elsewhere. Referrals may go through a manufacturer’s hub, directly to a local infusion center, or to an independent site. Each option has its own intake rules and paperwork. If a referral is sent outside the required channel- for example, directly to a site that cannot move forward without payor clearance- the case likely sits stalled until it is corrected. 

Financial clearance slows initiation. Infusion centers often wait to schedule until financial clearance is complete, which can include benefit verification, prior authorization, and patient assistance approvals. These steps are interdependent, so a delay in any one of them can stall the entire process. The longer patients remain in that waiting period, the more likely they are to reconsider starting therapy. 

Provider visibility is limited. Once the referral leaves the neurologist’s office, visibility drops sharply. Providers often do not know whether a patient scheduled, attended, or actually received the infusion. Without timely feedback from the alternate site of care, they cannot intervene if issues arise.  

Site readiness is uncertain. Because infused therapies are expensive to purchase and store, many centers carry minimal inventory. Instead, they order product in response to scheduled appointments and projected patient demand. This approach reduces financial risk but depends on accurate forecasting. If demand shifts unexpectedly or a shipment is delayed, patients may arrive to find their therapy unavailable. 

What Best-In-Class Support Looks Like 

Neurology’s pipeline will only reach patients if the support systems around it are built to handle this complexity. That means anticipating the most common breakdowns and designing programs that keep patients, providers, and sites aligned from the start. 

One priority is ensuring that referrals move cleanly from the neurologist’s office into the alternate site-of-care system. Digital handoffs that replace faxes and paper intake reduce errors and accelerate scheduling, while also creating the foundation for feedback loops that keep referring providers informed about whether patients scheduled, showed, and received treatment.  

Equally important is the timing of financial clearance. In many programs, benefit verification, prior authorization, and patient assistance determinations are handled sequentially. Stronger patient services bring these steps forward and run them in parallel, so by the time the alternate site of care is ready to schedule, the patient’s coverage and financial plan are already clear.  

At a strategic level, a strong patient services partner also identifies which neurologists are most likely to prescribe with a temporary j-code, understands the payer mix within those practices, and connects those referrals to infusion centers that can reliably deliver treatment. Just as important is laying the groundwork with payers: temporary J-codes for new therapies must be recognized, reimbursement pathways established, and benefit verification processes aligned.  

When these steps are not addressed in advance, bottlenecks in the first months after approval can slow adoption and frustrate both providers and patients. By anticipating these challenges and resolving them early, a hub ensures that enthusiasm at the point of prescription translates into timely initiation and sustained therapy. The neurology pipeline is rich with treatments that could redefine care, but their impact will depend on whether patients can access them without disruption. CareMetx partners with manufacturers to design patient services that do just that. If you are preparing to launch an infused therapy, contact us to explore how we can help build the support structures that turn clinical progress into patient impact.