Six Questions to Ask When Considering a Reimbursement Hub

Six Questions to Ask When Considering a Reimbursement Hub

The drug pipeline is filled with specialty medications that offer new hope to patients facing complex, chronic conditions. Once these life-saving drugs are approved, a patient still faces many hurdles before beginning a new therapy. A well-designed reimbursement Hub should serve as the center of activity to help patients, caregivers and prescribers navigate administrative obstacles while offering a variety of support services to patients. Here are six questions to ask when considering a Hub:

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 formulary decisions on newly approved products. A reimbursement Hub facilitates prompt access for your patients.

2. What barriers to access will my patients face?
When a new drug comes to market, insurance coverage often lags. Reimbursement specialists can monitor changes in coverage for individual patients and assist physicians with prior authorization documentation.

3. Would my patients benefit from additional services?
A Hub is the ideal setting for custom adherence programs because these programs can cross the bounds of individual specialty pharmacies, ensuring all of your patients receive important adherence support. Services can range from drug administration training to refill reminders.

4. How can I improve speed to therapy for my patients and prescribers?
Our specialists know that getting patients on therapy quickly is important. In addition to guiding patients through the insurance maze, Hub employees can also identify the proper specialty pharmacy for the patient.

5. How will Healthcare Reform affect my patients’ ability to afford their medications?
While the Affordable Care Act (ACA) is expanding coverage, many Americans will be left underinsured and unable to afford their prescription medication. Hub employees can provide personalized suggestions to your patients, identify expanded Medicaid programs, and walk patients through the application process for Part D Plans (PDP) and the Low Income Subsidy (LIS).

6. Are your patients aware of financial assistance programs?
Hub specialists can recommend alternate funding resources for patients with high out-of-pocket costs, including linking patients to a manufacturer-sponsored Patient Assistance Program.

Each Hub is based on the specific needs of the patient population and disease state. UBC works closely with each of our pharmaceutical and biotech manufacturer clients to provide strategic insight and offer our professional expertise to ensure that we are meeting the needs of all the stakeholders as we design and build the program.  

Next week I’ll join our colleagues at CBI’s Hub Models and Program Design conference, where Lee Ann Steadman will present “Navigating the Multitude of Choices in the Patient Services Market to Maximize Product Value” on February 27 at 3:30 p.m. I hope you can join us. In the meantime, if you have questions about Hubs, feel free to contact me to discuss your product and patients.