Systems and methods presented herein relate to managing ambulatory medical device data access. A computing system of a networked computing environment can establish a direct end-to-end data connection to an ambulatory medical device via a wireless wide area network. A public key of the computing system may be transmitted to the ambulatory medical device permitting the ambulatory medical device to encrypt data to be transmitted to the computing system. The computing system may receive, via the direct end-to-end data connection, encrypted data from the ambulatory medical device, and upon decrypting the data can generate a therapy report based at least in part on the therapy data. This therapy report may include time-series therapy data relating to the therapy delivered by the ambulatory medical device over a particular time period. The computing system can restrict access to the therapy report to authorized users.