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Electronic benefits verification (eBV) combines with patient access services
Hub services—usually funded by pharma companies to enable patients to navigate the complex administration of specialty pharmaceuticals—depend on solidly built IT platforms to manage the flow of data among patients, healthcare providers, insurers and, ultimately, manufacturers. Now, two of the players in this field, CareMetx and VirMedica, are combining. CareMetx CEO Mark Hansen, while noting that VirMedica will retain its brand presence in the market for the time being, says that the combination will provide a more comprehensive set of services for CareMetx clients, which range from specialty pharmacies to hub service providers and manufacturers.
Experienced operators in hub services speak of internal systems (operated by manufacturers to support their brands), external systems (operated by outsourced hub service providers) and hybrid combinations of the two. In a sense, CareMetx is a hybrid itself—it is both a hub services provider (now with a total staff of 450), and a vendor of IT systems and services to support others’ hub services, including those at pharma companies. A key client has been AllianceRx, the venture between Walgreens Specialty Pharmacy and Prime Therapeutics, a pharmacy benefit manager and mail pharmacy, but Hansen notes that CareMetx has managed dozens of hub programs for pharma brands.
VirMedica carved out for itself a specialized service: managing the benefits-verification process for patients going on new therapies. eBV, in turn, connects to the prior authorization process, another key step in getting patients on therapy, which CareMetx handles. Additionally, CareMetx provides data and folowup for maintaining patient engagement (as many therapies are for chronic care), and reporting outcomes. Overall, says Hansen, use of CareMetx’ IT tools can reduce the staffing necessary for comprehensive patient services by nearly a third.