As competition in a diversifying specialty drug business rises to fever pitch, manufacturers are seeking new ways to differentiate the product servicing model to help their brands stand out. Triplefin's Hub-Lite® program is adapting to these new expectations with a customized set of services geared to specialty's biggest growth segment: mid-range therapies with higher price tags than traditional retail pharmacy, but significantly lower than high-end specialty pharma.
Today’s dynamic, fast-growing specialty drug market represents a test of will for manufacturers – in relations with payers, patients and other stakeholders. Challenges include mediating a cumbersome “buy and bill” approach to pharmacy payment; handling the logistics of administering biologically complex therapies in both the clinical and ambulatory setting; and keeping patients compliant with their prescriptions. Most important, the specialty marketplace is increasingly competitive, and physicians are now able to choose among a variety of therapeutic options for the same illness.
In response, manufacturers have intensified their focus on offering value-added services beyond the pill. It’s accepted practice today among specialist marketers to sponsor a “hub” of clinical and administrative services to expedite the patient journey and differentiate these complex medicines against the competition.
But after some 15 years of industry experience with the hub model, is it enough to keep pace with the changes? This was the defining question at CBI’s 17th annual Patient Assistance and Access Programs Conference (PAP), held in Baltimore in March 2016.
Operations Vice-President Sandy Piscitello from leading brand-support company, Triplefin, was ready with an answer.
“Specialty manufacturers are seeking more service options – options that relate to different customer and patient needs, linked to the emergence of products that occupy the middle ground between the most expensive specialty category drugs and traditional retail pharmacy,” he told a conference workshop on PAP program design. Put simply, transition in the product space requires transformation in the service mix, with collaboration as the guiding premise for all stakeholders involved.
Hub-Lite®: Staking Out Specialty’s Middle Ground
To address the changing market profile, Triplefin has coined a flexible service program: Hub-Lite®. Hub-Lite® offers a higher level of service quality than traditional service models, while providing flexibility to customize services according to the brand’s needs. The traditional Hub is a case management tool involving as many as ten support functions ranging from benefit verification to group pharmacy shipment coordination. It is labor intensive and relies on professionals with specialized expertise, including knowledge of how to navigate a closed system of distribution and deploy multiple resources on a community-wide basis. Keeping patients adherent with therapy through that all-important first script fill – itself a vital PAP objective – requires some type of human intervention.
The sum of all these activities makes the traditional Hub program a costly proposition for the sponsoring manufacturer. The expenditure makes economic sense when the monthly pharmacy bill per patient is $1,600 or higher, the norm for specialty biologics commonly dispensed by infusion or injection. Hub servicing for large-population, small molecule medicines dispensed at a retail pharmacy is correspondingly rare, especially where monthly pharmacy costs per patient are below $400. But what about the sizable – and growing – market for specialty applications between these two extremes?
Piscitello explained that it is precisely this middle ground where the need for a Hub-based approach is greatest. Specialty brand sales are growing faster here than at the top end of the market, due to the increasing number of therapies competing within the same class or indication.
“Significant pricing pressure from the top is coming down, particularly as more oral oncology drugs are being introduced instead of physician-administered infusion drugs,” said Piscitello.
Triplefin Hub-Lite® relies on customized IT to integrate PAPs around a streamlined package of services linked to the brand. A suite of digital solutions includes a fully automated, portal-based application process; simultaneous processing of financial and insurance benefit data; and development of online, multi-purpose reporting forums.
The Hub-Lite® digital solution offers a considerable savings over a manual paperwork process. A key example is benefit verification services. When benefits extend from retail pharmacy to major medical, it can entail significant differences, including billing codes and prior authorizations. Hub-Lite’s® emphasis on state-of-the-art IT is central to the Triplefin strategy to work more collaboratively with those who set the rules on brand access. Piscitello notes, “It’s in the future of the Hub servicing space to say that providers and payers are not the enemy, but part of the solution.”
Triplefin’s Three Points of Light
Hub-Lite® is not just an automated vehicle for service delivery. The model is flexible in continuing to apply traditional “high-touch” human interventions where it makes sense to do so for the brand. For example, in tackling poor patient adherence, where the abandonment rate can be as high as 60 percent after only three months on therapy, Triplefin’s Hub-Lite® approach still recognizes the value of engaging patients directly.
“Our model allows for a tiered strategy of engagement, ranging from automated texting reminders to script-based coaching to full-on efforts of HCPs,” says Piscitello. “The key here is flexibility: what makes the best sense in aligning a Hub-based strategy to the brand manager’s objectives? It’s the first question we ask a client.”
Besides flexibility, Piscitello cites two other distinguishing characteristics of the Hub-Lite® model. One is seamless integration – directing needs-appropriate services to the right people, at the right place, at the right time. “Setting up the IT architecture, right-sized to each brand, is vital. But we also think it’s important that we meet outside vendors halfway in making these systems interoperable at sites where we interact in support of the brand.”
The other distinguishing characteristic is meaningful metrics. Hub-Lite® structures its service mix to actions that will overcome barriers at every stage of the patient’s journey with the brand. “A Hub-Lite® system design supplies the evidence around health outcomes best suited for a brand’s success in the market.
Case Study: Repositioning Reimbursement in a Specialty Niche Market
To highlight the responsiveness of the Hub-Lite® model, Piscitello presented a case study to the CBI workshop involving the struggles of a niche market drug to overcome reimbursement hurdles, preventing the manufacturer from gaining access to the eligible patient population. Triplefin applied its Hub-Lite® analytics tools to identify the underlying source of the hurdles, which it attributed to payers’ lack of understanding the disease, accentuated by the manufacturers’ strategy to promote the drug in multiple channels, including retail pharmacy; long-term care; and direct to patient. Piscitello said that to fix the problem, payers and providers needed to be educated.
“Using our Hub-Lite® model, we trained a reimbursement support team to respond specifically to the challenges identified and expedite decisions on reimbursement,’ he told the CBI workshop. “The team acted as a single point of contact for all sales channels where the medicine was being promoted. Help and information inquiries tied to decisions on reimbursement of the drug rose from around 50 in November 2014 to more than 450 in October 2015 – a considerable success in educating the payer class about the benefits of this drug for its niche condition. And on one crucial indicator, access hurdles went down. In less than a year, approvals from payers on prior authorizations necessary to obtain the drug rose from 26 in November 2014 to 352 in October 2015.
To Piscitello, the success the niche manufacturer had with Hub-Lite® is attributable not only to the comprehensive reimbursement support, but also to the coaching Triplefin’s team received in what he calls “empathetic engagement” with customers.
“Hub-Lite’s® approach responded directly to the customer pain points,” he said. In that regard, Piscitello emphasizes that Hub-Lite® should not be seen as “Hub-Less.” The model achieves its savings through digital automation and IT, but it is positioned to make sensible investments on the human side as well, toward a greater focus on direct engagement with the patient.
In a maturing market for all specialty products, with greater competition among brands distributed at variable price points and through different dispensing platforms, Triplefin offers flexible product solutions. With Hub-Lite®, a comprehensive hub experience is now possible for less than full specialty products. The Hub-Lite® option promises to be a differentiating competitive asset for manufacturers as the retail and local pharmacy channels capture more specialty business.
Published May 2016 | Reproduced with permission by Pharmaceutical Executive.