What should we expect for the future of patient support services?

What should we expect for the future of patient support services, particularly as biosimilars enter the market?

  • Over the past several years, the specialty pharmaceutical market has undergone dramatic growth, representing an estimated 27% of the pharmacy industry’s revenues in 2015.Such growth in specialty pharmacy has triggered a parallel expansion of the specialty pharmacy provider (SPP) market, within which increased competition has heightened patient support service offerings. Manufacturers of biologics/specialty drugs offer various types of patient assistance programs to help providers’ offices and patients navigate the complexities of specialty drugs – including insurance verification and requirements, special shipping, injection training, and assistance with out-of-pocket costs. As the market has evolved, enhanced patient support services are increasingly used to create competitive advantages between competing biologics in a crowded market. This trend has resulted in providers and patients expecting a high level of services from pharmaceutical companies, and resulting brand loyalties due to the support received.
  • It is expected that patient support services will continue to grow in breadth and depth of services. With the introduction of biosimilars, there have been questions as to whether biosimilar manufacturers will follow suit and match or increase patient support service offerings. The one example in the market, Zarxio, answers that question with a resounding “yes”.
  • While biosimilar manufacturers are expected to offer equal or enhanced patient support services, there are concerns about how biosimilars will be prescribed and dispensed, and about how payers will respond to their introduction.

What types of patient support services are available today?

Patient support services offered by manufacturers are generally classified in one of three categories, but are most often offered through a single manufacturer-branded program related to a drug or portfolio of products. Outlined below are the key types of programs and distinguishing features; the American College of Rheumatology offers a drug-specific overview of relevant programs.

  • Patient Assistance Programs, known as PAPs, are offered to uninsured and/or under-insured patients who are able to demonstrate a financial need. While PAPs are voluntarily offered by pharmaceutical companies, they have become an industry standard to provide assistance to patients with no or limited drug coverage. The eligibility criteria vary, but most often financial need is based on a percentage of Federal Poverty Level (FPL) or a fixed income amount. Medicare beneficiaries are able to participate in many PAPs, and CMS has catalogued available programs by drug for beneficiaries’ reference.
  • Copay Assistance Programs are designed for commercially insured patients and cover all or part of the patient’s out-of-pocket costs for the supported medication. Copay assistance programs’ eligibility criteria are similar to PAPs, with variety seen in the amount of copay assistance offered and the method for enrolling in the programs.
  • Manufacturer-sponsored “hub” type services provide patient assistance in order to coordinate plan-specific requirements such as benefit verifications and prior authorization assistance (to the degree the plan allows)..

 
While providing these types of services has become the “standard” for specialty pharmacy, the breadth and depth of these services only continues to increase. In the results of a 2015 survey of pharmaceutical executives conducted by Accenture, 85% of companies indicated they would be increasing investments in patient-centric capabilities as depicted below.
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What should we expect as biosimilars used to treat rheumatologic diseases enter the market?

As noted within the Executive Summary, it is expected that the introduction of biosimilars will heighten competition and manufacturers’ needs to differentiate their products and support services. While Zarxio– the biosimilar of the reference product Neupogen that is used in the treatment of certain cancer patients — is the only biosimilar approved and commercially available in the U.S. today, its release has supported this hypothesis. Sandoz, the manufacturer of Zarxio, provides patient support services (marketed as Sandoz One Source) that are comparable to the industry standard, and specifically to the services offered by Neupogen’s manufacturer, Amgen.
 

What other resources are available for understanding the implications of biosimilars in my state?

While the purpose of this content was to highlight patient support services, and how biosimilars are expected to impact those offerings, there are a number of implications related to the continued introduction of biosimilars in the U.S. The Academy of Managed Care Pharmacy recently launched an Online Biosimilar Resource Center, including state-by-state guidance on biosimilars laws, legislation, and regulations.
See the publicly available findings of the 2016 Report in Retail, Mail, and Specialty Pharmacies

  •  Covance’s 2016 report, “Creating a Robust Reimbursement Program for Biosimilars”
  • ACR’s listing of Assistance Programs drug-specific information.
  • Medicare’s page on Pharmaceutical Assistance Programs.
  • Accenture’s report, “The Patient is IN; Pharma’s Growing Opportunity in Patient Services”
  • Amgen’s Patient Support Services page.
  • AMCP Biosimilars Resource Center
  • See the Biosimilars Resource Center’s overview of State Biosimilars and Interchangeable Laws, Legislation, and Regulations.

 
 

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