In this final installment of a three-part series on integrating comprehensive hub services and adherence support for the creation of a single brand and patient experience, we will discuss the evolution of e-services and how digital capabilities can help improve the speed, cost, and accuracy of reimbursement access services.
With rigorous payer requirements to initiate therapy, increasing patient cost share responsibilities, and stringent FDA-mandated safety programs, pharmaceutical and biotechnology manufacturers face significant hurdles in their efforts to facilitate patient access to their products. As discussed in the first two articles, hub services continue to evolve with brands wanting to consolidate services under one umbrella, provide integrated data, and create a seamless patient experience that improves access, supports adherence, and reduces abandonment.
End-to-End Access Support
It is the mission of all hub service providers to design effective biopharma-sponsored programs to assist providers and patients with the drug access process. Hub providers are a critical component of the specialty pharmaceutical ecosystem focused on two primary goals: Facilitating patient access and adherence to prescribed medications and securing appropriate insurance coverage for these treatments.
Primary activities include assisting provider offices with benefit investigations to determine a patient’s drug coverage, coordinating the completion of prior authorization (PA) forms when required by payers, managing the appeals process when a drug claim is denied, and enrolling patients into financial assistance programs. Hub programs are designed to provide answers to the following questions:
- Does the patient have active insurance?
- Does the patient have coverage for this drug?
- If yes, how much will the patient owe out of pocket?
- What pharmacy can fill the prescription?
- Is a prior authorization required?
If performed well, hub services support the end-to-end process from the physician’s intent to prescribe to the patient’s long-term adherence to his/her treatment regimen. Further, an innovative, easy-to-navigate hub program can be the differentiator between competitive products, creating preference among providers and patients based on their experience with and perception of support services available.
e-services is More Than Just Going Digital
Traditionally, these services have been managed through brand-specific programs that utilize manual processes, including phone calls, faxes, and letters.
Over the past several years, the industry has begun to shift to more technology-driven solutions to better leverage real-time, electronic transactions to replace manual intervention (which includes McKesson’s own hub solution center). Efforts to introduce innovative technology and real-time payer transactions into the hub workflow has netted positive results, including improved turn-around time, which is the time from the point of entry to when the patient gets his/her medication. According to the ePA National Adoption Scorecard published by CoverMyMeds, a McKesson-owned company, electronic PA reduces time to therapy for specialty products from more than 17 days to as few as 1.5 days1. Additionally, electronic PA and auto-renew processes have improved abandonment by 40%2.
While substantial progress has been made over the past few years with the development of real-time drug access support, e-service solutions currently offered by hubs and niche technology players remain incomplete. Oftentimes, a solution can provide benefit information for drugs billed to the patient’s pharmacy benefit insurance, but cannot deliver coverage information for drugs billed to the patient’s medical insurance. In other cases, products offer real-time prior authorization support, but do not facilitate patient enrollment into co-pay or other financial assistance programs. Over the course of 2018, the industry will begin to see more complete, universal solutions that can better manage the complexities of drug access support in real-time.
Improving Speed to Therapy with a Universal Hub Platform
While the shift to e-services may seem like a tactical application of reimbursement access and patient support, it is really the first stage of the transformation to a universal hub services platform designed to improve efficiency, reduce costs, and facilitate patient access. The ability to provide all key pieces of drug coverage information in real-time would be a game changer for patients, providers, and biopharma manufacturers.
One key benefit of a universal hub platform is to eliminate the need for physicians, patients, and other providers to navigate multiple brand-specific portals and websites to obtain the support they need to secure drug access. The roadmap for a universal hub platform calls for the creation of a comprehensive digital solution that allows users to complete these activities for all drugs on the market in a single place, the same way every time. In essence, this evolution can make a meaningful difference by:
- Integrating best-in-class technology
- Leveraging real-time payer connectivity
- Performing benefit verification, benefit investigation, and PA in real-time
- Increasing operational efficiency
- Improving provider and patient access
To alleviate the administrative burden on physician practices and speed time to therapy, the system must provide accurate, real-time eligibility information, access to PA forms for all payers and drugs, claims and reimbursement data, and information on available drug assistance programs. This requires a unique blend of technology, industry collaborations, and innovation that supports real-time connectivity to electronic health records (EHRs) and pharmacy dispensing systems—and it must be integrated into existing workflows.
To support a true end-to-end solution that improves access, shortens time to therapy, and reduces abandonment, a universal hub platform must also have a consistent and efficient approach to managing the reimbursement and access process. For example, when an end-user initiates a request, the platform should identify other services or information the user might need. So, if a physician practice indicates that they would like to start a patient on a therapy and requests a benefit investigation, the system should let the user know if a PA is required, whether financial assistance for the patient might be available, whether there is a REMS requirement for the drug, and instructions on how to e-prescribe and order the drug through the system. Even after universal connectivity has been achieved, a small number of cases will still require live, personal support due to their complexity.
In addition to the obvious time and cost efficiencies, speed to therapy is the most important outcome of a universal hub platform, as it is unacceptable for sick patients to wait extended periods of time to obtain access to needed therapies. By building and deploying universal, digital patient access solutions, the hub industry can better support patients along their treatment journey and contribute to improved patient outcomes.
1. CoverMyMeds: Data on File
- CoverMyMeds ePA National Adoption Scorecard