Patient access strategy: specialty pharmacy, hub—or both?

In my career, I’ve worked in the pharma industry, at specialty pharmacy (SP), and at a patient-support services provider, or hub. Hub services can be set up inside a pharma company (and many have been), or can be outsourced to a company in that business. Today, the question is often asked, “How best to provide the patient access and support necessary for today’s specialty pharmaceuticals?” There are advocates for both sides of the question, but the answer is, a combination of hub (whether internal or external) and SP is the right answer.

Given our current health insurance marketplace as well as the ongoing transformation of the patient being central to a brand’s go-to-market strategy, having a hub act strategically to capture data and relay critical product communications is critical. You need a communication platform which your patients and their healthcare providers can leverage in order to access all available reimbursement and patient services that are available. You need to build a meaningful relationship with patients who are wielding more power and decision making in their pharmaceutical use.

Today’s patient needs significantly more support than ever before to understand their prescribed drug, how much it costs, what the insurance coverage is and what support services are available. Patients are savvy enough to know about coupons that reduce co-pay amounts. Historically, this level of support was provided by the prescribing physician and his/her office staff. Most healthcare providers (HCPs) have the expertise to provide this support, but they rely heavily on hubs to provide answers and solve problems.

Commercialization leaders within biopharmaceutical companies need to think of hubs as a tool to disseminate the services available to support patient use, adoption and adherence to medication. Additionally, hubs can be relied on to collect detailed data regarding how their product is used. Hubs will provide manufacturers with significant patient demographics that will inform thinking about product adoption, adherence, managed care acceptance, patient support needs and product affordability, in order to provide frequent updates to management. While there are regulations that oversee the execution of how data is used in a marketing manner, there are ways to engage your legal team to guide you away from trouble and still ensure your hub is providing you meaningful information on your patients so that you build a positive relationship with them. Consider your hub as the central point for data collection to provide you with insights that further enhance and develop a detailed patient engagement strategy—ultimately supporting your patient relationships long term.

SPs are in the business of dispensing specialty medications. No medication can be dispensed without getting a paid claim from insurance for that product (pharmacy benefit managers provide payment to pharmacies for drugs dispensed to members of insurance companies). In order to get a paid claim, every pharmacy, whether your local retailer or a SP, needs to understand the payment rules of the insurance company, and thus employ reimbursement experts to navigate the process. Additionally, to coordinate delivery of the specialty drug, SPs need to operate a call center with patient care coordinators to get all information needed from the patient to dispense the medication. A SP considers success a paid claim and delivery set-up with a patient. Getting paid claims keeps pharmacies in business. Indeed, specialty pharmacies support reimbursement services just like a hub, but for vastly different reasons, creating somewhat of a conflict and challenge if you hire a specialty pharmacy to be your hub.

So while it is true that specialty pharmacies do offer some of the reimbursement services within a hub, their function and purpose are distinct from a hub. It would be ideal if hubs and specialty pharmacies agree to coexist and appreciate each other’s role in the patient journey. Hubs need to have stellar relationships with SPs in order to ensure their patients get set up for medication delivery with a high degree of urgency. Having strong relationships with SPs is critical for your hub, not just for seamless transition to dispense, but also for data aggregation and adherence strategies. Frequent communication and candor between hub and SP is recommended as a top priority before product launch and should be continued throughout the product lifecycle.

Can hubs and SPs coexist? Absolutely! Frequent communication between your hub and SPs is key. As the commercial leader in charge of patient access, it is your leadership challenge to set a vision for your patient access strategy, and your opportunity to communicate your vision to your hub and SP partners. Consider your challenge one that helps evolve commercialization of new pharmaceuticals with the patient at the center of your go-to market strategy for new product adoption.

ABOUT THE AUTHOR

Valerie Sullivan is former president of inVentiv Patient Access Solutions LLC (now TMS Health). Previously, she worked in various management roles at Ascend Specialty Pharmacy and SpecialtyScripts Pharmacy, and started her career in the pharma industry. She has a chemistry degree from College of the Holy Cross, and an MBA from Northeastern University. [email protected].

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