Who Buys and Who Uses: The First Three Workstreams of a Commercial Plan

Series · Commercial Planning · Part 2 of 5

1. Why one buyer is a myth

A sales plan tends to carry one line for the buyer: a title, a department, a target list. A commercial plan splits that line in three. The economic buyer approves the spend. The daily user decides whether the product earns a place in the workflow. The account owner, on your side, makes sure the account is still healthy at day 90.

These roles can sit with one person in a small practice. In a hospital they rarely do. A surgeon can champion a product for two years and still wait on a committee that meets monthly. A committee can approve a product that no one on the floor was shown how to use. Each gap costs a quarter, and each one is visible in advance if someone asks the question.

The planning question for workstream 1 is who the beachhead buyer is, and the answer comes with a payment path attached. The question for workstream 4 is what has to be true for a champion to become a system decision. The question for workstream 5 is who on your team holds the account once the first case closes, and what that person reviews every week.

2. Case: Beta Bionics and the two payment channels

Beta Bionics sells the iLet automated insulin delivery system. In its second quarter 2026 results, the company reported net sales of $32.0 million, up 38% from the year before. It splits sales by reimbursement channel. Durable medical equipment channel sales were $20.4 million, up 9%. Pharmacy benefit plan channel sales were $11.6 million, up 153% from $4.6 million, which the company attributed to expanded channel access and contracting. All figures are company-reported.

On the earnings call, management said a high-30s percentage of new patient starts were reimbursed through the pharmacy channel, and guided to 37% to 39% for the full year 2026. The lesson for a commercial plan is about the buyer. The same device can be paid for through two different routes, and each route has its own gatekeeper, paperwork and contracting work. Choosing which route leads is a beachhead decision, and the growth in one channel in this report followed contracting work done to open it.

Read this as one company-reported example, and label it that way in your own plan. It shows that the buyer question has a payment-path half, and that the answer can change a quarter later.

3. Case: Medtronic Hugo and the first installs

Medtronic announced FDA clearance of the Hugo robotic-assisted surgery system for urologic procedures on December 3, 2025. On February 17, 2026 it reported the first US commercial case, performed at Cleveland Clinic by Jihad Kaouk, MD, whose team was principal investigator for the Expand URO investigational device exemption study. Duke University Hospital and Atrium Health Wake Forest Baptist High Point Medical Center were among the first US installs, and the company described High Point as the first install outside the IDE study.

Medtronic also stated that about 80% of urologic abdominal surgeries in the US are robot-assisted today, and that this community of experienced robotic surgeons is available to support training. Both statements are company-reported.

For this series the useful reading is about champions. The first case came from a site whose clinical team had already run the study, so the champion and the evidence were in the same building. The first install outside the study is the real test of system adoption, because there the champion has to bring the committee, the OR staff and the capital process with them. A plan that treats the first site as the pattern for the tenth is missing that step.

4. The committee layer

Many hospitals route product decisions through committees. Advisory Board describes value analysis committees as bodies that evaluate products on clinical and financial impact and engage clinicians in evaluation, selection and contract adherence, alongside pharmacy and therapeutics committees for pharmacy items and capital expenditure committees for larger purchases.

For planning, that means the beachhead buyer is often a process rather than a person. A useful account map lists the committees a product passes through, who presents to each, what evidence each one asks for, and how long the cycle runs. That map is the first deliverable of workstream 4, and it tells you which champion to equip before the meeting rather than after it.

5. The three workstreams in one table

6. A weekly review for buyer, champion and owner

1. For each target account, name the economic buyer, the daily user and the account owner. A blank is a finding.
2. Write the payment path next to the buyer. If two paths exist, mark which one leads and why.
3. List the next committee date for each account and who presents. Add the evidence that committee asked for last time.
4. Mark each champion as informed, equipped or committed, and set one action that moves them one step.
5. Review every account that had a first case in the last 90 days. Record who owns it, what is open and the next contact date.

Sources

1. Beta Bionics, second quarter 2026 financial results and corporate update. Company-reported figures.
2. Beta Bionics Q2 2026 earnings call transcript. Pharmacy channel share of new starts, 37% to 39% guidance.
3. Medtronic, first surgery with Hugo RAS in the US at Cleveland Clinic, February 17, 2026. Company-reported.
4. Medtronic, FDA clearance of Hugo for urologic procedures, December 3, 2025.
5. Advisory Board, Introduction to Value Analysis Committees.

What comes next

Part 3, Evidence and economics (workstreams 2 and 3): what clinical evidence each committee asks for, and how pricing, contracting and reimbursement fit together. Part 4, After the first case (workstreams 6, 7 and 8). Part 5, Running it weekly (workstreams 9 and 10).

New to the series? Start with Part 1: A Sales Plan Sits Inside a Commercial Plan.