The Value of Pharmacy HUB Services for Rare Disease Therapies

For rare diseases, barriers to treatment don’t end with a prescription. Patients often face a maze of delays, denials, and confusing next steps, especially when fulfillment is fragmented across multiple touchpoints.

HUB services address this issue to facilitate access and keep patients from falling through the cracks, but not all HUBs are built to meet the demands of rare, high-touch therapies. And not every model provides the patient experience that pharmaceutical brands seek to deliver.

In this article, we explain key considerations when selecting an impactful HUB for your rare disease therapy.

What Are Pharmaceutical HUBs?

Pharmaceutical HUBs are third-party service partners that help coordinate and simplify patient access to treatment, particularly for rare, high-cost, and/or complex therapies. These organizations act as a centralized support system for patients, providers, and manufacturers, offering services like benefits verification, prior authorization assistance, financial aid coordination, and patient education.

By streamlining these steps, HUBs reduce administrative burdens, support adherence, and help ensure patients can start and adhere to the therapies they need.

As we explain below, not all HUBs are created equal, and understanding the strategic nuances of HUB design is critical for shaping effective rare disease marketing programs.

Mandatory Vs. Non-Mandatory HUBs

A fundamental choice in HUB program design is whether to require all prescriptions to flow through the HUB. In mandatory models, referrals are centralized, enabling the HUB to capture comprehensive data, enforce routing consistency, and direct each patient to the pharmacy best equipped to fill the prescription quickly. This ensures tighter control, improves payer visibility, and limits referrals to out-of-network providers.

Mandatory HUBs are very important for orphan and rare therapies. These HUBs give patients a single focus for their access barriers, assist MDs with authorizations, and help patients find convenient and economical sites of care. Mandatory HUBs allow the manufacturer to have 100% control of both the treatment network as well as the associated data.

In non-mandatory models, health care providers can bypass the HUB and send prescriptions directly to their preferred specialty pharmacy. This can be convenient for some prescribers and is common in oncology, where hospital systems often use buy-and-bill workflows. Even so, many still depend on the HUB for reimbursement support and referral tracking. Non-mandatory HUBs require well-defined processes, data feeds, and reconciliation strategies to avoid duplicate records or lost referrals.

Example Use Case for Mandatory HUBs

An example from TJP’s work vividly illustrates why mandatory HUBs provide an impactful solution. In this case, a patient with commercial insurance has a rare disease, and their prescribed infusion looked to be covered on their medical benefit. The relevant HUB completed intake from the MD request and helped with the authorization process. 

After the insurance company denied the authorization three times for claimed policy reasons, the HUB assisted the patient with submitting a Medicaid waiver in their state. The state approved the patient who is currently receiving infusions.

Notably, pharmacy-centered HUBs are not experienced with this process: SOPs from the manufacturer often need to be comprehensive and carefully monitored to ensure the HUB provider takes the necessary additional steps.

The Value of a HUB Service Provider

Specialty pharmacies play an important role in patient access and are capable of handling drug dispensing, supporting adherence, and sometimes offering limited administrative services. However, their visibility is confined to the prescriptions they fill. 

HUB service providers address this limited focus by operating at a broader level to deliver centralized coordination and consistent support across all dispensing channels. While HUBs do represent an added cost, they can drive substantial value through the breadth of services outlined below.

HUB Patient and Provider Support Services

• Case management and field support: Dedicated case managers serve as a single point of contact for patients and providers, offering help with onboarding, troubleshooting, and prescription fulfillment. Field teams can provide in-person support to prescribers when needed.
• Reimbursement and co-pay assistance: HUBs handle benefits investigations, prior authorizations, and appeals, while also enrolling eligible patients in co-pay programs and coordinating coverage with pharmacies.
• Nursing and psychosocial support: Nurse navigators deliver clinical education, assess patient needs, and guide individuals through diagnosis, access, and treatment. They help set expectations and provide continued check-ins throughout the care journey.
• Free drug program management: HUBs can qualify patients and dispense products through non-commercial channels, including bridge, voucher, quick-start, or patient assistance programs.
• Provider education: HUBs also serve prescribers by guiding them through enrollment, reimbursement, and clinical protocols. A dedicated point of contact ensures providers get consistent support and rapid answers.

