Getting to the 'hub' of the matter

The perfect pharmaceutical product would be a pill or injection that, once taken, has a near-immediate beneficial effect. The disease disappears; the condition improves and quality of life is demonstrably upgraded; and the beneficial effects are experienced by nearly all patients. The biopharma industry has known for many years that these perfect therapies are not easily obtained. A large part of the industry deals with situations where some of the patients, some of the time, get better; or where there is a cacophony of voices recommending one therapy over another.

Enter hub services, funded by the innovator drug companies, but focused on patient interactions. The very term is in dispute; some prefer some variation on “coordinated care” or “integrated services.” Another aspect of the concept is to manage the complexities of reimbursement, especially for expensive drugs for chronic conditions. A fully equipped hub handles patient intake and benefits investigations, oversees drug administration (which might involve a doctor’s office, an outpatient clinic, a home health service or a hospital), and strives to keep the patient on therapy—medication adherence.

Veterans of the pharma industry have seen this before: the run-up to “disease management” that occurred during the 1980s and 90s, culminating, arguably, with the acquisition of pharmacy benefit management firms in the early 1990s—and fading from the scene a decade or so later with divestitures of those PBMs and related services. Health economics studies showed that the combinations did not result in clearly identified health improvements. There was friction between manufacturers and the rest of healthcare—pharmacists and medical doctors and payers never got comfortable with the conflicting goals of selling more drugs and managing patients’ lives.

There are clear signs that the picture is considerably different now. Especially with high-cost specialty pharmaceuticals and their attendant copays, reimbursement is not solely in the hands of the payers; hub service providers strive to match up patients with sources of financial support, and work closely with some patient-advocacy groups. Equally significantly, the complexity of many therapies, with accompanying companion diagnostics, and with the trend toward self-administration, means that hubs can fill a gap between the provider and the coordination of services.

The clearest test of how hub services will lock in as a part of biopharma’s routine activities will be the extent to which the services demonstrate improved outcomes. The ability to do that is spotty, but all parts of healthcare—payers, providers and biopharma manufacturers—have a common goal.

With our first Hub Services report, we plan to track this evolution closely.

Editor’s note: With our new cover treatment, we’re honored to feature John Gray, president of the Healthcare Distribution Management Assn., the association of primary drug wholesalers. Our goal is to continue to bring attention to the key business and policy partners of the biopharma industry in future issues. Tell us what you think!