Hubs West: Balancing patient care and profitability

When it comes to patient access programs, “maintaining profitability is hard,” says Nancy Bell, vice president, head of U.S. Patient Value & Access, at Takeda.

Building and sustaining patient access programs requires a balancing act between patient support and profitability. While patient access programs are aimed at helping patients, they must also be financially viable, according to Bell.

“Maintaining profitability is hard,” Bell told delegates at Hubs West 2024 in San Diego, especially with the increasing scrutiny as the market continues to evolve.

Bell, who oversees the “business side of the brand”—which includes pricing, contracting, patient services, reimbursement, trade and distribution, among other areas—discussed how the days of multibillion-dollar blockbuster brands are “few and far between” and sees a shift toward smaller, biomarker-driven rare disease products to address unmet needs. In turn, these products are generating lower revenue, “which means more critique and eyes on what the business side looks like,” she said.

“So understanding it and where the patient services, hub, and all of that comes into play is mission critical moving forward.” Recognizing the business side of patient access programs can lead to informed decisions, she noted.

Bell went on to discuss “gross-to-net,” sharing how different factors can impact a brand’s profitability, such as discounts, copay programs, rebates, payer contracts, fees, etc.

“Maintaining that gross-to-net bubble is getting more and more difficult,” she said. “If you read any access papers, you’ll hear the phrase ‘gross-to-net bubble is going to burst’ because there’s just so much pressure you can put on it on the system before it blows up.

“Welcome to the US healthcare system,” she told the audience.

Evolving market

No matter where you’re positioned in access, Bell said the market is evolving faster than anywhere else.

“When you think about things like the IRA, the 340B growth, the level of vertical and horizontal integration and the impacts that has on the business and how you execute your strategies, it’s unlike anything that’s ever happened in the industry,” she said.

Bell shared her top matters to be conscious about in this ever-growing space, starting with the importance of understanding market trends.

“Some things that are specific to hub services that I keep an eye on very closely now … are these accumulator and maximizer programs,” she said.

“They’re a pain in the butt to be quite frank and identifying them isn’t always easy. But they, again, impact your co-pay program, which impacts your gross-to-net, which impacts your revenue.”

Additionally, Bell addressed alternative funding programs, which she describes when company sells employers a program that appears to remove drug coverage for patients, allowing them to access free medication. If the company identifies this, they can deny the free drug, forcing the patient to get the medication covered through their insurance instead.

“So the question becomes, if you pay for coverage, they should cover you, right, instead of trying to play these games. But if you don’t catch it within your hub, don’t have business rules and process and systems in place, again, it’s free drug out the door - that much more hitting your revenue again.”

Logic vs. emotion

Bell highlighted the logic versus emotion aspect in patient services.

“When you are in patient services, your first thought always is I have not met one person that touches patient services where their first and foremost thought every time is patient first and what’s right for the patient.”

However, without logic, “we don't have a viable brand, [and] we can’t help any patients,” she said.

Bell emphasized making hard decisions such as managing alternative funding or co-pay accumulators and maximizers because of the amount of impact it has on a brand, for example, delayed access.

“At the end of the day, it’s our job to separate our fiduciary responsibility to the company into the broader patient population versus just the one patient that we really want to help.

“And that is probably the hardest thing for any leader to admit is that sometimes the individual patient isn’t the center of a decision,” Bell said.

Forecasting

Bell focused on the importance of accurate forecasting and why it matters in patient services.

With new or accelerated launches, she said, “It’s even hard to get it right,” – one of the many challenges of demand forecasting.

Additionally, inventory levels and having supply issues could lead to mistakes in forecasting. “If you do not have the ability within access to make sure you look at your inventory and know exactly how much you need. Even if you’re running hot against your demand forecast, you run the risk of running out of supply.

“I always say to people, if you think about market access, about the business, when we make a mistake, we don’t lose a patient, we lose millions. We lose tens of patients, hundreds of patients because of the decisions that we do or don’t make,” Bell said.

Essentially, understanding market dynamics, patient type, and company priorities are necessary for accurate forecasting, she noted.