Pharma Tech: The Next Wave Will Focus on Patients at the Point of Care

The required transition to highly personalized patient journeys involves more than just automating or digitizing the status quo of pharma patient services: it means rethinking it.

As founder and CEO of MedVantx, I spent 20 years pioneering technologies and business models that brought healthcare constituents together to improve patient care.

As a Senior Operating Advisor at LLR¹, I’m applying my experience in patient engagement, specialty pharmacy and supply chain services to help support LLR’s continued involvement in pharmaceutical patient services, a space that is ripe for the next wave of innovation. In this GrowthBit, I’ll examine some of the biggest changes and pharma patient services trends impacting the patient journey and their impact on future growth for this sector.

From mass market to specialty approaches

Spurred by technological advances, regulatory changes and, most importantly, evolving patient needs, the pharmaceutical industry is undergoing a structural shift away from mass market therapies (both branded and generic) and toward complex, specialized treatments.

In 2021, specialty medications—those that treat complex medical conditions such as cancer, multiple sclerosis, rheumatoid arthritis or rare and orphan diseases, have more serious side effects and require complex specialty pharmacy logistics—accounted for over 50% of all drug spending in the U.S.² (up from 20% in 2010). New incentives such as tax credits, accelerated approval processes and extended market exclusivity periods should create even greater incentives for pharmaceutical manufacturers to bring these specialty medications market. In fact, of the estimated $118 billion of total specialty market expansion through 2025, we anticipate new products to account for $62 billion of that growth³.

Making specialty medications more widely available has the potential to revolutionize care for millions, but first, we need to figure out how to address the complexity and expense involved in managing these highly personalized patient journeys.

This is not just about protecting margins. It’s about protecting the bandwidth of an already overburdened healthcare system and the outcomes of the patients who navigate it.

Old patient support models are breaking down

As the pharmaceutical industry began the initial transition to specialty treatments, it relied on large call-center based hubs to manage highly fragmented and largely paper-based enrollment mechanisms to help patients navigate increasingly complex treatment journeys at scale. These legacy support models are both inefficient and expensive with high staff turnover and reliance on an antiquated and “one size fits all” phone-first patient support model. And given the higher cost of developing, manufacturing and distributing specialty pharmaceuticals and the consequent impact on pharma margins, both large and small manufacturers are motivated to find new ways to more cost effectively engage patients.

But this is not just about protecting margins. It’s about protecting the bandwidth of an already overburdened healthcare system and the outcomes of the patients who navigate it. Even under today’s largely standardized eligibility requirements, there were more than 375 PAPs available in the U.S.⁴, and each program had its own enrollment form and eligibility criteria.

A study conducted by the NIH further indicated that the patient enrollment process consumes an average of 190 working hours⁵ for providers and patients or 7.9 days elapsed before notification of approval or denial of the application by the PAP. The result is not only costly and inefficient but also potentially harmful, as it can delay treatment by days or even weeks. As specialty medications become more prevalent, the situation has the potential to become untenable unless the traditional hub services model can evolve to a more efficient and patient centric support system

Pharma patient services trends are driving the ecosystem to fully digitize and shift upstream

Pharmaceutical manufacturers, hubs and healthcare providers know they need to embrace new technologies that streamline the patient journey. Many are actively exploring automation and innovation that can help them simplify existing processes and prepare for more complex, personalized care journeys.

But the required transition involves more than just automating or digitizing the status quo: it means rethinking it. Traditional pharma commercialization HUBs play a critical role in creating access to these emerging therapies, but what if we could redesign patient support for the era of personalized care? Would it look anything like the current fragmented and reactive service model?

I think we would all agree that our industry needs to focus on bringing critical information and support services upstream to the point of care rather than pushing support downstream via distant call centers. We foresee this new generation of technology-enabled programs wrapping around the patient and provider to deliver vital patient services in real-time.

By initiating patient support services at the point and time of prescribing, hub service providers and pharma manufacturers can pivot to digital programs that meet the specific needs of patients and providers, with clear eligibility criteria and streamlined processes for enrollment and accessing support. For example, patient assistance provider (PAP) services could be integrated into provider workflows though APIs, and AI, machine learning and advanced analytics could identify and proactively engage and support patients at high risk of medication non-adherence.

Pharma patient services trends tell us this is a well-defined market with many participants delivering valuable solutions, but we think these areas are ripe for innovation and most integral to the evolution of patient-centric care:

Hub services. Next-generation technology-enabled or digitally native hubs that can play a vital role in aggregating data and insights across an increasingly diverse and discrete set of stakeholders.

Patient engagement. Best-in-class point solutions that support highly customizable patient engagement and education while connecting siloed data systems and providing meaningful insights to pharmaceutical companies.

Integrated logistics. Many of the novel specialty therapeutics coming to market have unique and complex limited and or even exclusive distribution models that require real time data exchange between support providers, 3PLs and specialty pharmacy networks to increase speed to therapy and to support ongoing adherence and compliance.

Coverage. Real time Benefit Transactions (RTBTs) Technologies that can ensure healthcare providers and their patients receive critical coverage, cost and eligibility information at the point of prescribing by automating verification and prior authorization processes.

Financial assistance. Technology that improves access to financial assistance and helps patients and physicians navigate complex eligibility and application processes.

Here’s the bottom line.

With the rapid growth in highly specialized pharmaceutical therapies, we believe our overburdened healthcare system will need to find new ways to help patients and care providers navigate and access a complicated network of options. Biopharmaceutical companies, hubs, physicians and emerging technology vendors all need to collaborate on a patient-centric support model that empowers patients and physicians at the point of care. With extensive experience investing in and growing tech-enabled biopharmaceutical and patient service companies such as Medmark, RealTime, SDI Health, Suvoda and Phreesia, LLR is excited to collaborate with the companies that are re-envisioning biopharmaceutical patient care.

Learn more about the LLR team, relevant investments and our focus on Pharmaceutical Patient Services.