A specialty pharmacy must be able to have seamless collaboration and communication with the pharmaceutical manufacturer’s hub. In a recent manufacturer survey regarding specialty pharmacy, all manufacturers indicated that they work with a third-party vendor for their hub services for their patients and providers. Interestingly, when asked, “Overall, how satisfied are you with your current hub model?,” 83% of all manufacturers surveyed indicated room for improvement in their current hub model, and 17% revealed they are not pleased and are pursuing other options.
Like the service they provide, hub services can be complex and challenging to define. A hub is a comprehensive suite of service offerings by a pharmaceutical manufacturer. Given the complexities of specialty medications, ensuring patient compliance and preventing therapy abandonment are the primary goals of a hub. Historically, hubs primarily provided reimbursement services, helping patients and providers navigate the process to obtain reimbursement for specialty medications. Hub services perform as an intermediary between payors, providers, patients, and specialty pharmacies.
Today, under the umbrella of manufacturer support programs, a comprehensive hub, depending on the specialty drug, could provide multiple services.
Here is where the value of an experienced specialty pharmacy comes into play, especially if the rare disease medication will be distributed through a limited or exclusive distribution model servicing smaller patient populations that may require cold-chain storage. A specialty pharmacy with extensive experience developing custom solutions for rare and complex patient populations would make an excellent partner for the pharmaceutical manufacturer. Working with the manufacturer hub, a specialty pharmacy can individualize the specific educational program to meet the needs of the patient, family, and caregiver involved. Due to the nature of the disease process, the specialty pharmacy can provide comprehensive training regarding dosing regimens and administrations, and reinforce the reasons for therapy and address any issues encountered. These services might include in-home nurse assessments, phone assessments, and written materials in coordination with the hub. Since patient compliance and preventing therapy abandonment are primary goals of a pharmaceutical manufacturer, an experienced specialty pharmacy will have a 24/7 internal call center staffed by pharmacists and nurses to triage the needs of complex therapy patients.
While some hubs do provide benefits investigation/verification (BI/BV) as well as prior authorization and appeals support, well-seasoned specialty pharmacies can expedite the prior authorization and appeal process by working in tandem and communicating with the hub, providers, and patients. Experienced specialty pharmacies have the latest technology architecture to provide custom, program-specific, dashboard-driven workflows that provide efficiencies through automation. Examples include the ability to auto-enroll new referrals from a secure electronic data feed, automate pharmacy BI where exceptions would be routed to an internal BI/ BV team for further review, provide reports and documentation necessary to validate that orders are fulfilled under any REMS program, as well as, support the handling and reporting for pharmacovigilance, adverse events, and product quality complaints. Working with a hub, an experienced specialty pharmacy will report on agreed-upon key performance indicators (KPIs) such as order volume and status, conversion rate, time to first fill, shipment volumes, on-time delivery, and call center metrics. Depending on the program specifics, program management reporting by the specialty pharmacy can be daily or weekly followed up by Quarterly Business Reviews.
The overarching goal of a pharmaceutical manufacturer hub is to ensure a positive patient journey experience. The experienced specialty pharmacy will develop a customized communication platform with the ability to communicate directly with the patient, family/caregiver, provider, health plan, and manufacturer hub. This seamless communication network will keep all stakeholders informed and track “what stage or where” the patient is on the patient journey. To ensure a positive patient journey experience, a well-seasoned specialty pharmacy would provide the patient, family, and caregiver with benefits verification, prior authorization assistance, manufacturer copay card enrollment, patient assistance program (PAP) coordination, foundation patient assistance coordination, welcome call by nurse/pharmacist, welcome kit distribution, home administration coordination (if needed), proactive refill calls, re-authorization coordination (30-45 days before the expiration of both prior authorization and prescription), and pharmacist medication review and counseling. Fortunately for rare diseases with an FDA-approved treatment, specialty pharmacies with rare disease experience can play an integral part in a successful patient journey, especially those with the appropriate accreditations.
In our digital guide, Rare Diseases, Gene, and Cell Therapies: Specialty Pharmacy Considerations, we cover what is most important when selecting a specialty pharmacy to partner with for your next drug launch. Download your digital copy of the rare disease guide. If you have immediate questions, you can also connect with an Orsini representative at any time.
Orsini is a leading independent national specialty pharmacy accredited by ACHC, JCAHO, URAC, and VIPPS. The services we provide allow patients, physicians, payers, and manufacturers to improve care, simplify processes, and achieve better outcomes.Learn More