Traditional specialty drugs — which are notably expensive and often have complicated administration requirements and safety issues associated with them — are increasingly supported in the marketplace by a hub model program. A hub model program aims to streamline and automate many of the services and information offerings associated with a brand.
This model is also being used to support branded products that occupy the "middle ground" between high-cost specialty drugs and traditional prescription products sold through retail pharmacies. These drugs require many of the same types of support services (for patients and prescribers) but do not necessarily justify the cost of a comprehensive hub model.
The types of branded medications that can benefit from a Hub-Lite® approach tend to share several hallmark characteristics. In general, they:
- Have moderately high cost ($400-$1,000/month)
- Are typically reimbursed via the patient's pharmacy benefit
- Tend to be oral or self-administered via subcutaneous injection
- Are typically dispensed through a mix of retail specialty pharmacies or home delivery
- Often require educational support materials prior to administration, or to support adherence goals
- Require sustained adherence over time
- Often treat asymptomatic diseases (thus, patients don't necessarily feel better or worse when on the medication, which may lead to drop-off)
- Have unpleasant side effects that must be properly managed to prevent drop-off
"Our Hub-Lite® model provides a mechanism to offer a pared-down selection of value-added support elements for certain brands, without necessarily going for the entire 'white glove' approach often used for costly specialty pharmacy products," said Triplefin Account Manager Amanda Dean, PMP. "This helps brand managers to cost-effectively address the needs of the brand and provide the solutions to ensure successful uptake in the market, at a cost that can be justified by the brand's revenue stream and business model."
From the pharma brand manager's perspective, three objectives are essential to the successful update of a product in the marketplace:
- Get patients on the brand
- Keep patients on therapy
- Optimize the experience of all who interact with the brand (patients, physicians and other healthcare professionals)
"Any hub program model can help the brand team meet these three objectives, but the cost to develop a complex, high-touch hub to support, say, oncology and other expensive specialty drugs can be very high," said Elvin Knight, Executive Account Director. "When it comes to other pharma brands that need some level of patient and physician support, but cannot justify the cost associated with developing a comprehensive hub model, the development of a modified Hub-Lite® approach provides the perfect compromise."
Building a customized solution
"The Hub model developed for many specialty drugs involves many 'spokes,' each representing a specific type of clinical or financial support service associated with the disease or the drug. These spokes include contact centers, clinical support, patient-education materials, reimbursement support, prior authorization support and more," said Knight. "Triplefin's Hub-Lite® approach allows brand teams to pick and choose which spokes are most critical to leverage," said Knight.
For many patients, out-of-pocket expenses related to doctor visits, medications and other services create barriers that reduce drug adherence, decreasing the potential for optimal health outcomes. Today's hub program models give patients easy access to specialized healthcare professionals (for instance, certified diabetes educators) who are highly trained around the disease state, medications, proper administration, side effects and more. "This provides a valuable clinical support resource to the patient after they have left the physician's office — at no charge — and can help to alleviate some of the out-of-pocket burdens they face," said Dean.
One of Triplefin's clients produces a medication that is used on a long-term basis by patients who have experienced a serious heart event "After you have had a heart attack, you are at supreme risk of having another one, so the onus is really on the patient to help manage this risk," said Dean. Nonetheless, due to a confluence of factors — ranging from the patient's denial or misunderstanding about the seriousness of the condition to financial issues — this medication typically experiences a high drop-off rate among patients.
The Hub-Lite® design that Triplefin developed for the brand includes a tailored suite of services, centering on a high-touch Contact Center with access to highly trained patient advocates who offer dedicated service to the brand and provide educational materials that aim to connect the importance of this drug to the heart event. Also featured is a pharmacy finder, which can help patients find a nearby pharmacy that stocks the drug and has a 30-day supply.
Using insight gained from focus groups, the brand team was able to tailor the educational outreach materials to help patients understand the importance of managing their health after a heart attack (rather than looking "for a cure") and the role that this medication plays. And, using information gleaned from patient data collected through the hub, the brand team is able to assess adherence patterns and identify important lifestyle and emotional themes that resonate among different patient groups. Such insight is then used to both produce the most impactful educational outreach, and to target different levels of outreach and personal coaching, in order to optimize the patient experience with the drug, increase the number of days on therapy, reduce repeat hospitalizations, and improve related health outcomes.
"Through data collected through the hub, we are able to help the brand team understand what motivates their patients. For this particular medication, a big theme for heart attack survivors is that they want to survive "for their loved ones," said Dean. "In the focus groups, many patients say they are working for long-term survival to 'see their son or daughter get married' or 'be at their grandchild's graduation.' This, coupled with insight gained about their particular interests (such as gardening, sports, vacations and so on) helps the brand team to create impactful educational support and marketing outreach for the brand."
Assume Some Risks with New Adherence Technology
It was a dark and stormy night...a scenario that may play out when contemplating using any of the many new electronic tools pharmaceutical companies are employing to enhance patient adherence to their drugs. As the health system in the United States continues to become more complex, pharmaceutical brand managers are faced with mounting pressures in having to navigate these challenges in order to build their brand's business. The old model of sending out an army of sales representatives to call on thousands of physicians in order to build brand awareness and ultimately usage, is a thing of the past. Today, it is all about 'e' this and 'e' that, which is to help brand managers build awareness and prescribing. It is also getting the brand much more involved in the patient journey, something unheard of just a few years ago.
But all of this new technology, while the hot new thing in pharmaceutical marketing, poses significant risk to the companies employing them. This is especially true when employing these tools to enhance patient adherence as the HIPAA and Privacy rules come into play. While the HIPAA security rules do not explicitly call out these tools, they do require that security measures be put in place to protect patient information if PHI is involved. Encryption is just one of the security measures that can be employed. However, encryption itself has its limitations. While the sender can encrypt the message, often times the receiver has to have a special password or even software to receive the message. This can become problematic when dealing with thousands of potential users.
Patient authorization is another factor when using technology to help enhance adherence. When signing patients up for refill reminders, email blasts, reminder phone calls, texts, etc. it is crucial that the device can capture and store patient authorization. In addition, the patient must feel confident that the pharmaceutical company is protecting their health information. With all the data breaches of late, patients are becoming more leery of signing up for many of these new programs.
There is a litany of data out there now that suggests that leveraging technology to enhance the patient's adherence to their prescription protocol is working. But if you are thinking of adding a new technology tool to help your brand, you will want to make sure you have considered all the HIPAA and Privacy risks before venturing out into the dark and stormy night.