Proactive Point-of-Care Support

Because I work in tech, my retired-physician parents have decided that I am a great resource for tech support. So naturally, whenever they run into issues with their laptop, smart TV, smartwatch, or smart-whatever, I get a call from Dad (but never from Mom; she feels bad pestering me about tech issues, so instead she pesters my dad, who invariably calls me). I often miss those calls or just can’t talk at the exact moment their need arises. The result is that they’ll spin on it and just feel super frustrated by the time I can offer help. For healthcare providers, these feelings of helplessness are all too familiar – even when the assistance isn’t coming from their son.

Unfortunately, the pharmaceutical support services industry can often evoke those same feelings. Since its inception with growth hormone therapy and the launch of infusible drugs like Rituxan and Herceptin nearly three decades ago, the “hub” industry has had an immense positive impact on overcoming the difficult (and sometimes unnecessary) obstacles that make it harder for patients to get and stay on life-changing treatments. But the same set of services that enabled patients to access specialty drugs in 1997 is now facing challenges created by the very proliferation and success of those drugs. To prevent patient access obstacles from slowing and ultimately diminishing the success of specialty medications, the industry needs to pivot to more proactive and point-of-care-based support.

In its original form — which we’ll call Pharmaceutical  Support Services V1 — manufacturers set up phone banks to help doctors and patients navigate the most pressing access challenges. V1 has three characteristics:

1. “Pulled”: the healthcare organization (HCO) must take initiative to “pull” support assistance from the manufacturer.
2. Delivered via manufacturer-specific channels: HCOs get support via a hotline or brand-specific website that is operated exclusively for one treatment or one manufacturer.
3. “Event”-focused: Services are structured around specific events like running a Benefit Verification (BV), submitting a Prior Authorization (PA), applying for Copay Assistance, etc.

V1 has, of course, evolved to incorporate technology in both obvious ways — e.g., adding web portals to allow HCOs to digitally pull services — and novel ways — e.g.,using artificial intelligence to mimic aspects of human support. However, it still retains those three characteristics: “pull”-based, delivered via manufacturer-specific channels, and focused on “events”.

This makes sense given V1 was set up in a world where prescribers were using a much smaller number of extremely complex drugs and where payer access was much simpler. That world is now behind us:

• While specialty drugs were extremely rare beforehand, between 2004 to 2023, 170 new biologics were approved by the FDA.

Source: https://docs.google.com/spreadsheets/d/1bDjnTQCZgGxQUiQURBqwHexl7wvjYaNt2JZm46Uu3GQ/edit?gid=0#gid=0&range=I11

• More new drugs launched in competitive classes of therapy — each indication had 40% more therapy options in 2019 vs 2006, according to McKinsey.
• Not surprisingly, the McKinsey study found “in markets where multiple comparable drugs are available, 60 percent of launches fail to meet prelaunch expectations.”

This complexity undermines the ability for the most miraculous drugs to actually reach the patients who need them most:

• Patients are increasingly less likely to know about relevant support services, and correspondingly less likely to start therapy if they don’t know about or use those services, according to a study by Accenture.
• Providers and patients are more likely to abandon treatment altogether due to administrative issues or financial issues.  
• A Bain study of launch failures found one important factor between failures and success: physician and patient pain points around access & reimbursement.

The momentum behind specialty drugs risks collapsing under its own weight if it can’t address the challenges posed by this growing complexity.

Patients need the industry to evolve towards Pharmaceutical Support Services V2 — Proactive Point-of-Care Support. In this new world, the basic tenets of V1 are inverted:

• Proactively “pushed” to healthcare organizations (HCOs), rather than pulled. Proactive Point-of-Care Support uses data to facilitate assistance that HCOs are likely to need, often before the HCOs even know they need the support. That is possible because:
• Delivered within the existing workflow of the provider — at the Point-of-Care — rather than solely through manufacturer-specific channels. By living within the existing tools and day-to-day operations of the HCO, that support lives where the providers and their staff are, and can pre-empt challenges before prescribers and patients abandon the optimal treatment for something inferior.
• Holistically focused on the “script-to-therapy” journey, rather than just on discrete events. Each event is instead treated as a precursor to flow into the next event to ultimately get a patient started on treatment.

Until we fully transition from the traditional model of V1 to the Proactive Point-of-Care Support model of V2, specialty drug adoption — and thus the health of the patients we aim to treat — cannot reach its full potential. When my parents don’t get the tech support they need from me at home, the worst case scenario is a “hard reset” to the device in question – pull the plug on the Smart TV. When providers don’t get proactive, in-workflow, holistic support they need, there’s no reset button — and patients feel the impact.