Technology is becoming increasingly important in the hub and patient services space supporting specialty pharmacy, as the effective use of innovative platforms continue to accelerate patient access to care. These platforms and innovations are critical in efficiently driving process flows, managing customized telephonic solutions, capturing and reporting on comprehensive program data, keeping a manufacturers’ field teams updated on patient cases, and driving improved program consent. 

New innovative products are also regularly being introduced to help more efficiently manage existing programs. Artificial intelligence (AI) will inevitably play a major role in hub services, improving efficiency and speed to therapy.

Other comprehensive solutions are also being created to address the challenges of new therapeutic areas, such as those in the fast-growing and rapidly evolving cell and gene therapy space.

Varying Solutions for Patient and Process Flow Management
Many specialty pharmacy hubs, such as Sonexus, RxCrossroads, and Lash partner with well-respected third-party CRM providers, such as Salesforce, to create their technology platforms.1 These platforms in many cases offer sophisticated reporting dashboards for manufacturers, providers, and patients.  

Others are building their own in-house technology platforms. RareMed Solutions and ConnectiveRx both utilize home grown, internally managed solutions. These platforms can allow for increased customization and faster program changes, all at lower costs given their inhouse development teams.

“Our proprietary technology platform allows us to build an entirely customized patient experience tailored to the unique needs of each biopharma partner and disease state,” said Doug Gebhard, general manager of RareMed Solutions. “Our nimble technology platform, SWFTTM, allows us to incorporate manufacturer requests and make process changes to our programs in a matter of hours or days versus other hubs, which may take weeks or months. SWFTTM is able to capture and report on essentially any data element desired by our partners to help identify program insights.”

Although many advanced systems are being used to automate hub process flows, telephonic support is still a critical element for most programs. In order for larger hubs to manage the challenges associated with high patient volumes, some have implemented advanced telephonic technology to record and tag specific phone calls to cases within their process flow systems.

Another challenge some hubs face is manufacturers now frequently asking to listen to recorded patient and health care provider calls. In order for hubs to provide call recordings, patients must have either provided the appropriate program consent or calls must be scrubbed for any element of PHI.

Entities such as CallMiner are able to provide automated PHI scrubbing, however these services can be prohibitively expensive unless the hub has very high call volumes. Language lines are also used by most hubs to provide multilingual support. Some of these providers, such as LanguageLine Solutions, offer support in more than 240 languages.

Advances in Reimbursement Support
Benefits investigation (BI), benefit verification (BV), and prior authorizations (PAs) are frequently managed by specialty pharmacy hubs. While launching products that fall under the pharmacy benefit, this process can be streamlined through electronic solutions such as ERx Network for BI/BV. In some cases, this electronic BV can be integrated into process flow platforms.

PAs can also be managed through electronic solutions. For example, CoverMyMeds and Prior Auth Now are frequently used by health care providers. In some cases, manufacturers may need to contract with these entities from a marketing/branded perspective in order for hubs to be able to use these platforms.

Medically billed products, however, have less automated and electronic solutions, and still rely heavily on outbound phone calls to confirm benefits and manage prior authorizations.

Increasing Demand for Extensive Data, Reporting, and Analytics
Extensive data and reporting services have become essential for hubs and specialty pharmacies to compete. Most manufacturers now expect hubs to collect data, proactively analyze it, and suggest actions that improve their program efficiency and patient outcomes. Pharmaceutical manufacturers also use data to monitor and refine their marketing efforts.

Patient outcome data are important for hubs to collect and provide to manufacturers. This helps manufacturers respond to payers’ value-based contracting pressures and the data can possibly extend or improve labeling with the FDA. 

The data is captured via patient and HCP interaction or documents received at the hub. The data are entered into hub process flow platforms and reported through direct feeds, such as SFTP transmissions.

It is important for hubs to offer a nimble technology solution, as if a manufacturer finds new important data elements important during the first few months of their launch, this type of platform can make these changes quickly and efficiently. For example, a manufacturer may learn that a new genetic test is being required in order for patients to be approved on a specific commercial plan.

Rather than investing resources to update their referral form to capture this information, it can potentially be captured by a hub during the first HCP interaction or welcome call to a patient. A nimble system would be able to add this to a call scripting prompt and add a data capture field quickly and at minimal cost.

Some hubs are offering portals to manufacturers in an effort to illustrate program trends. However, in many cases, information is limited on these portals, as they do not incorporate data provided from other network partners, such as specialty pharmacies.  

Many hubs are also offering HCP portals to provide physicians and their staff close to real-time statuses of their patients. However, these are less effective in rare disease programs, as HCPs may have only 1 or 2 patients.

