Access USA 2023 Trending Topics and Recap

AssistRx leadership recently traveled to Philadelphia for Informa Connect’s inaugural Access USA Conference. For the first time, Hub and Specialty Pharmacy Models East, Patient Assistance and Access Programs (PAPs), and Rare Disease Innovation and Partnership were held under one roof. Our team was proud to facilitate dialogue around digital hub models, technology-first patient support strategies, and improving PAP performance through automation.

Three conferences in one are a lot to digest. Missed any sessions or just want the highlights? Here are, in my opinion, the two top prevalent topics:

1.????Defining and delivering a “digital hub”

2.????Optimizing affordability programs

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1.??Defining and delivering a “digital hub”

A common theme throughout the event was the specialty pharmaceutical space’s progress toward digital hub models. Life sciences organizations with products across disease states and in various lifecycle stages are embracing digital strategies and creating digital ecosystems to best support patients, healthcare providers (HCPs) and patient support program performance.

During one session, Sanofi Head of Innovation, Patient Support Services Anthony Scatamacchia joined AssistRx Patient Solutions Division President Jan Nielsen and Vice President of Business Development Brok W. Vandersteen on stage as they shared their takes on today’s “digital hub.”

What truly is a digital hub?

The concept of a digital hub is continuing to evolve. What defined a digital hub five years ago or even in 2022 has already changed. In Jan’s opinion, a digital hub in 2023 requires the capability to deploy technology-first experiences with technology-enabled talent available to step in as necessary – and a strategic approach to both. Digital hubs must offer interoperable, real-time solutions that deliver an automated process. Further, digital hubs need to take an agnostic approach, meaning they are willing to integrate and share data with other parties to support the patient and therapy journeys.

According to Brok, digital hubs need to deliver the right capabilities, at the right time, and through the right delivery channel. Some services, such as AssistRx’s Advanced Benefit Verification (ABV) tool, can be technology-first, meaning they’re completely automated from end to end. Other services, such as AssistRx’s Advanced Prior Authorization (APA) tool, can be technology-enabled, meaning all steps except HCP submission are completed in an automated, digital fashion.

?For Anthony’s team at Sanofi, it’s about removing hands from the keyboard when it’s not necessary. Digital hubs should make patient support services more efficient so that not every problem requires more people, and people are focused on the most critical cases and human engagement.

How do life sciences organizations determine if a digital hub is right for their product?

Jan tackled this question, sharing life sciences organizations should consider the following:

• Product stage in its lifecycle: Mid-lifecycle products looking to reduce overhead or end-lifecycle products approaching the patent cliff benefit from digital hubs’ technology-enabled solutions, but even products at launch can benefit from automation.
• Type of product: Low WAC products requiring specialty-lite services like PAs are typically better served by a digital hub than a product with a complicated method of administration or complex therapy regimen.
• Patient and HCP population: Products having highly motivated, technology-savvy patients and technology-savvy HCPs familiar with specialty drugs are great fits for a digital hub. Products having non-technology-savvy patients with high adherence risks and HCPs who prefer manual methods may benefit most from technology-enabled talent teams.

All factors considered, if a digital hub is right for a product, the life sciences organization needs to think through a few more considerations—according to Brok, Jan and Anthony:

• Which technology and balance of tech + talent best support the product? Direct connectivity may be more accurate than artificial intelligence (AI) when pulling coverage and affordability program eligibility. Jan shared that she would not suggest investing in AI for a brand new launch, because AI requires data to improve accuracy. However, if the life sciences organization plans to buy data and mine it because the drug is entering a crowded market, that’s a different story. Brok stressed that a digital hub partner should provide guidance on the right balance of tech + talent, which tech- or talent-enabled touchpoints best differentiate the product, and how the support program approach should evolve throughout the product lifecycle.
• Is the organization aligned and bought-in on a digital hub? According to Anthony, the life sciences organization needs to be aligned on the strategy. Internal partners need to understand what the problem is and the methods that can be deployed to solve for it. He emphasized that life sciences organizations need to make sure when building processes and solutions, it is the patient journey they’re building for. Further, all partners associated with building solutions must act as a team and test the solutions all the way through. For example, a solution his team built to support e-prescribing defined 195 different scenarios that a patient may experience.
• Does the organization have the right expectations? There will always be a manual component in the specialty pharmaceutical space. Life sciences organizations need to design programs for the 80%—the majority of customers and therapy journeys. At the same time, program design needs to account for 10% disruption—factors unaccounted for—and 10% safety net for cases that require talent or for customers who will always prefer talent-enabled support.

