This article was originally published on the Drug Channels Institute site as a guest blog post.
When people hear “hub,” everyone has a different idea of what that looks like. While hubs can certainly make magic happen for patients, there’s no wizardry in them.
All hubs are uniquely designed to solve an access problem, but nearly each of them can be broken down into four functional phases that rely on excellent tools and processes for effective outcomes. These are:
Functional Phase # 1: Enrollment
In a May 2022 survey of specialist providers conducted by the Prescribers’ Digital Reference (PDR) network, we discovered that a web-based provider portal remains the preferred method for enrolling patients in a hub (55%) despite perceived “portal fatigue” throughout the market. In fact, portal use increased significantly during the pandemic. Next in line were e-prescription workflows (24%), with email (11%) and fax (10%) being the least preferred.
However, an evolution of enrollment tools is happening rapidly, and while traditional enrollment channels maintain their purpose, we are predicting a greater market shift towards electronic patient enrollment form (ePEF) solutions. These online fillable PDFs or webforms connect directly to the hub and launch patient intake upon submission. We can also expect to see greater use of non-commercial pharmacies to enroll patients as they accept e-prescriptions directly from prescriber’s EHRs.
We recommend that brands consider multiple electronic methods as well as insights from experts in their specific therapeutic class in order to create the right combination for their audience.
Functional Phase # 2: Verification
For years, hubs and brand leaders have struggled to find the right amount of information to provide on verification of benefits forms (VOBs). Often, the industry erred on the side of caution and furnished robust data and short narratives packed into tiny grids. The result of our collective toiling has led to a physician population who has become conditioned to expect in-depth information on every patient.
In fact, according to the same PDR survey, the individual components of a verification of benefits (i.e., patient pay amount, prior authorization (PA) requirements, deductible and out of pocket maximums) are mostly valued equally by physicians. This creates a challenge for our desire to move towards more e-enabled tools, like electronic benefit verification (eBV), since the information gap between eBV results and VOB fields can be vast.
We are seeing pharmacy electronic benefits verification (eBV) becoming “table stakes” in this process, essentially becoming baseline functionality. Coverage estimates via self-service tools, medical eBV, and voice AI are all becoming increasingly leveraged. With these multiple technologies emerging, it’s vital for each brand to strike a balance between speed and accuracy.
Functional Phase # 3: Coordination
Interestingly, nearly 90% of physician respondents say they are more willing to complete a PA if patients can start therapy immediately with a free “bridge” fill while the PA is being processed. These help patients get on product more quickly and hopefully stay on product longer with an approved PA. But this also means we need better adoption of electronic PA solutions that create as many real-time/near-time PA outcomes as possible, including those delivered to physicians through their existing EHRs.
Adopting a holistic approach to coordination that combines oversight of electronic processes, consideration of the pros and cons of bridge or quick-offer programs, and the leveraging of advanced processing for patient assistance programs (PAP) and assistance support is increasingly important. It’s vital that a brand’s patient support program has comprehensive processes during the coordination phase to help ensure managed care hurdles are cleared or alternative funding is secured to transition the patient to permanent coverage.
Functional Phase # 4: Fulfillment
There is a continued emphasis on streamlining channels and using greater connectivity to ensure patients get started on medication. Since we know most physicians still prefer web-based provider portals, building better buy-and-bill programs that combine patient access and product ordering and fulfillment support into a single user interface can provide physicians with a one-stop shop that helps them overcome the obstacles to fulfillment more easily.
We continue to see a trend towards the need for more frequent, convenient, and qualitative patient communications. Connecting with patients is a critical step to therapeutic success, and we are seeing greater attention being paid to the fulfillment phase of the journey where there are often delays in connecting patients with pharmacies for product shipment.
Looking Ahead for Hub Services
Hubs are doing amazing work for medication access, but it’s crucial that providers and patients know they exist when there’s a need, and it’s our collective job to raise awareness of how they can smooth the patient journey. Understanding how the four functional phases—enrollment, verification, coordination and fulfillment—work together to support the unique challenges of each therapeutic area down to the individual brand level can result in better decision-making to implement an effective hub program.
The Evolving Roles of Hubs and Patient Services
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