10 Questions to Ask When Considering Implementation of a Reimbursement Hub

Reimbursement Hubs act as a single source of contact for patients and other stakeholders

10 Questions to Ask When Considering Implementation of a Reimbursement Hub

Pharmaceutical and biotech manufacturers are faced with questions every day about the best way to provide support to patients and prescribers of their products.  However, support can mean many things to many people: financial, emotional, physical and clinical. 

When the need of support is associated with specialty drugs, costly retail products, or drugs that demand special handling, it is often necessary to find a qualified partner to serve as the Reimbursement Hub or single point of contact to help patients, caregivers, and prescribers navigate many of the obstacles associated with initiation and ongoing therapy continuation. 

So how do you know if your product could benefit from a Reimbursement Hub?  Here are 10 questions to ask:

1. Is the cost of my therapy higher than other drugs in the same class?  With so many competitive drugs in the marketplace, insurance companies look for cost-saving options before making coverage determination.  These options could impact formulary decisions and utilization management requirements. A Reimbursement Hub facilitates prompt access for your patients by uncovering the determining factors required for product approval.

2. What kind of patient support services are my competitors currently providing?  It is important to benchmark and understand what is being offered by your product competitors to make informed business choices related to implementation of a Reimbursement Hub. Your decision to include or exclude patient support services could have a significant impact on your market share. 

3. What barriers to access will my patients face when attempting to obtain my product?   Each patient and product is unique as are the barriers that they may face.  When dealing with a specialty product or high cost retail product, not only will you encounter restrictions from insurance providers, but many patients will have financial barriers that will prevent them from filling their prescriptions. Experienced reimbursement specialists can identify and provide guidance at these roadblocks to ensure coverage initiation and monitor changes in the market landscape that may affect the patient’s likelihood of therapy adherence.

4. How can we help support the patients and prescribers with payer Prior Authorization requirements? It is quite common for insurance payers to have policies/guidelines in place to ensure that each patient meets the policy criteria. Prior Authorizations are one way to enforce their requirements and completion can be time consuming for prescribers and their office staff. Your Reimbursement Hub should have knowledgeable specialists  as well as the technology support to rapidly identify the necessary requirements, communicate with the prescriber, and facilitate the Prior Authorization with the patient’s insurance payer in a timely manner.

5. Would my patients benefit from additional clinical services? A Reimbursement Hub is the ideal setting to incorporate many Nursing & Adherence services to create an efficient and seamless patient journey.  Clinical support can cross boundaries between the care a patient receives in their prescriber’s office and their dispensing pharmacy.  Typical clinical services can range from drug administration training, custom adherence programs, and refill reminders. 

6. How can a Reimbursement Hub improve speed to therapy for my patients and prescribers? Your Reimbursement Hub specialists must have an in-depth understanding of your product that will allow them to design the appropriate processes and utilize technology to get your patients on therapy quickly.  In addition to guiding patients through the insurance maze and determining the potential need for financial support, Hub employees should identify the proper dispensing pharmacy for the patient and ensure product fulfillment. 

7. What help can be provided to ensure my patients’ ability to afford their medications? Many Americans are still uninsured or underinsured with no ability to afford their prescription medication out-of-pocket costs. Hub employees can research funding  and refer your patients  to financial support resources that may be available based on their individual eligibility.  This could include manufacturer sponsored co-pay card, Patient Assistance Programs, and referral to independent foundations.

8. How can I ensure that my patients receive their medications and refills in a timely manner from the pharmacy? Not only is it important for your Hub to identify the appropriate dispensing pharmacy for your patient’s medication, they should also ensure that the necessary processes  are in place to monitor the initial and ongoing dispensing activities.  Insight into this information could potentially identify delays that may put your patients at risk of non-adherence.

9. Will we need to offer onsite reimbursement support in our prescriber’s offices?  There are many factors to consider when determining if the addition of a Field Reimbursement team is beneficial for your product.  This team can play an integral role in supporting multiple stakeholders throughout the patient journey.

10. How will I know if my Reimbursement Hub is effective? It will be important to establish key performance indicators and the means to monitor the performance of your Hub activities on a continuous basis.  Open communication with your Hub program management is vital to quickly identify trends that could impact your market share.

UBC is uniquely positioned to leverage and analyze data and national trends to help our clients design the most effective Reimbursement Hub.  Each of our Hubs are uniquely developed based on specific key components such as the patient population, disease state, and drug profile.  UBC delivers strategic insight with each of our pharmaceutical and biotech manufacturer clients to ensure that we are meeting the needs of all the stakeholders. 

Contact us to discuss how our Reimbursement Hub solutions can help support your patients and prescribers.