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2.??Optimizing Affordability Programs

Multiple sessions covered rising operating costs among PAPs, the increasing number of payer-driven cost avoidance programs, and how technology can reduce operating costs and enhance experiences. Automation and payer access barriers were particularly popular topics.

During another session, AssistRx Patient Solutions Division President Jan Nielsen and Vice President of Business Development Jordan Armstrong shared the ways a technology-first approach can optimize PAPs and how to supplement them with technology-enabled talent.

Today’s traditional PAP experience can take up to 18 days from the point of prescription, to the benefit investigation, to the PAP eligibility screening, to the patient receiving free drug. Many manual tasks are performed by hub staff throughout this process, driving up costs for free drug programs. However, a technology-first PAP can reduce this time to 12-72 hours and avoid costly FTE-based activities.

What is a technology-first PAP?

Jan summed up the technology-first PAP (e-PAP) experience as putting all eligibility and enrollment steps upfront and electronically to get PAP drug out the door and over to the non-commercial pharmacy to dispense. In other words, an e-PAP gathers patient consent, coverage information, eligibility requirements and more upfront and triggers the appropriate remaining automated steps—all in one workflow.

Jordan elaborated on the e-PAP experience by outlining its impact on program performance throughout each step:

• Eligibility screening and enrollment: Through e-support services like e-Income Verification and direct connectivity to payers, patients and HCPs can screen the patient for eligibility—based on the life sciences organization's business rules, complete enrollment and generate a card/voucher in real time. Patients and HCPs can complete these tasks at their convenience via engagement websites, text and email.
• Reverification: Automated reverification eliminates blizzard season headaches, reduces FTEs — and recaptures revenue. AssistRx’s ABV solution searches for insurance coverage, both at the time of application and at various times throughout the year, to identify patients who obtain insurance coverage during PAP eligibility and transition them to commercial scripts. On average, we find at least 2% of PAP patients gain coverage each month. In under one year, we achieved $20M in recaptured revenue for an immunology drug portfolio’s PAP.

What’s the right balance of tech + talent for e-PAPs?

As Jan stated earlier, there will always be a need for talent-enabled services in specialty. While an e-PAP should be technology-first, talent should complement technology in the following instances:

• Denied coverage: Talent can leverage Advanced Clinical Documentation (ACD) to pull patients’ medical history, including items that support PAs and appeals. ACD uses integrations with leading data health exchange service providers to return comprehensive patient information, such as tried-and-failed therapies, contraindicated medications and lab work, in real time.
• Alternative coverage: Experts on Medicare, Medicaid, alternative plans and third-party foundation research can support patients in finding and understanding eligibility requirements for alternative affordability assistance.
• Copay accumulators/maximizers: Talent can use ABV to identify which patients were or are likely to be targeted. Once AssistRx identifies targeted patient populations, we step in to support their continuity of care and input that data into our system to proactively flag and support similar patients.
• Specialty carve-outs: Two technologies can be used by talent to address specialty carve-outs. As described above, talent can leverage ABV and ACD to identify patients likely targeted by carve-outs, as well as competitor drug PAPs that may have modified their program eligibility accordingly. In fact, Jan shared that AssistRx has 24 specialty carve-out programs flagged in our system. Thus, we can identify alike patients as they enter our system and go through ABV, and then administer a copay alternative or look into alternative coverage.

Another area in which talent supplements technology is the non-commercial pharmacy. Having e-PAP and the non-commercial pharmacy under one roof leads to improved efficiency, reduced compliance risk and fewer channel fees. For one AssistRx client, implementation of an end-to-end e-PAP model drove a 40% reduction in FTEs and projected $9M in savings over two years.

Jordan presented one last recommendation for life sciences organizations looking to optimize their affordability programs: These technologies are not limited to PAP. e-Support Services like e-Consent, e-Enrollment, ABV, APA, etc., can and should be applied to all life sciences organizations’ affordability programs to optimize program performance and create differentiated patient and HCP experiences.

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To learn more about how AssistRx delivers the advanced way to initiate and support life sciences organizations’ brands, meet with us at Asembia Summit. Schedule your meeting here .