Them: Hey, Can You Put Our Hub Together? Me: Why Do You Think You Need a Hub?

“Wow, that was a fantastic customer service experience, from the phone tree through the follow-up case resolution fax.”
– No one. Not ever.*

So, I was chatting with a former colleague the other day, and she graciously asked, “Tell me again exactly what it is you do so I can tell people about you.”

Virtual hug, oh my gosh, thank you so much! So I tried the most recent version of my consulting fishing line:

I help Biotech Leaders enable their patients to start and stay on therapy.

And she replied, “But you do call centers and hubs, right?”

Uggh. Groan. No. Well, yeah. Actually, no. Sometimes.

Here’s what I mean when I use the term Hub:

Hubs are telephone call centers staffed by personnel with experience ranging from recent high school grads to experienced pharmacy techs and reimbursement specialists. Hubs are live customer service centers, and the service offering is most often related to insurance coverage information. When you engage a Hub, you are solving for:

  • A product with tricky insurance coverage, or
  • A product with complicated distribution, or
  • A pharmacy that can’t get a product out the door fast enough

And, to be a little spicy about it: you’re ultimately solving for overwhelmed HCP offices bogged down by prior authorization requirements and unable to keep track of all their patients’ different health plan hoops.

Are you using a Hub to address one of the challenges bulleted above? 

My feelings about Hubs are not as strong as my bias against Manufacturer-created brand apps, but they’re close. Hubs make sense in particular circumstances. Otherwise, they’re expensive (you’re looking at either FTE or transaction-based pricing), underused, and may not offer a meaningful return on objective. 

Side note: I cannot understand why vendors tout their “Virtual Hubs” or “e-Hubs.” Lose the “Hub”– it’s not a term that inspires confidence in your prospective leads.

Hubs are often the only live, personal interaction your patients and your HCPs will have with your brand. 

I gotta ask: Why on Earth would anyone choose a call center to be their patient’s or HCP’s Brand experience?

Commercial Directors (note: I’m looking at you, Brand Managers, not your Market Access colleagues), did (or will) your brand face any of these challenges at launch?

  • NDC payer block 
  • Multiple states imposing a 6-month Medicaid reimbursement moratorium?
  • Questions about average reimbursement when billing under a miscellaneous J-code?
  • Introducing a new distribution channel (example: Buy and Bill) to inexperienced HCP offices with already thin margins and a low appetite for risk?
  • Coordinating medical benefits and pharmacy coverage for a combination therapy initiated in an infusion center but followed by an oral med taken at home?
  • A rare disease with a high dollar, potentially curative treatment administered at select few Centers of Excellence (CoE)?

If you’re thinking, “These are all Access problems, not Marketing questions,” you are only 49% correct. 

I spend a lot of time speaking with clients about promotional vs. non-promotional activities. Why? Brand Marketing teams are often strictly promotional, whereas Patient Support Programs fall after the decision to treat has been made. Rather than risk the appearance that Patient Support Programs could be an inducement (or service with remunerative value to HCPs), many Brand marketing teams stay far away from Patient Support workflows. 

But who owns the patient’s Brand experience?

A classic example: a Brand’s copay enrollment website looks and feels ENTIRELY different from the Brand’s; not because the program’s vendor hosts the copay website, but because the Brand’s agency of record had zero involvement in the copay website build. The copay vendor didn’t even get the Brand’s colors. Ditto on Hub enrollment forms, collateral, even verbiage. 

Brand experience should be consistent across all channels, from product packaging through Hub fax sheets.

I broadly define promotional as:

1. Disease state awareness coupled with product education: Hmm, maybe I should get those scaly patches on my knees and elbows looked at by a trained medical professional. They’re uncomfortable and make me feel self-conscious.