HUB Network Coordination Services

Many HUBs include multiple participating specialty pharmacies, as not all specialty pharmacies have payer contracts for reimbursement. 

• Distribution network management: HUBs help manage limited distribution networks by standardizing provider and patient support across all participating specialty pharmacies. They ensure patients are directed to the most appropriate dispensing partner to improve efficiency and cost control.
• Referral reconciliation: In non-mandatory HUB models, referrals can land in multiple places, creating confusion or duplicative effort. A proactive HUB strategy tracks, reconciles, and resolves referral conflicts to prevent delays, payer issues, or therapy interruptions.
• Smart referral triage: Advanced HUB programs apply automated routing rules based on payer mandates, physician preferences, and performance-based logic.
• Expanded data visibility: HUBs increase patient authorization rates for data-sharing programs, often through digital consent tools. 
• Customizable payer program design: HUB services can be configured to reflect brand-specific requirements, provider needs, and patient engagement preferences. 

Key Considerations for HUB Selection

HUB services are not one-size-fits-all, and manufacturers will need to select the appropriate mix of services based on product complexity, distribution strategy, and the needs of relevant patient populations.

HUB-Lite Vs. Full-Service Models

Some brands opt for a “HUB-lite model”, where the HUB performs core intake tasks (such as receiving referral forms and conducting limited benefits investigations) before passing the case downstream to a specialty pharmacy.

By contrast, full-service HUBs own a broader portion of the patient journey, handling reimbursement, case management, clinical support, and nursing services directly. This approach ensures patients receive a more consistent experience across the network, especially when working with specialty pharmacies that vary in capabilities.

Dedicated Vs. Transaction Support Models

HUB programs also differ in how they resource their teams. Transactional models, common in high-volume therapeutic areas, rely on shared staff and charge manufacturers per completed task, such as each referral or call. 

Dedicated models, more suited to rare diseases, build disease-specific teams trained on the product, provider landscape, and patient population. These staff offer high-touch support and continuity across every interaction. Manufacturers pay a monthly fee for each team member, and service is tailored for depth rather than volume. For rare or complex programs, this model offers the consistency and personalization that larger transactional HUBs often struggle to deliver.

The Challenge for Pharmaceutical Manufacturers: Finding a HUB That Aligns With Your Market Access Strategy

HUB services represent a meaningful investment, often accounting for 1–2% of sales, and their ability to reduce access barriers can have a direct impact on patient outcomes. However, not every HUB is equipped to deliver the level of support complex therapies require.

While some HUBs operate within specialty pharmacies, this model can present challenges. Pharmacy-based HUBs may prioritize fulfillment efficiency over patient-centric coordination and may have limited experience navigating the medical benefit space. This can create friction, especially if the HUB inadvertently pushes medical benefit claims through the pharmacy channel, resulting in delays or misaligned coverage.

For rare disease therapies in particular, it’s critical to select a HUB that views the patient journey holistically, not just as a series of transactions. That requires experienced leadership, robust data capabilities, and a service model built around personalized access, not just the prescription.

How Can Your Access Strategy Best Leverage HUBs?

In our experience, the most effective HUB strategies start by looking specifically at what works in rare disease. HUBs that already manage rare products tend to bring the right mindset: proactive, detail-oriented, and patient-centered. Additionally, HUBs with on-site, centralized call centers often deliver faster, higher-quality service than distributed or remote models. 

Large transactional HUBs may promise full-service delivery, but too often fall short on experience and focus. The single most important factor in a HUB’s success is the Program Manager. A dedicated leader with real experience in rare disease can make the difference between a program that runs smoothly and one that loses patients in the handoff.

Looking for a HUB strategy built around your brand, your patients, and your access goals?

Talk to our team.