Rethinking the Role of the Hub in Immunology

Immunology is one of the fastest-changing specialty markets today. New IL-17, IL-23, and JAK-targeted therapies continue to enter a crowded dermatology and rheumatology landscape, each bringing its own prior authorization pathway, payer requirements, and affordability resources.

As this market grows more complex, so does the environment providers are being asked to navigate. Every new therapy is an opportunity to improve the patient experience, but for providers, it can also mean another set of processes and requirements to learn. The brands that gain traction aren’t the ones that ask providers to adapt to something new; they’re the ones designed to fit seamlessly into the way providers already work.

The Problem with Designing for One Journey

Most patient support programs are designed around a single, standard pathway for providers to enroll patients and access services. But in immunology, providers don’t all engage with support in the same way, and their preferred workflows can vary significantly from one practice to the next.

Across the 55 immunology programs CareMetx supports today, we see firsthand how differently those preferences can take shape. In dermatology for example, many practices have historically treated a significant portion of their patients with topical therapies, so they may have less experience navigating the processes that come with specialty products. These practices may need greater guidance on when and how to engage the hub, and what support is available to them.

Rheumatology often presents a different dynamic, wherein many practices have extensive experience with specialty therapies and already have a process for getting patients on treatment. Some have dedicated staff who manage benefits verification, prior authorization, and other access requirements internally, or work directly with specialty pharmacy partners. Others rely heavily on the hub and expect it to manage those activities with a high level of service and coordination. In either case, these practices know how they want to manage specialty access, and they bring those established workflows and expectations to each new therapy they adopt.

For manufacturers in this space, program design should start with a simple goal: ensuring patients receive the support they need, regardless of how their provider prefers to work. That means giving providers the flexibility to engage with the program in the ways that make sense for their practice, without losing access to the broader resources available to their patients.

Three Ways Providers May Engage with Patient Support

In our experience, provider preferences for patient support often fall along a spectrum. While every practice is different, three common approaches can help illustrate the range of support a program may need to accommodate.

The targeted-support practice: Some academic centers, KOLs, and high-volume immunology clinics have robust access resources already in place, and may prefer to engage manufacturer support at specific moments in the journey. That could include copay enrollment, quick-start or bridge support, or PAP eligibility, allowing the practice to access additional resources when needed while maintaining its existing workflows.

The SP-first practice: Other providers may prefer to send prescriptions directly to a specialty pharmacy and have the SP manage much of the access and fulfillment journey. In these cases, manufacturer services can complement that pathway by bringing in affordability, appeals, nursing, or other support when needed, without requiring the provider to change how they work or duplicate steps already underway.

The comprehensive support practice: Other providers may prefer more extensive hub involvement across the patient journey. These practices can engage support spanning enrollment, benefits investigation, prior authorization and appeals, affordability, nursing, and ongoing patient engagement, with the hub helping coordinate activities and maintain continuity from one step to the next.

These approaches are not necessarily fixed, nor is one better than another. They reflect differences in how practices are staffed, the resources they already have in place, and where additional support can be most valuable. Designing with that range in mind gives programs more flexibility to support providers in the ways that work best for their practice.

Building Flexibility Into Your Support Model

For manufacturers launching in immunology, designing around these preferences does not mean building a different program for every practice. It means building the flexibility to support each of these archetypes within the same program, including the operational realities that come with each pathway.

For a targeted-support practice for example, flexibility may mean giving providers self-service options that connect directly to back-end hub support. These practices often expect to access services in their preferred workflow and in real time, while still having the hub available when additional support is needed.

For the SP-first practices, flexibility looks different. Providers may send a prescription or enrollment to both the SP and hub at the same time, creating the potential for duplicated work. Tight integration between those partners allows the program to recognize what is already underway, avoid repeating completed steps, and bring the hub in when a delay, barrier, or need for additional services arises.

Supporting these different pathways effectively ultimately depends on keeping them tightly connected. At CareMetx, we connect the hub, specialty pharmacies, field teams, and other partners through direct integrations and data feeds, bringing activity from across the ecosystem into a connected view of the patient journey. That visibility creates a clearer picture of what has already happened, where the patient is in the process, and whether something is preventing the journey from moving forward.

From there, our technology can identify what needs to happen next and who is best positioned to take action, whether that means allowing work already underway to continue or bringing in a hub service, field team, or other partner to address a specific need. In this way, the program can respond intelligently as the journey unfolds, without duplicating work or requiring every patient to follow the same path.

Building for the Immunology Landscape Ahead

As immunology continues to evolve, provider preferences and workflows will continue to vary. With 15 years of experience supporting complex specialty access across more than 300 brands, CareMetx recognizes that no program will achieve 100% provider adoption of a single pathway. Rather than designing around the assumption that every patient will enter through the hub, we help manufacturers build archetype-aware programs that can support patients across the channels and workflows their providers already use, with the connectivity and orchestration needed to keep each journey moving.

Ready to explore what a more flexible approach could look like for your immunology launch? Let’s talk.