UBC

Dana Edwards

Complexities in the oncology therapeutic area range from new products and therapies; to modern technologies and new diagnostic tools; and an ever-evolving reimbursement and access landscape. Innovations and disrupters in these areas drive change for oncology practices, while these same practices are also faced with the continued variability in stability of healthcare staff. These trends come together to create opportunity for biopharmaceutical manufacturers to support their stakeholders and ensure patients gain access to therapies.

The number of patients with new cancer diagnoses continues to grow each year as does the number of specialty drugs available as treatment options. The future of oncology continues to be shaped by advances in medicine and better technology. As therapies become more complex and involve more stakeholders from diagnostics prior to starting therapy to traditional and now cell therapy, product manufacturing and product logistics, biopharmaceutical manufacturers are expected to orchestrate and guide stakeholders, to connect the dots between the patient and product journey. This has driven a transformation in the space of patient services to move beyond traditional access and affordability services to encompass a much wider array of business functions and disparate systems. The goal is to align all stakeholders and guide them through an intuitive user experience, while adopting new measures to treat each stakeholder as a consumer.

Supporting patients with financial hardship continues to be the primary service that oncology offices depend on biopharmaceutical manufacturers to provide, for both uninsured and underinsured patients. Program design for manufacturer-sponsored patient services in the oncology space should include a combination of patient assistance programs (PAP) and copay assistance to cover both patient sub-sets. The recent emergence of alternate funding plans (AFPs) or Specialty Pharmacy Carve Out Plans is a trend biopharmaceutical manufactures should be aware of and continue to look out for. These plans are sold primarily to self-funded employer groups as a cost saving measure. The plans are designed to exclude some or all specialty drugs from their formulary so the patients are considered uninsured or underinsured so that the alternate funding vendor can help the patients apply for needs-based charities or assistance. Whether these funds are provided by charitable donations or direct manufacturer-sponsored assistance, resources are finite, and the unintended outcome is that these plans may divert assistance from patients who do not have other resources available. Biopharmaceutical manufacturers should monitor the combination of payer coverage outcomes for their products and PAP application volume to assess impact to their brands.

“Supporting patients with financial hardship continues to be the primary service that oncology offices depend on biopharmaceutical manufacturers to provide, for both uninsured and underinsured patients.”

Reimbursement support, especially for new product launches, to verify insurance coverage, prior authorization and/or formulary exception processes continue to be essential services in the oncology therapeutic area. Oncology offices leverage reimbursement support to work through challenging cases, including prior authorization denials and claim appeals. Oncology has been a key area hit by the massive healthcare turnover in recent years, resulting in some oncology practices relying more on patient service programs for core services, like benefit verification and prior authorization assistance, in addition to the typical challenging cases that they have historically submitted.

The staffing issues that oncology providers are experiencing also affect their ability to support patients and provide education. Biopharmaceutical manufacturers are being looked at to provide more educational support to help patients understand their therapy and disease state and provide resources and referrals to other patient support organizations. This has become an even more essential safety net as an increasing number of patients may not receive educational support directly from their oncology providers.

Patient services and the required support from biopharmaceutical manufacturers continue to evolve to meet the needs of novel therapies, such as CAR-T treatments. This requires a broad approach to patient services, requiring a patient service team with a combination of oncology, insurance, healthcare provider office management, specialty pharmacy, and patient service experience to support oncology providers and patients as they navigate these innovations and disruptions.