Supporting High-Touch Specialty Products | PRO-spectus

The global healthcare product pipeline is increasingly focusing on specialty and orphan drugs, with a robust growth trajectory. Attributable to this dynamic is the elevated prevalence of conditions such as cancer and autoimmune diseases, in parallel with advancements in therapy development and approval of new medications.

The Challenge: Due to the unique nature of these high-touch products, patients and healthcare providers require enhanced support services to navigate the complexities of the U.S. healthcare system. Navigating the market for specialty products presents several challenges.

What can you do? Rethink the basics.

• These services should include comprehensive patient-centric engagement solutions that facilitate seamless connections between patient services and provider support.

• Consider all potential paths forward, including innovation and creative solutions to overcome access barriers and get a patient on therapy.

Embedded Complexity Backdrop – 5 Key Takeaways:

1. Obtaining insurance authorization typically requires a manual review process that can delay treatment.
2. High-cost interventions meet reimbursement uncertainty, as the intricacies of provider-level contracting emerge to the forefront.
3. With both coverage and payment facing added scrutiny, patient access to care can be at risk.
4. Patients face the dual challenges of financial responsibility and uncertainty in the magnitude of out-of-pocket costs. These issues are exacerbated by piecemeal insurance coverage and are subject to the associated network status of providers.
5. These potential obstacles, along with related delays in treatment, can create unnecessary stress for patients in the vulnerable state of seeking prescribed care.

Enhanced Support Services – Rethink the Basics. 5 Key Takeaways:

1. High-touch products or interventions require a comprehensive approach that includes a thorough understanding of the complex patient and provider journey, to ensure that the unique needs of every stakeholder are met at every step.
2. Integration of high-tech solutions is crucial, enabling streamlined processes and efficient communication, which are essential for facilitating access and supporting overall market acceptance.
3. In conjunction with value-added technology solutions, there must also be dedicated and determined humans to push the process toward a positive resolution. Further, the scope of support required for a healthcare product or treatment can vary greatly. Some interventions may only necessitate targeted assistance, focusing on specific stages of the insurance or administrative processes.
4. Create an environment that facilitates more efficient resource allocation and can be tailored to the unique demands of each treatment or intervention.
5. Service level differentiators include:

• CRM bi-directional supplier/distributor feeds
• CRM customization by program/product
• AI enabled automations
• Real-time dashboard reporting for HCP and manufacturers’ field sales
• Dedicated Case Manager point of contact
• Clinically trained/educated case team for specific product
• Medical benefit investigations
• Reimbursement pathway analysis
• Patient and provider onboarding and education
• Custom authorization submissions and appeals through IRO
• Unique workflows to support patient, provider, and product needs
• Robust KPI
• Adverse Event training and reporting
• Adherence and patient follow-up

With a growing focus on specialty and orphan drugs in the healthcare product pipeline, deploying enhanced support services to help patients and providers navigate the complexities of the U.S. healthcare system, and overcome barriers to access timely treatments, is increasingly critical.