Patient Support & Hub Services Continue to Evolve

The business of providing outsourced patient support and hub services is growing in lockstep with the growth of specialty pharmaceuticals, which are now approaching nearly half of pharma spending in the US. Specialty pharmaceuticals are not only growing in number, but also in cost, with the latest cellular and genetic therapies reaching a half-million dollars or more for a dose.

Even so, the hub business is extraordinarily dynamic, with businesses merging at the same time as others are opening their doors, with competing loci of patient attention from specialty pharmacies and from service providers to healthcare systems, and—crucially—a riskier element of regulatory compliance, as government regulators look more closely at industry practices. Yet another factor is the ebb and flow of pharma’s own interest in owning the patient experience, through in-sourcing some or all patient support activities.

Through it all, the outsourced hub providers are expanding staff, facilities and technology assets, and expanding the range of their offerings to manufacturer clients. Even though only a handful of the buzz-generating cellular and genetic therapies (CGTs), such as Gilead’s Yescarta and Novartis’ Kymriah, have reached commercialization, some hub providers are already building service bundles in anticipation of this next wave of therapies.

“Ten or 15 years ago, the specialty pharmaceutical space was a handful of drugs costing $5,000 per year so, and the rest were mass-market products. Now, you can’t just say “specialty,” because the market is segmenting and realigning—there’s a real transformation occurring in the industry,” says Shawn Seamans, president of the newly reorganized McKesson Life Sciences unit, which includes their traditional hub and patient-support offerings. According to Seamans, different specialty pharma products call for distinct patient-support offerings, ranging from automated patient contacts to healthcare services delivered in the patient’s home.

Most hub providers have claimed highly individualized support programs; as Scott Dulitz, VP of strategy for TrialCard puts it, “if you’ve seen one hub, you’ve seen one hub.” But now, according to Seamans and others, the industry will see different categories of patient support providers, with competitive offerings more attuned to sectors of the specialty pharmaceutical arena.

Growing their businesses

Here are some of the business actions that have occurred in the past 12 months or so:

Consolidation: There have been at least five rollups in recent months: Eversana now incorporates the assets of Dohmen Life Sciences Services and Triplefin (a former unit of HD Smith), among other acquisitions; CareMetx has acquired Biosolutia (another hub provider) along with Virmedica, a provider of electronic benefit verification (eBV) services; ConnectiveRx, formed in 2016 from a variety of patient service assets, added a consulting firm, Macaluso Group in 2018; and McKesson has completed its integration of RxCrossroads, acquired in 2017 from CVS Health.

Expansion: Cardinal Health Specialty Solutions, which acquired the hub provider Sonexus Health several years ago, has opened an additional facility in Louisville, TX. Trialcard added a facility in Oakland, CA. Asembia has added a fourth location, Trevose, PA, to its other sites of patient support centers. In addition, ConnectivRx is about to open its own noncommercial pharmacy, as is CareMetx.

Introduction: The new year has seen the launch of a new hub provider, Diligent Health Solutions; and it’s roughly the one-year anniversary of another entrant, PharmaCord.

It’s worth noting that all these organizations, as well as the hundreds of pharmacies now accredited as specialty pharmacies (SPs), operate in the spaces around the major pharmacy benefit managers (Express Scripts, CVS Health, Optum and Prime Therapeutics [partnered with Walgreens]), each of which has its own large mail-order pharmacy, and offer some level of patient support. The PBM channel dominates in market share; however, many pharma companies will include other pharmacies in their distribution network, and, for some rare diseases, use an independent specialty pharmacy exclusively. The general rap against the PBM patient-support services is that they occur in the context of the PBMs hardball negotiating over drug prices and rebates; and a fraught dynamic is set up between the manufacturer, the PBM, and the insurer over who gets medications, and how they’re reimbursed.