What is Patient Access?
An overview of what patient access is, where it came from, and where it is headed.
Patient access is the term used to describe the full range of services and processes that help patients obtain the medications they have been prescribed. In specialty and rare disease therapy, this means navigating insurance verification, prior authorization, financial assistance, and ongoing case management so that patients can start and stay on treatment. Patient access exists because the path from a prescription to a dispensed medication is rarely straightforward, and for complex therapies, it almost never is.
A Brief History of Hub Services
The modern infrastructure behind patient access programs, commonly called hub services, traces its origins to the 1990s. When patient hubs started in the 1990s, they provided minimal services, such as helping patients and providers with the complex reimbursement process for specialty medications and collecting program data. At the time, the primary challenge was financial: specialty medications were expensive, insurance processes were inconsistent, and patients needed help understanding their coverage options (Source).
The model expanded significantly as the specialty pharmaceutical market grew. Hub services originated with an earlier wave of biologics that required diagnostic tests and more complicated means of administration, such as infusion, and were initially provided by the biotech companies themselves. As manufacturers recognized that getting a patient on therapy required more than just dispensing a product, the scope of what hubs were expected to do broadened considerably. (Source)
By 2010, manufacturers commonly tasked hubs with verifying patient insurance through benefit verification, assisting with prior authorizations, enrolling patients in financial assistance, and coordinating shipment to network pharmacies. Third-party hub providers emerged to meet the growing demand, and the market for specialized patient support services became its own industry
Originally, hubs provided manufacturers with a central point of contact for their therapies to ensure efficient medication distribution. With the evolution and growth of specialty pharmacies, the services provided by hubs grew and diversified as well. Today, hub services encompass benefit verification, prior authorization, claims denial support, personalized case management, financial assistance coordination, adherence support, and data and analytics.
What Patient Access Does for Patients
For the patient, patient access programs serve as a buffer between the complexity of the healthcare system and the therapy they need. Specialty medications treat conditions that are serious, often rare, and sometimes life-altering. The administrative burden of accessing these therapies can be significant, and without support, patients frequently abandon treatment before it begins.
Patient access programs exist to remove those barriers. A benefit verification confirms that a patient's insurance covers their medication and identifies what their out-of-pocket responsibility will be. A prior authorization secures the payer's approval for coverage. Financial assistance programs address affordability gaps for patients who cannot meet their cost-sharing obligations. Case managers follow up, answer questions, and keep the process moving when it stalls.
The primary task of the patient hub is to enhance engagement by reducing the barriers of affordability and access so that patients are more adherent to their treatments and have better outcomes. Programs that execute these functions well produce measurable results: faster therapy starts, higher adherence rates, and fewer patients falling out of the pipeline before treatment begins. Pharmaceuticalcommerce
The Challenges with Patient Access Today
Despite decades of development, patient access remains a difficult and often fragmented problem. Payer requirements vary across plans and therapy types, prior authorization criteria change frequently, and the administrative systems that govern coverage decisions are not designed with speed or transparency in mind.
The doctor who writes the prescription often does not know if a prior authorization is required, what information the payer needs, or the status of the request. Specialty medications are split into two administrative silos, with the pharmacy benefit on one side and the medical benefit on the other, and they operate with completely different rules for prior authorizations (DrFirst.com, Inc.).
Technology has introduced new efficiencies but has also introduced new challenges. Vendors across the market have invested heavily in automation, yet automating a flawed or incomplete process accelerates the dysfunction rather than resolving it. Electronic benefit verification tools can return results quickly, but speed without accuracy creates rework, delays, and ultimately worse outcomes for patients. The tension between processing speed and data completeness is one of the defining challenges in the current patient access environment.
The Five-Year Future of Patient Access
The forces shaping patient access over the next five years are already visible. The specialty pharmaceuticals market grew from $92 billion in 2023 to $129 billion in 2024 and is expected to continue growing at a compound annual growth rate of nearly 40%, approaching $1 trillion by 2030. As the volume of specialty therapies increases, the infrastructure required to support patient access will need to scale accordingly (Definitive Healthcare).
Artificial intelligence will play a larger role in how prior authorization and benefit verification workflows are managed. 92% of managed care pharmacy respondents in a 2025 AMCP survey said it is likely that AI will be incorporated into more than 50% of prior authorization reviews. That shift carries real potential to reduce administrative burden and accelerate approvals, but it also carries risk. A 2024 American Medical Association survey of 1,000 practicing physicians found that 61% expressed concern that AI tools used by health plans are increasing prior authorization denial rates (AMCPPharmacy Times).
The most effective programs will not treat automation as a replacement for human judgment. They will use technology to handle repeatable, standardized tasks and deploy credentialed specialists where complexity, exceptions, and patient-specific circumstances demand expert attention. Programs that get this balance right will produce faster starts, fewer denials, and more patients who remain on therapy long enough to benefit from it.
The fundamentals of patient access have not changed: patients need help navigating a complicated system, and the quality of that help determines whether they get the treatment their prescriber intended. What is changing is the scale of the problem, the tools available to address it, and the standard that pharmaceutical manufacturers and their hub partners are expected to meet.
Brittney Vigna, MPH, CHES
Executive Director, Marketing
Brittney Wysong is the Executive Director of Marketing at Elusa Health. She has held roles in health education and healthcare marketing for over 15 years.
