In the U.S., the number of specialty pharmacies is on the rise, and hub services are growing in lockstep to meet the needs of the industry. Specialty pharmaceuticals, which include therapy classifications and orphan drugs designed to treat rare diseases, are also increasing in cost, with some genetic treatments exceeding half a million dollars for a single dose. With the upward propulsion of specialty pharmaceuticals, hub services providers manage a variety of functions in order to make the process easier for all involved.
What Is a Specialty Pharmacy?
Today, a host of accredited specialty pharmacies function on the peripheries of the major pharmacy benefit managers (PBMs). PBMs are national systems, such as Express Scripts, CVS Health, Optum, and Prime Therapeutics/Walgreens, which manage prescription drug benefits on behalf of insurers along with a level of patient support.
While the PBM channel dominates the pharmaceutical market, many smaller pharmacies work within their distribution networks. But when dealing with rare diseases, the dominant players use an independent specialty pharmacy almost exclusively to fill prescriptions for uncommon or scarce drug therapies. Many industry players have expressed concern over the rebates PBMs receive from drug manufacturers, arguing that there is not sufficient disclosure of how much gets passed along to the insurers or other payors, resulting in increased drug costs. This creates friction in the process between the manufacturer, the PBM, and the insurer, and ultimately impacts patient affordability and access to care.
How Do Hub Services Providers Help?
The primary mission of a hub services provider is to ensure patients get access to lifesaving therapies by simplifying the process and reducing out-of-pocket expenses. The term “hub” describes how these service providers act as core in the process connecting the patient, prescriber, manufacturer, specialty pharmacy, and insurer. Their role is crucial to making this process viable and is considered a best practice for coordinating a well-rounded care protocol.
Hub services can include an assortment of programs – mostly funded by pharma manufacturers. These services often include education and counseling of patients, end-to-end case management, refill prompts, adherence programs, a data repository that connects patients, hospitals, clinics, labs, and pharmacies, and finally, reimbursement support. Reimbursement is one of the key factors affecting patient access, which is why hub services providers need a specialized payment solution.
Reimbursement Solutions for Hub Services Providers
Paysign partners with hub services providers to deploy payment solutions that create a seamless, complication-free process for patient access to care. Our Patient Affordability Solutions feature our enrollment-and-issuance portals designed to enable hub services providers, specialty pharmacies, prescribers, and patients to access customized affordability products.
Our Centralized Billing Solutions offer end-to-end payments programs that cover long-distance travel necessary for patients in the rare and orphan disease space, including patient travel services, per diem and lodging, and records management.
We work closely with hub services providers and manufacturers to design and deploy the right portal for the individual brands and offers industry-best support and training after deployment.
To learn more about how Paysign’s solutions increase patient retention, care access, and create a seamless and cohesive process, visit paysign.com/affordability.