The Benefits of the Hub for Specialty Patients

Consider a second example of the specialty pharmacy patient experience, in which a similar patient goes to their prescriber and is started on a new specialty therapy. The prescriber is not familiar with the patient’s specialty pharmacy benefits, so they submit a prescription form to their local specialty pharmacy.

The pharmacy enrolls the patient and during benefits verification, they must triage the prescription to the pharmacy that is contracted with the patient’s insurance company. The contracted pharmacy enrolls the patient and bills the claim to the insurance.

A prior authorization is required, so the specialty pharmacy calls the patient to update them on the status of their order and inform them that it may be up to 7 days before they can start their medication. This is an example of the bicycle wheel without the hub.

The above example demonstrates the potential benefits that hubs provide to the specialty patient experience. Hubs ensure that patients gain quick access to their medications and help to coordinate the transition for patients starting their specialty therapy through their contracted pharmacy.

They also perform benefits verification, frequently submit prior authorization data for patients to assist with coverage, and provide co-pay assistance and patient assistance programs when needed.
The patient experience without a hub is not always like the one described above. There are plenty of patients who are able to start specialty medications relatively seamlessly without intervention.

However, it is extremely beneficial to have the hub between the spokes of the wheel to function as the experts in coordinating patients starting on specialty therapies. The routing of prescriptions to the correct pharmacies, data collection and reporting, and patient assistance programs work in collaboration with the services offered by specialty pharmacies to ensure the best care for our specialty patients.

About the Author
Kimberly Firtz earned her Doctor of Pharmacy degree from Duquesne University and is currently enrolled in the Masters of Science in Pharmacy Business Administration (MSPBA) program at the University of Pittsburgh, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines. Kimberly has spent the last 5 years working in Specialty Pharmacy, initially as a clinical pharmacist and most recently working on a variety of high profile Specialty Operations Projects. Her current role is working with the Process Innovation team on an effort to transform Specialty Operations and optimize the stakeholder experience. 

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