This blog post was written by John Yu, Vice President, Patient Experience at Phil.
Getting prescribed medications – especially those that treat more complicated, chronic conditions – into the hands of patients is like navigating a maze filled with roadblocks. Consider that out of all the products launched in 2019, only 1 out of 3 patients who tried to initiate a treatment could get it filled – with over half facing a formulary restriction and others abandoning due to cost.
As PBM organizations plan to increase price negotiations and utilization management requirements to reduce pharmacy spending by more than $1 trillion through 2029, it's no wonder that many manufacturers shoulder patient access program investments of up to 60% of their gross-to-net (GTN) in the first year of a brand's launch to reduce financial barriers to adoption of their therapies.
Pharmaceutical manufacturers with specialty and specialty-lite therapies lean heavily on the solutions offered by hub providers because, with the right design, they present the best option to address the roadblocks that may stop a prescription dead in its tracks before it ever gets to the patient. Setting the stage for your patient services program's successful launch entails three critical steps to ensuring a patient-centric experience that can optimize access to your therapy while maintaining a positive GTN.
Whether you’re looking at the patient or healthcare provider (HCP), a poor experience can translate to a loss of brand loyalty. A 2022 survey revealed that patients with positive experiences with a pharmaceutical company’s services were 18 times more likely to enroll in a patient services program. Those with poor experiences were twice as likely to seek an alternative treatment option.
Thus, it’s up to the brand to select the right channel partners that are capable of delivering an access experience that makes it as seamless as possible for patients to start and stay on therapy. Patients should not be left wondering about the status of their prescriptions or why they cost a certain amount. A responsive, digital hub partner can mitigate access barriers and keep patients in the loop, earning their trust and the level of program engagement essential to improving access and overall brand adoption.
The HCP experience is also critical throughout the access journey. The prior authorization process tends to be clunky, with most still relying on antiquated paper-based communication systems and telephonic engagement. HCPs and their staff struggle with increasingly burdensome prior authorization requirements, which explains why more than 8 out of 10 avoid prescribing certain medications over half the time because of utilization management. The right hub partner should simplify the whole process by making HCP workflows more efficient to free up time to focus on treating patients, ultimately delivering a positive experience that will promote brand loyalty.
Brands would be wise to remember that a patient’s poor access experience often makes it back to the prescriber; it’s not unusual for the HCP to abandon that brand altogether based solely on the feedback from that one patient’s bad experience. Effective hub services can ensure patients and HCPs have a positive experience with your brand, resulting in higher brand loyalty - something that is increasingly important in increasingly competitive therapeutic categories.
A Hub partner should act as more than a "vendor". They should serve as an invaluable ally from a product's launch phase and throughout its commercial lifecycle. Hubs that leverage their expertise to take a consultative approach can cut through the complexity by helping recommend and ultimately deliver a tailored solution based on the manufacturer's business goals. Establishing a responsive workflow is critical for effectively streamlining patient access and addressing barriers to treatment for all patients - Commercial, Government, Underinsured, and Uninsured. For optimal results, Hub teams should actively collaborate with the manufacturer's internal teams, such as the market access team during pre-launch, the sales and marketing team leading up to launch, and the patient access team after launch.
Improving access to specialty and specialty-lite therapies is a challenging problem to solve. Traditional hub partners have leveraged a people-driven, call-center approach to engage the appropriate parties, collect information, and facilitate actions to support coverage. The cost of running this type of program is astronomical from an operational standpoint and is not scalable. When you consider that industry benchmarks for enrollment rates for these programs are 20% or less, the ROI can be dismal with the lion share of fees going to outreach attempts to connect with stakeholders vs. getting patients started on therapy. A tech-enabled hub platform allows manufacturers to communicate with patients more efficiently and through the channels they prefer, such as SMS, boosting enrollment while automating the PA process to drive more submissions translating to higher rates of overall coverage. It also allows for a faster, more flexible, and cost-effective hub launch than traditional hubs.
To effectively balance speed to therapy and program cost, manufacturers need to implement business rules that set the parameters for their tech-enabled Hub services. These business rules should be constructed according to a manufacturer's goals, the drug's lifecycle, and their patient mix. For example, a newly launched novel drug may not have a favorable formulary placement or any formulary placement at all. The primary goal would likely be centered on volume adoption to get the therapy in the patient's hands, so business rules may favor shorter wait times for payer PA approval before a manufacturer-subsidized program kicks in. The focus may not weigh as heavily on overall gross-to-net or profitability quite yet. Once there's more product adoption, manufacturers can start evaluating payer-specific behavior and data to evolve their business rules based on new business goals and how the drug is performing in the market over time.
At Phil, we are driven to help pharmaceutical manufacturers unlock patient access. Once we've determined your goals, we configure our platform based on your business rules and your patient access services program can be up and running in weeks. With enrollment rates in the 80-90% range, our digital Hub does an excellent job of streamlining patient access.
As a data-driven tech company, we have the data to inform decisions around copay design, PA wait time thresholds, patient drop-offs at one cost vs. another, and numerous other variables. Along the way, we provide manufacturer teams with actionable insights to help them evolve their program and realize greater brand value. Our key differentiator is that we leverage our technology and data to partner in making a manufacturer's brand outcomes a reality. We lean in and say, "Hey, we've seen this data. Here are some proven proposals for you to implement based on the data we're seeing."
Learn more about how we help leading life sciences brands modernize their hub services programs.
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.