It’s estimated that within the next four years, specialty medications will account for 65 percent of the products launched by pharmaceutical manufacturers.1
This progress is exciting for the healthcare network — and especially so for providers and their patients living with unmet rare and chronic conditions.
On the other hand, specialty therapies are among the most complex and difficult medications for patients to access, afford and adhere to. From clinical complexity and unique distribution models to enrollment and reimbursement processes, specialty medications present challenges that can be difficult for all network stakeholders to overcome on their own.
For patients, this can mean delays in time to therapy and medication non-adherence. In fact, inefficiencies within the specialty workflow can result in treatment delays of eight weeks. During the interim period, patients have reported deteriorating health and worsening of symptoms.2
Manufacturer-sponsored hub programs sit at the center of this complexity. They work to connect and coordinate all steps within a patient’s specialty journey, focusing on reducing the burden on the patient and provider.
These programs act as a primary liaison to patients prescribed a complex therapy. Over time, services offered through hub programs have expanded to include:2
- Connecting commercially and government insured patients to financial assistance
- Completing reimbursement activities like prior authorization (PA) and PA appeals, benefits investigation (BI) and benefits verification (BV)
- Collecting patient data for FDA-mandated regulatory compliance
- Supplying patients with bridge therapy while coverage is being determined
- Facilitating lab services
- Reporting outcomes data
Yet the traditional hub is not without its own complexity, involving a manual process of back-and-forth communication — via phone and fax — between providers and their patients’ health plans.
Many steps in the specialty workflow have the potential for automation. By making manual steps the exceptions within a primarily electronic workflow, more patients can experience support and accelerated time to therapy. In a preliminary study, this model has already contributed to a 27 percent reduction in time to therapy.3
Outlined below are key benefits that this innovative model offers providers and their patients.
An electronic patient support model automates patient enrollment at the point of prescribing. This method uses the ePrescription to trigger the support services enrollment process — which includes patient authorization and consent to opt in — when the provider prescribes to a program-operated, non-dispensing pharmacy.
Additionally, this model creates a consistent workflow regardless of brand: Providers experience the same start for every medication they prescribe.
By capturing the hub enrollment earlier in the patient journey, care coordination activities can be completed sooner to help improve time to therapy. Additionally, this allows a clean prescription to be triaged to the appropriate pharmacy.
The research and development process for specialty medications can take many years and cost billions of dollars,4 as today’s medications are much more targeted and personalized, resulting in smaller patient populations. As a result, specialty medications are often significantly more expensive than retail medications, and the reimbursement landscape is complicated by strict PA and step-therapy criteria that must be met before patients can begin treatment.2
Many of these steps — including BV, BI, PA and scheduling patients’ lab work — lend themselves to automation. Platforms for completing BV/BI and PA electronically already exist and have been integrated into electronic patient support services — allowing for automatic determinations based on preset payer-defined criteria, as well as streamlined processes
A centralized platform, accessible to all relevant healthcare stakeholders within the specialty workflow, creates visibility for completing tasks and driving efficient care coordination — allowing stakeholders to work together to help patients get on therapy faster. Such a complete view of patient cases can limit unnecessary phone calls among stakeholders and patients, as progress is tracked virtually in real time.5
In today’s healthcare landscape, technology is just part of the solution — we must also have network connectivity to leverage that technology. This innovative take on the hub model has the capability to provide real-time connectivity of all stakeholders in the patient journey. And, by expanding on familiar technology with an existing user base, the barrier to viral stakeholder adoption of electronic patient support services is lowered.5
More than ever, patients view themselves as consumers of their healthcare, and expect to engage with their care teams in a way that suits them. For many patients, electronic communication is preferred. Tech-enabled tools can support patients through reminders to take medications or refill prescriptions, automated by the tool itself.6 By leveraging text and email, care coordinators can remain in contact with patients through preferred communication channels and provide assistance when needed. This open dialogue can be important for improving adherence to medications.
Through technology, many steps in the specialty workflow have the potential for automation. By making manual steps the exceptions within a primarily electronic workflow, more patients can experience support and accelerated time to therapy.
- The Global Use of Medicine in 2019 and Outlook to 2023, IQIVIA Institute, 2019
- Specialty Patient Support, CoverMyMeds, 2020
- Revolutionizing Patient Access and Support for Specialty Therapies: Multiple Sclerosis, CoverMyMeds, 2019
- Innovation in the pharmaceutical industry: New estimates of R&D costs, Journal of Health Economics, 2016
- End-To-End Electronic Support Improves Patient Access for Specialty Medications, CoverMyMeds, 2019
- Finding the ‘HUB’ in Specialty Pharma Services, Pharmaceutical Commerce, 2013