Picture your childhood bicycle, banana seat and all; now picture the front wheel of that bicycle. That bicycle wheel can serve as a metaphor for the holistic specialty patient experience.
Around the outside of the wheel at the end of the spokes reside the patient, the physician/prescriber, the insurance provider/pharmacy benefit manager, the specialty pharmacy, and the pharmaceutical manufacturer.
Now, picture the same bicycle wheel without a hub in the center holding the spokes together. That’s a bit more challenging because of what the hub signifies within the specialty patient experience.
I remember how confusing the concept of a hub was when I first started my career in specialty pharmacy. I really wish someone had helped me out with a bicycle reference.
The concept of this connector, this interface between the stakeholders in the specialty pharmacy experience, was daunting at first. Once I began to understand the purpose of a hub as the experts that pharmaceutical manufacturers put in charge of streamlining access to their drugs and coordinating patient care, my mental picture got a little bit clearer.
According to an article published in Pharmaceutical Commerce
, “Hubs have been around for over a decade, starting out as ‘reimbursement hubs,’ usually provided as a service by manufacturers to help patients and providers navigate the process of obtaining permission to use, and reimbursement for, expensive specialty therapies.”
Hub services have continued to evolve over the years to include big data collection and reporting, prior authorization and appeals, patient assistance programs, quick starts and bridge programs, e-prescription routing, and more. Pharmaceutical manufacturers depend on hubs to act as connectors between all of the “spokes” of the wheel.
Consider this patient example: A specialty patient visits their physician and is started on a new specialty therapy. In order to begin therapy, the physician fills out an electronic form that includes the prescription and patient information, such as benefits and clinical data.
This form is submitted to the hub. When the hub receives the form, they identify which specialty pharmacy is contracted with the patient’s insurance company and/or the pharmaceutical manufacturer to fill the medication.
The hub verifies the patient’s pharmacy or medical benefits to ensure coverage and submit for a prior authorization, if required. In the meantime, the hub contacts the patient and ships them a bridge supply of medication so that they have immediate access to begin therapy while their prior authorization is pending.
The hub also reaches out to the patient’s specialty pharmacy to enroll the patient and facilitate the transition from the bridge supply to the patient’s first order from their pharmacy. When the specialty pharmacy is able to fill the patient’s first order, they follow their standard process and send the dispense data back to the hub.
The hub then compiles these data for the patient, which are sent to the prescriber and manufacturer. This is a fairly common example of the activities performed within a hub to coordinate specialty pharmacy care for 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.