Access solutions: the missing link that prevents biopharma innovation from reaching patients

Pharma Market Access
missing link

We live in unprecedented times, where innovation in biosciences continues to accelerate. Science has taken a vertical growth trajectory, yet such innovations are, at best, slow to reach the patients in need. We believe that innovation in patient access models is the necessary catalyst to aid patients in starting on and staying on the therapies they need to improve their lives.

Why current patient access solutions have come up short

Patient access solutions, including hubs and specialty pharmacies, play a vital role in getting patients started on therapy. However, most models are based on an old-fashioned and expensive call centre-based approach that fails to meet the needs of patients and healthcare providers (HCPs) as consumers. Additionally, with traditional solutions, brands are hurt by misaligned incentives that drive low adherence and diminished gross-to-net.

Patients as consumers have moved on: today’s consumers have come to expect smartphone-based e-commerce convenience, reliability and transparency in their day-to-day interactions. Yet, the healthcare experience is antiquated. In this day and age, a call from a 1-800 number is more likely to go to spam than considered a “white glove” experience. As a result, therapy starts are delayed and often result in patients never starting their prescribed medication.

Uniquely positioned, traditional patient access hubs promise to simplify the process of getting patients started on therapy and offer to provide HCPs with much-needed assistance in navigating payer requirements leading up to therapy starts. However, the cumbersome hub workflow overshadows the purported gains in productivity. The clerical overhead of enrolment forms navigated over fax and phone calls fails to deliver on the promise, resulting in lower-than-expected prescription volumes and lacklustre adoption among prescribers.

Dispensing pharmacies, while incentive-aligned on starting and keeping patients on therapy, may not have the tools, time, or incentives to secure the lowest out-of-pocket pricing for the patient. Typically, a covered script is the most affordable script for a patient, but in the absence of technology to help them secure coverage, dispensing pharmacies often use an uncovered coupon to quickly dispense the medication. This, once again, leads to abandonment caused by patient out-of-pocket costs as a critical driver in non-adherence.

Brands, faced with issues ranging from poor user experience to misaligned incentives, must contend with poor adherence and diminished gross-to-net that impede their ability to re-invest in patient access. On top of that, traditional solutions provide delayed program data. The data they do provide is often missing abandoned patients and information about why they didn’t ultimately receive their medication. Lack of transparency further exacerbates decision-making challenges—and the quality of data input gates good decision-making into the process. Eventually, the costs of an inefficient patient access model accumulate at the brand P&L; a low percentage of covered scripts and low adherence turn into low gross-to-net, resulting in a novel innovation that could have helped patients fail by its deployment model.

Unfulfilled promise of technology

Technology is upending every aspect of our lives, from retail to transportation. Yet, the track record for technology for securing access to life-saving therapies has been dismal, and I see at least five trends that have led up to this:

  • Inflexible, legacy technology: most patient access technology solutions available to biopharma are built on third-party, off-the-shelf platforms that do not anticipate the specific healthcare use cases. As a result, most CRMs built as general-purpose platforms cannot be customised sufficiently to fit the unique needs of a specific therapy.
  • Cost: solutions based on inflexible platforms require considerable customisations, running into millions of dollars to be usable. Often, such customisation projects fail at an enormous expenditure of time and money. Brands must take a leap of faith that such solutions will work and plan for huge financial outlays to underwrite such projects.
  • The shiny new thing syndrome: while it is exciting that information technology is advancing rapidly, the less-understood reality of the technology lifecycle is one that often causes disappointment. Advancements in information technology undergo a maturation cycle involving working out various kinks in less mission-critical applications that can tolerate failure (e.g., entertainment or consumer apps), before it is production-worthy for mission-critical healthcare applications.
  • Partial digitisation: some patient access models have adopted superficial digitisation, typically by way of text messages or digital patient enrolment. While admirable, most aspects of the behind-the-scenes workflow continue to be manual in nature, ultimately providing limited upside to the overall experience.
  • Technology over user experience: the other end of the approach mentioned above is to build a cutting-edge platform in terms of technological infrastructure. Still, it does not consider the stakeholders’ appetite to adopt new user experiences. Hence, the lukewarm success of proprietary portals and EMR plugins that require HCPs to learn entirely new workflows for each patient access program.

The times, they are a changing: economic and political uncertainty is the catalyst to change

The industry has been slow to adapt to change, primarily driven by the inertia of a system that has reached an uneasy equilibrium.

The current inefficient patient access models are better than none at all. However, this equilibrium presupposes an economic and political reality that is static. As is increasingly becoming evident, economic and political uncertainty is causing brand managers to have to accomplish more with less. While this sounds like an impossible feat, we see tremendous possibility: uncertainty drives long-pending change, and we believe such change for the better is coming to patient access models.

Why this time is different

Our thesis has always been that well-considered technology has the potential to truly transform patient access. What does this mean? I outline below the salient aspects of a technology-driven patient access model, embraced as design principles, while designing and iterating a patient access platform with several large and small biopharma brands.

Emphasis on user experience: this does not always mean shiny new things - it means meeting the stakeholder where they are in order to create simple, intuitive tools.

  • For HCPs, this means a minimal-to-no learning curve or departure from their established workflows. With no new tools to learn, all of the innovation works hard behind the scenes to lower the workflow burden of meeting payer requirements.
  • For patients, that means a familiar browser-based smartphone experience with no apps to download, allowing adoption across all age groups. Not all patients want to use their smartphones and, even if they do, sometimes they need to talk to a fellow human who can empathise and assist. Our approach has been to let technology succeed for the majority of patients for whom it is the most convenient and make it easy to interact with a person for those who prefer to, and understanding the needs of other patients who may prefer to interact with, say, a nurse navigator over a phone call at their convenience.

Platform, not features: Our approach has been to a completely new solution, using the modern yet proven building blocks of consumer internet technologies that have transformed consumer lives. We use the same technologies and adopt them for the rigors of the patient access use case, resulting in a platform that spans all stakeholders: brands, patients, HCPs, pharmacies, and payers.

Use technology to align incentives: technology frees up information. Workflow automation lowers the level of effort required to meet payer requirements, reduces patient out-of-pocket expenses, and further aligns incentives.

Focus on patient out-of-pocket as the key driver of adherence: a flexible, customisable platform helps brands balance speed to therapy (patient experience) with patient out-of-pocket expense - the two key drivers of adherence. A purpose-built platform allows the brand to build custom scenarios that help achieve this balance unique to the combination of patient, therapy, and payer requirements.

Data: our emphasis on real-time data from the time of prescription to dispense, tracking all aspects of the patient and HCP experience, has delivered insights that help brands design efficient copay assistance programs to understand the patient journey in depth.

Cost: technology should reduce program overhead. The advantages of tech-first platforms are deployments that require little to no upfront costs and fast launches. Brand P&L managers can see the direct correlation between investment in their patent access program and the results that it delivers quickly, without the risks associated with traditional access programs.

During this time of economic uncertainty, brand managers must seek new ways to improve patient access, while driving down costs to maximise brand value. Technology will play the most crucial role in improving patient access and medication adherence. Life science companies do not need to be technology companies, but they do need to integrate technology solutions that will take the medications they have developed and ensure that they reach patients in need.

About the author

Deepak ThomasDeepak Thomas is the founder and CEO of Phil Inc. He started the company to build a solution that expands and simplifies patient access to specialty drugs, while aligning economic incentives for therapy manufacturers.