2. Patient decision to seek treatment: My friend Joaquin had something similar on his scalp and neck, and he said taking his Brand X shots made it go away. And that the shots weren’t bad; they just mail him a little pen he uses on his thigh, and then he tosses it in a coffee can. Oh, look, there’s a picture of the pen thingie on the website.

3. HCP decision to prescribe: 

  • The patient’s presentation suggests [Diagnosis/Disease Name], confirmed by [Lab Test]. 
  • [Therapeutic Class of Drugs] appropriate. 
  • The patient requests [Brand X], but [Brand X] not on the health plan formulary per EHR. 
  • Prescribed 30-day supply of [Brand Y] with one refill. 
  • Instructed patient to schedule follow-up appointment for 6 weeks after initiating treatment. 
  • Referred patient for injection training with [Clinic Nurse]. 
  • Also will refer to [Brand Support Program] for follow-up injection support; sent a message to check-out desk to secure patient signature on the [Manufacturer] enrollment form.

4. Product information as outlined in the FDA-approved Prescribing Information.

I see heavy Access Marketing content in #2 & #3. When I use the term “Access Marketing,” clients consistently jump to payer marketing, i.e., how Biotech and Pharma manufacturers explain a therapy’s value proposition to insurance companies. That’s not what I’m referring to (although payer marketing does fall under the larger umbrella of Access Marketing). I’m referring to how a manufacturer communicates to both HCPs and patients about insurance coverage, patient out-of-pocket costs, financial assistance, distribution, and administration. 

Access Marketing is not intended to drive the decision to prescribe, but it is integral to the patient’s Brand experience.

True, Hubs can provide coverage and reimbursement support, and they may offer patient case management. But nowhere is it written in stone that you need a Hub. Are there more effective communication channels than a traditional call center for your Patient Support messaging? Many times, yes. Sometimes (especially in the first nine months or so post-launch for novel therapies), no. 

The following may offer better solutions for your patients:

  • Expert payer accounts management team (9 times out of 10, Patient Support Programs are solving for formulary position)
  • Timely EHR uptake
  • Robust brand HCP and websites 
  • Patient engagement coordinated with pharmacy workflows
  • Field reimbursement teams

Start here: the HCP has written the Rx. Now what?

How does the HCP select your medication in their EHR? 

Follow-up question: How do your compendia listings impact uptake in different EHRs?

How does the Rx get routed to the Pharmacy?

  • Is an infusion appointment only scheduled after the referring HCP secures prior authorization?
  • Is this a retail product, sent directly to the Pharmacy via e-prescribing, and the only touchpoint your patient may have with your Brand will be a voicemail from the Pharmacy, maybe?
  • Is this a limited distribution, Specialty product? Does the EHR have an embedded logic that cross-references the patient’s payer against the distribution network, and then forwards the Rx to the appropriate Specialty Pharmacy? Or does one of the medical assistants working on auths– when she’s not rooming patients– need to figure this out?

How does your patient know what to do next?

  • Did the HCP clearly explain the next steps?
  • Did the patient go online to discover that they need to download a multiple-page form dense in Legalese, sign it, drop it off at their HCP (emailed forms not accepted, even during COVID), and hope that it lands on the right desk?
  • Does the patient receive a text message from a Pharmacy saying their prescription is ready for shipment, and they need to call a 24-hour phone line to confirm their address and authorize billing to their insurance?
  • Does the patient discover a cryptic voicemail (because who answers their phone these days, especially if it’s from an unknown 888-number?) asking for a call back anytime from 9 am-5 pm… Eastern? When the patient lives in California and works all day?

Brands, how do you want your patients and HCPs to learn about obtaining their medicine? Do you want that message to come from the health plans? The pharmacies? Your own field teams? Call center personnel? 

You need to jump in and own the messaging.

Please don’t hesitate to reach out if we can help you enable your patients to start and stay on therapy (with, or without, a Hub).


* I love to be proven wrong. If there is an outstanding telephone call center that creates an amazing customer service experience, could you please drop me a line? Thanks!