The emergence of expensive biologic therapies in the early 2000s led to the creation of patient support services primarily aimed at financial assistance. These services have since evolved to include additional functions such as onboarding, adherence, and market data, with manufacturers now outsourcing these “hub” services due to their complexity.
Pharma and biopharma hub services can play a critical role in ensuring patient access to therapies that require a higher level of support and assistance. This is particularly important for rare diseases, complex products, and high-cost therapies, which can be challenging to access and afford for patients and their families.
Hubs have become an important player in ensuring patient-centric care, serving as a single point of contact for patients, prescribers, payers, and manufacturers. Hubs play a critical role in reducing the burden on patients by connecting the various stakeholders in the treatment process, providing financial assistance, ensuring payer coverage, and providing ongoing support throughout the treatment journey.
In addition, hubs help prescribers navigate the complex reimbursement landscape, providing updates on coverage status, prior authorizations, and assistance with the appeals process if needed. By working closely with payers, hubs can identify coverage outliers and work with manufacturers to create a more transparent and streamlined process for drug coverage. This ultimately reduces overall claim processing time, allowing patients to start critical therapies in a timely manner. One of the key areas where hubs provide value is in the financial assistance provided to patients. As more breakthrough therapies and orphan drugs emerge into the market, the processes for payer coverage become more challenging. Hubs partner with the patient’s insurance payer to ensure that all coverage determinations and potential payer policy requirements are met prior to the medication being dispensed. This ensures that the patient can quickly initiate treatment without being burdened by financial concerns.
The financial aspect of starting and staying on a new therapy can be a significant source of stress for patients. As new breakthrough therapies and orphan drugs emerge into the market, the cost often increases, and navigating the processes for payer coverage becomes more challenging. Hubs play a crucial role in partnering with the patient’s insurance payer to ensure that all coverage determinations and potential payer policy requirements are met prior to the medication being dispensed.
As the central representative for the patient’s specialty process, a hub provides the prescriber with updates on coverage status and prior authorizations and even walks the prescriber through the steps of appeals if needed. By assisting patients in their reimbursement process, Hubs can find payer outliers that are shared with pharma manufacturers, allowing these manufacturers to work closely with many payers in creating the most transparent and smooth process for drug coverage.
Hubs have extensive knowledge and experience focusing on a medication’s billing codes and overall adjudication process. As a result, they can reduce overall claim processing time, drastically reducing the time it takes a patient to start critical therapies. This is crucial in ensuring that patients receive timely access to the therapies they need.
Global A1 RCM suite of reimbursement support services can help manufacturers navigate the complex reimbursement landscape and ensure patients receive the therapies they need. Patient intake/onboarding services provide a seamless process for patients to initiate therapy, while verification of benefits ensures that patients are eligible for coverage before therapy is initiated.
Prior authorization services can help facilitate the validation of medical necessity, while appeals services can help patients navigate the appeals process in the event of a denial.
Overall, pharma and biopharma hub services that provide reimbursement support can help ensure that patients receive the therapy they need, reduce financial burdens for patients and their families, and assist manufacturers in navigating the complex reimbursement landscape. This can ultimately improve patient outcomes and help ensure that life-changing therapies are accessible to those who need them most. Hubs have become an essential part of the patient-centric care process by providing comprehensive support and assistance for patients, prescribers, payers, and manufacturers.