diff --git a/docs/superpowers/specs/2026-06-08-paste-mcp-ambient-layer-design.md b/docs/superpowers/specs/2026-06-08-paste-mcp-ambient-layer-design.md
index a40b2c8..b24d754 100644
--- a/docs/superpowers/specs/2026-06-08-paste-mcp-ambient-layer-design.md
+++ b/docs/superpowers/specs/2026-06-08-paste-mcp-ambient-layer-design.md
@@ -71,6 +71,9 @@ Paste holds the hot layer. It does not replace any deep storage system.
 - Pricing tiers: Worklist $149-199, Connected $349-499, Intelligence $699-999+usage
 - Pitch anchor: "$400-500M/yr spent documenting the problem Signal solves; Worklist costs $1,788/yr"
 - CMS PA exemption: ≥90% affirmation rate = PA exemption, June 1 2026 first cycle
+- Pharmacy vs DME adherence (PMC11301113, 2,356 matched adults): 6mo DME 65% vs pharmacy 52%; 9mo DME 61% vs pharmacy 49%; 12mo DME 58.8% vs pharmacy 48% — pitch framing: "nearly half of pharmacy patients have lapsed by month 9"
+- Medicare DME vs pharmacy (separate study): 78% vs 64% at 12 months; total annual costs 35% lower for DME ($6,967 vs $10,635)
+- CRITICAL PITCH CONTEXT: Pharmacies carry significantly reduced documentation requirements vs DME (Part D prescription vs Part B CMN/PECOS/qualifying visit/PA). The DME adherence advantage is achieved DESPITE the regulatory handicap. Signal removes that handicap — protecting and extending an advantage the channel already earned. Never cite the adherence stats without this framing in a supplier or VC pitch.
 - Brand sign-off block: "Signal. / Powered by STTIL Solutions"
 
 **How it stays current:**