HCPs have thousands of patients using various treatments and it can be difficult to remember the login for each of these. Patient-facing portals are also being utilized in the hub space to provide up-to-date status and resources such as educational information; however, their value to patients is still considered questionable. 

Additionally, depending on the disease state, patients may suffer from comorbidities and be on multiple specialty products, therefore they may not want to manage multiple portals for each product.

Many manufacturers partner with a specialized data aggregation company to receive full visibility of their network data across all of their network partners. Data aggregators in this space include Prometrics, LiquidHUB, ValueCentric, and Shyft Analytics.

Data aggregators, such as Prometrics, offer portals for pharmaceutical manufacturers. This can incorporate data feeds from all network partners to provide critical updates to the manufacturers’ field reimbursement, patient access, and, in some cases, sales teams.

Information provided to sales teams must be highly restricted in order to not violate HIPAA laws and regulations. Many manufacturers now use patient access teams who are not incentivized by sales numbers to help expedite the referral process.

These individuals would be allowed to view certain data elements from a data aggregator that the sales team would not be able to view.

Leveraging New Technologies to Drive Patient Consent, Adherence, and Efficiency
Patient enrollment consent has become increasingly important to manufacturers. Not only does this consent give patients access to enhanced services that may increase adherence, but consent also in many cases allows the manufacturer access important patient data.

Historically, consent has been captured by hubs through the referral form. If consent was missed on the referral form, hubs could attempt to collect this from patients through faxes or mail.

This process was inefficient and relatively ineffective. Recently new businesses are offering consent capture websites, which enable patients to submit their consent electronically.

Text or e-mail links can be sent to patients, and they are able to simply enter their information, and electronically sign these forms almost instantaneously after a welcome call. These platforms can be managed by third-party providers of eConsent platforms, such as eHIPAA. Some hubs have launched their own integrated platforms to capture consent electronically.

Patient referrals and associated data intake tends to still be quite manual in the hub space. Some feel that this is because the original referral image must be maintained to ensure no manipulation to the form by the hub or downstream partners.

As hubs continue to advance, automated data entry through electronic forms that use required fields and automated electronic submission may be implemented.  This would reduce the possibility of manual error and streamline the process overall.

However, this may not occur for a long time given health care providers’ slow adoption of electronic solutions. AI may provide an alternative automated solution. Many AI firms have launched programs that could enable a hub to entirely automate data entry with a simple review after the referral is received.

Future Challenges and Emerging Solutions
With the explosion of cell and gene therapy, new logistical coordination challenges have arisen for both manufacturers and hubs. These extremely expensive and time-sensitive treatments with limited viable treatment windows require intense coordination between the hub, manufacturer field team, specialty pharmacy, specialty distributor, third-party logistics firm, hospital staff, and patient.

New technologies have been introduced to help manage this intense and critical coordination. TrakCel, for example, is a cloud-based software that delivers personalized processes and workflows for all of these participants in the supply chain, allowing cell and gene therapy owners to safely manage and scale with confidence.

This platform can help coordinate collection, logistics, manufacturing, and treatment administration within a single platform, providing the manufacturer with full supply chain visibility. It will be interesting to see whether hubs are asked to use this type of technology with their own systems to provide an integrated solution.

As competition in the specialty hub market continues to intensify, technology remains a key element for hubs to differentiate themselves from others and accelerate access to patient care. New advances in technology have allowed hubs to efficiently manage complex process flows, manage custom telephonic solutions, capture and report on comprehensive program data, keep manufacturers’ field teams updated on patient cases, and drive improved program consent.

As hubs begin to adopt AI and automation, this will inevitably allow providers to become more efficient and accurate, accelerating patients’ access to therapy. Hub platforms will continue to evolve, and new players will enter the market to meet the needs of quickly evolving specialty pharmacy niches and the cell and gene therapy markets.

Sources
1Basta, Nicholas. “Patient Support / Hub Services Continue to Evolve.” Pharmaceutical Commerce, 4 Apr. 2019, https://pharmaceuticalcommerce.com/brand-marketing-communications/patient-support-hub-services-continue-to-evolve/.

About the Author
Gannon Vanscoy is the Director of Specialty Markets at RareMed Solutions, the nation’s first rare disease focused specialty pharmacy HUB.  Gannon leads RareMed’s overall business development efforts and manages strategic partnerships across the company’s portfolio. Gannon began cultivating his expertise in rare and orphan disease states at PANTHERx Rare Pharmacy, where he participated in a rotational development program focused on hub services.  Prior to working at PANTHERx Rare, Gannon served as a leader at a number of large multi-national banks, both in internal and client-facing roles. Gannon earned his Bachelor of Business Administration degree from the University of Miami and is currently pursuing a Master of Pharmacy Business Administration (MPBA) from 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.