Why Pharma Is Rethinking the Centralized Hub Model

For decades, pharmaceutical companies have relied on centralized hub services to manage patient access by coordinating benefits investigations, prior authorization support, and patient services through large, outsourced call center operations.

Recent shifts in the market including McKesson’s decision to exit its CoverMyMeds human hub services business, are bringing renewed attention to the limitations of that model. While the move reflects a specific business decision, it also underscores broader pressures that have been building across the industry.

The traditional hub structure, while foundational, is no longer sufficient to meet the growing complexity of specialty therapies or the expectations placed on modern market access teams. What is emerging in its place is not a wholesale replacement, but an evolution toward a more flexible, technology-enabled approach that some are beginning to describe as a “hubless hub.”

Why Did the Traditional Hub Model Work?

The centralized hub model was designed for a healthcare system defined by fragmentation. Payer requirements varied widely, provider workflows were disconnected, and access-related data was difficult to capture or standardize.

In that environment, consolidating access services into a single operational layer made sense. Hubs provided scale, consistency, and a centralized point of coordination for patients, providers, and manufacturers.

But the assumptions that made the model effective are shifting.

Why is the Model Straining Under New Demands?

Today’s specialty landscape is far more complex. Therapies are more expensive, payer requirements are more dynamic, and utilization management has become increasingly stringent.

According to EY, a majority of drugs in major therapy areas miss their projected sales forecasts in the US, with rates ranging from approximately 56% in oncology to as high as 67% in infectious disease.¹ While multiple factors contribute to these gaps, access barriers — especially delays and denials in prior authorization — play a meaningful role.

This is forcing a shift in how pharmaceutical companies think about access.

From Centralized Hubs to Distributed Systems

Rather than simply replacing one hub vendor with another, many organizations are beginning to explore a more modular approach, one that distributes capabilities across a coordinated set of technologies and partners.

In this “hubless hub” model, the traditional functions of the hub are still performed, but not necessarily by a single entity. Instead, different layers of the access workflow are handled by specialized systems:

• Prior authorization workflows are increasingly supported by automation and real-time payer intelligence built into the point-of-care workflow.
• Financial assistance and affordability programs are being managed through digital enrollment tools and patient support platforms that are initiated at the point-of-care.
• Data and analytics platforms provide visibility into approval rates, turnaround times, and access barriers.

The result is a more flexible architecture that can adapt to the specific needs of a therapy, a provider network, or a payer landscape.

How Does Prior Authorization Reflect this Shift?

Nowhere is this shift more visible than in prior authorization.

Historically, prior authorization support has been one of the most labor-intensive components of hub services. Prior authorization is also where variability has the greatest impact on patient access.

Recent real-world benchmarks from SamaCare illustrate the scale of this challenge. In the first quarter of 2026, the average net approval rate for medical benefit prior authorizations was 79.6%, meaning roughly one in five submissions were ultimately denied. At the same time, the average time to resolution varied widely, from as little as two days to more than a week depending on payer and therapy.²

These differences directly affect whether and when patients start treatment. As a result, prior authorization is increasingly being treated as a critical lever for improving access performance.

Why is Access Becoming a Commercial Function?

Another force driving this evolution is the growing integration of market access with broader commercial strategy.

Historically, access teams operated somewhat independently from marketing and brand teams. That separation is breaking down.

In new product launches, access considerations are now being addressed earlier and more proactively. Teams are anticipating potential barriers such as coding confusion, documentation requirements, or provider education gaps that could slow uptake.

Similar dynamics are emerging in response to competitive events, such as the introduction of generics or biosimilars. Changes in coverage, step therapy requirements, or payer preferences can quickly alter the access landscape, requiring coordinated responses across access and commercial functions.

At the same time, shifts in site of care, such as the continued growth of infusion centers, are adding complexity to the patient journey. Understanding how patients move from prescription to treatment now requires visibility across multiple settings, stakeholders, and decision points.

In this environment, access is no longer just about navigating processes. It is about shaping outcomes.

Building What Comes Next

The shift toward a “hubless hub” does not mean the end of hub services. Rather, it reflects a broader reconfiguration of how those services are delivered. Human coordination and support are increasingly being complemented, and in some cases augmented, by technology layers that provide greater efficiency, transparency, and control.

For pharmaceutical companies, the question is not whether to move beyond the traditional hub model, but how to do so in a way that aligns with their access strategy, data capabilities, and commercial goals.

References

1. EY. Driving growth via commercial transformation in pharma. EY Insights. Published September 30, 2025. Accessed May 14, 2026. https://www.ey.com/en_us/insights/life-sciences/driving-growth-via-commercial-transformation-in-pharma
2. SamaCare. Market access benchmarks. Accessed May 14, 2026. https://www.samacare.com/market-access-benchmarks