When prescribing a specialty or specialty-lite therapy with hub services, a healthcare provider can often jumpstart getting their patient started on the treatment by sending the script directly to the hub. However, six out of ten providers report that they are uncertain of the insurance benefits information needed to start patients on complex therapies, and submitting the wrong information can hold up a prescription from the get-go. Health insurance plans typically have specific requirements that must be met before covering an expensive branded therapy
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The evolution of healthcare consumer expectations and proliferation of expensive specialty and specialty-lite therapies have led to the rise of innovative solutions to clear an often onerous path to prescribed treatment. In 2022, specialty drugs accounted for 55% of the net spending in the pharmaceutical market, up from 28% in 2011. And an estimated 3 out of 4 patients who try to fill a new prescription for a recently launched brand are unsuccessful due to payer controls
In 2023, a growing number of patients are enrolled in high deductible health plans (HDHPs), which require members to pay healthcare costs out-of-pocket until they meet their annual deductible amount before the plan starts covering eligible costs. A recent analysis found that over half of American private-sector workers are now enrolled in HDHPs – a 14.5% increase from 2017. The current minimum deductible for an HDHP set by the IRS is $1,500 for an individual and $3,000 for a family
In the highly-competitive life sciences industry, optimizing access is key to success. Offering timely and affordable access to treatment can significantly improve your patients’ health outcomes, strengthen relationships with your provider network, and determine the overall success of your brand. Manufacturers at the top of the industry are streamlining medication access by modernizing the patient experience through breaking down utilization management barriers and strengthening workstreams with pharmacies and providers
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.