The success of specialty therapeutics often hinges on navigating a complex, multi-step process to initiate patients on a new therapy. Without ensuring a positive experience from the outset, there is a significant risk that patients may not engage with, or adhere to, the treatment plan. Merely confirming a patient’s benefits and providing a prescription are insufficient to establish a solid foundation for patient initiation.
CareMetx, as part of our industry-wide survey of prominent pharmaceutical and biopharmaceutical manufacturers, aimed to comprehend the potential pitfalls throughout the patient's care journey that could jeopardize initiation. By adopting a more comprehensive perspective on initiation, manufacturers can effectively eliminate or mitigate these obstacles.
Challenges Along the Patient Journey
Manufacturers, healthcare providers, and patients all share a vested interest in ensuring that patients start their treatment plans on the right foot. However, numerous hurdles can impede therapy initiation at different stages of the patient's care journey.
For example, a physician may have written a prescription, but the patient’s benefits have not been verified, resulting in an unfillable script. Alternatively, their benefits may have been verified—and the prescription sent to a specialty pharmacy and filled—but the patient never collects it. This scenario is common and can arise due to many reasons, including transportation limitations or other social determinants of health.
Additionally, it’s not uncommon for patients to pick up the prescription but never initiate the therapy. This can occur if they are unconvinced about the necessity of the medication, concerned about potential side effects, or uncomfortable with self-administration, particularly when it comes to self-injectable drugs.
These examples represent a fraction of the many barriers that can prevent patients from initiating critical therapies and adhering to prescribed treatments. A comprehensive understanding of these challenges, their likely occurrence points, and effective resolutions is crucial for establishing successful patient services programs, especially for complex specialty medications and medical devices.
Examining Patient Services Priorities
During CareMetx's research involving manufacturers and healthcare providers, it became evident that specific criteria play a pivotal role in selecting a patient services solution provider, and subsequently influencing the patient's therapy initiation experience.
Several criteria emerged as the top priorities for manufacturers seeking a Digital Hub to support their patient services programs. Notably, in the era of Big Data, manufacturers rated patient data as highly important, scoring 8 out of 10 in importance when selecting a services Hub. Other key priorities included the Hub provider's ability to coordinate a comprehensive range of patient services and demonstrate the effectiveness of their service offerings. Manufacturers searching for a Digital Hub to facilitate their drug programs also sought innovative technologies that support the entire patient care journey, as well as a comprehensive suite of patient services.
The Impact of Hub Services on Patient Success
According to the feedback respondents shared with us, the ability to support patients throughout their care journey—particularly during critical points when therapy initiation and persistence are most at risk—is vital for the success of outsourced patient services programs. However, some Hubs primarily concentrate on addressing and mitigating cost-related issues.
While services like benefit verification, prior authorization, and assistance with financial aspects can certainly help overcome cost barriers to therapy initiation, manufacturers are increasingly recognizing that these services represent the bare minimum. This recognition is especially true for complex therapies, such as those in the field of oncology, which patients may find challenging to comprehend or self-administer.
For intricate therapeutics, successful treatment initiation relies on patient services programs that address the myriad of potential challenges beyond cost barriers. For instance, patients may require preliminary blood work or need to adhere to a regimen of frequent appointments for infused therapies. They may experience anxiety related to their diagnosis or concerns about the medication itself. Some patients may need encouragement or reminders in order to adhere to a complex treatment plan over an extended period. Insufficient emotional support systems can hinder therapy adherence, particularly for chronic or life-threatening conditions. Various social determinants of health—ranging from education and literacy to transportation and nutrition—can threaten the successful initiation and completion of treatment plans.
A patient services program primarily focused on eliminating insurance and cost barriers, rather than addressing the full spectrum of challenges patients may encounter, falls significantly short of preparing patients for a successful care journey and positive health outcomes. Fortunately, adopting a best practices approach allows manufacturers to take a holistic view of the therapy initiation process and effectively address the complex, interconnected factors that impact patients' ability to begin treatment on a positive note.
Our report presents a comprehensive survey analysis, detailing three best practices that can assist specialty pharmaceutical manufacturers and medical device makers in their assessment, selection, and implementation of patient services programs aimed at improving therapy initiation. You can learn more about these best practices by downloading our report.