Low enrollment in manufacturer-sponsored patient services programs is rampant, so much so that many industry stakeholders have come to accept this as inevitable. This disappointing trend nearly always holds true if brands employ traditional “call center-based” hubs or specialty pharmacies that lack consumer-friendliness, creating unnecessary friction for patients and HCPs. These “clunky” programs typically result in enrollment rates between 20-30%. Whereas, digital hubs that deliver more responsive user experiences, in line with what patients engage with in other industries can witness up to 90% enrollment rates. However, numerous factors can diminish those rates, resulting in suboptimal results for brands looking to improve adoption, patient outcomes, and gross-to-net. At Phil, we’ve learned that there are a number of proven strategies that companies should deploy to maximize enrollment in patient services programs.
A crucial objective for pharmaceutical manufacturers – second only to developing an efficacious drug – is getting that therapy into the patient’s hands. A brand’s go-to-market strategy must be built around the most productive channels and channel partners to make this happen. Additionally, brands going to market must have a realistic timeline of when they can expect to receive payer coverage. The right hub partner can be the most effective tool to maximize patient access and covered dispenses, yet this approach often takes a back seat to other priorities like building a large sales team or investing in marketing campaigns which are necessary but not sufficient to ensure strong brand growth. When the hub is viewed simply as a service provider at the end of the line, it’s unlikely to help the manufacturer meet its access and growth goals.
Designing your hub as a core part of your brand’s go-to-market strategy that evolves with your patient access strategy requires integrating it within the prescription journey to maximize field team promotion, patient enrollment, prescription pull-through, and coverage. The bottom line? If you fail to treat your hub as a primary go-to-market partner, you are leaving patients and net revenue that can drive growth on the table.
Not taking the time or investing in the resources to effectively educate key stakeholders in the prescription journey on the value of your hub partner is a critical mistake. A lack of knowledge about the existence of the patient support program and how it works will significantly chip away at not only adoption but also its overall potential to transform your gross to net. Your field teams must ensure that healthcare providers and their office staff know what to do when a script is generated and that they are educated on the correct information to send to the hub. Patients will not enroll or engage in a hub if they don’t realize what it is, its benefits, and what they need to do to enroll, and their most trusted source is their provider. So, field representatives must be armed with the knowledge, messaging, and resources to educate healthcare provider offices properly. Manufacturers should monitor key success factors such as hub adoption, script quality, and patient enrollment at the territory level to gauge field performance to optimize outcomes nationally. With PhilRx, manufacturers have access to territory and HCP level insights to help them create hub performance benchmarks, so that they can identify and address any territories that are not effectively delivering strong outcomes.
With the vast majority of brands coming to market today falling into the specialty and specialty-light categories, the hurdles to obtaining coverage are growing exponentially. The reality is that if a manufacturer thinks that utilization management is going to be a barrier (which it almost always is), the decision not to have a hub is very shortsighted because retail pharmacies are not going to provide the necessary diligence to fill out prior authorizations, step therapies, or whatever other coverage hurdles exist.
Many specialty-light manufacturers have shied away from hubs because they perceive that a hub is 1,000 people in a call center with many fax machines. While these burdensome and expensive “traditional” hubs still exist, they’re no longer the only option. A digital hub can onboard and integrate into a brand’s patient access program quickly and essentially be up and running in just weeks at a fraction of the cost. Ideally, a digital hub partner enables manufacturers to only pay for outcomes like enrollments, coverage, and dispenses, eliminating the considerable overhead fixed costs incurred by legacy hub solutions that rely on human capital to generate activity.
Additionally, digital hubs are much better equipped to partner with specialty-lite manufacturers using telehealth channels. For example, they can directly enroll patients in the support programs and automatically route the scripts to the hub pharmacy.
Incentivizing sales reps, patients, and HCPs to use your hub is crucial to maximizing patient enrollment and access. From a patient and HCP standpoint, you want to incentivize the program not with actual dollars but by employing a differentiated copay strategy. For example, suppose a manufacturer has a $1,000 WAC drug with a $30 copay with insurance coverage. The data clearly shows that they lose about 15% of their covered patients at that copay level. Their goal should be to incentivize the patient support program to reduce that out-of-pocket hurdle by an amount that incrementally increases the volume of filled scripts while maintaining positive gross-to-net and enables reps to assure potential prescribers by saying, "Your patient can get their prescription filled at the lowest cost by enrolling in our hub."
It's also imperative to financially incentivize field reps to drive patient enrollment. While field reps must understand how the hub works and trust that it will work as promised,the best way to get buy-in and drive the desired actions is to develop a rep compensation scheme that heavily favors enrollment in your most productive channel. This can be accomplished either by incentivizing based on the number of new prescriptions sent to the hub, or offering incremental incentives for scripts that get covered - the logic on the latter is that the hub will deliver the highest percentage of covered dispenses.
Sending a product into the retail “wild”without a preferred channel that is likely to get coverage is a recipe for stagnation in the modern drug channel. Phil’s manufacturer partners are achieving 90%-plus enrollment rates and improving their visibility beyond lagging retail claims data, so they can map out friction points along the patient journey to make program adjustments accordingly. One example is a women’s health brand that was working with a large specialty pharmacy witnessing enrollment rates in the single digits. Once they adopted the PhilRx platform, they quickly reached a 91% program enrollment rate. As their trusted partner, we co-developed their hub program and have helped them mold it as their brand goals and market conditions have changed. Visit https://phil.us/life-sciences to learn more.
Andrew Duncan is Vice President of Business Operations and Analytics at Phil, Inc.
Our consultants will work with you to analyze your current channel strategy and make recommendations for how to improve patient access and increase the percentage of scripts getting covered by insurance.