pLOG

2025-09-03

The Development Needs of PSPs Amid the Decentralized Trend Toward Home-Based Healthcare

The Need for Support of High-Cost Medications in Home Care and Chronic Disease Management

In recent years, as changes in medical demand and supply have unfolded, the healthcare system has been increasingly driven toward decentralization. In the United States, more and more insurers and PBMs (Pharmacy Benefit Managers) are adopting benefit management tools such as Alternative Funding Programs (AFPs), Copay Accumulators, and Copay Maximizers. These tools are primarily designed to strictly control reimbursements for high-cost, innovative therapies, while shifting the financial burden onto pharmaceutical manufacturers. As a result, patients face mounting obstacles in accessing treatment.

For example, under the AFP model, insurers may exclude certain high-cost medications from coverage, making patients appear as if they are uninsured, and then redirect them to Patient Assistance Programs (PAPs) to cover the cost of the medication. This directly leads to a surge in demand for PAP services within PSPs, forcing pharmaceutical companies to respond in more flexible and scalable ways.

Under such financial pressure, pharmaceutical companies must rethink their PSP models. The traditional fully outsourced approach may no longer be able to respond promptly to these complex and constantly evolving reimbursement strategies. As a result, adopting a hybrid decision-making model—integrated into internal information systems—has become increasingly important to better manage patient and HCP experiences while gaining more comprehensive data insights. This shift in model directly responds to the decentralization of hospitals, where patient and HCP interactions are extending beyond the hospital setting into external care environments.

The Complexity of Home Care: Challenges Beyond Logistics

As treatment shifts from hospitals to the home, patients transition from passive recipients to active managers of their own care, and the challenges faced by PSPs rise accordingly. The complexity of home care extends far beyond medication logistics, encompassing patient education, adherence monitoring, side effect management, and emotional support across multiple dimensions.

For patients who need to self-inject or infuse medications at home, PSPs must provide comprehensive training and guidance to ensure safe and accurate administration. In the past, such education was typically delivered by in-hospital nurses or healthcare professionals. However, under the home care model, PSPs must bridge this service gap through telemedicine, in-home visits by specialized nurses, or digital tools. Patient satisfaction with telehealth nurse support has been shown to be very high, underscoring the indispensable role of skilled professionals in home-based care.

Moreover, medication adherence is one of the core challenges in home-based care. Without direct supervision from healthcare professionals, patients can easily miss doses or discontinue treatment on their own due to side effects. In the future, PSPs will increasingly integrate technologies such as artificial intelligence (AI) and data analytics to accurately predict patients at risk of dropout. Through personalized, multi-channel communication, they can deliver timely interventions and support, ensuring that patients remain committed to completing their full course of therapy.

Technology-Enabled: Building a New Blueprint for Home-Based PSPs

Technology-First: From Passive Support to Active Empowerment

Traditional PSPs have largely relied on labor-intensive services, but in the face of the growing demands of home-based care, this model has become difficult to scale. The report highlights the rising need for “technology-first” PSPs, where technology is regarded as a core component rather than merely a supporting tool.

The concept of a Digital Hub is a prime example. By leveraging interoperable technology, it can automate tasks such as electronic benefits verification (e-BV) and electronic prior authorization (e-PA), reserving human intervention for the most complex cases that require personal interaction. This not only shortens treatment initiation times but also allows PSP staff to focus their efforts on delivering higher-value patient services.

AI and Big Data: The Key to Personalization and Precision

In home-based care, each patient’s journey is unique. PSPs must be able to provide customized services tailored to individual needs, and AI and big data are key to achieving this goal.

Current applications of AI in PSP development span multiple scenarios, including operational efficiency improvement, patient coverage optimization, personalized patient interactions, and conversational intelligence analysis. For example, AI can analyze patient data to accurately predict potential dropout points and deliver the right message, through the right channel, at the right time, via personalized communication. This not only enhances medication adherence but also helps patients feel valued and cared for.

However, AI is not omnipotent. In certain scenarios, such as determining patient coverage, AI relies on large amounts of historical data for predictions, which may carry risks of inaccuracy. Therefore, integrating AI with direct access to payer and PSP information is essential to ensure data timeliness and accuracy, highlighting the ongoing need for seamless information exchange.

Redefining and Repositioning the Role of Professionals

Talent Shortage in Healthcare Benefits and Digital Transformation

Although technology plays an increasingly important role in PSPs, it does not replace the value of professionals. On the contrary, as home-based care becomes more complex, the demands on PSP personnel are rising. Skilled PSP professionals must possess expertise in areas such as disease management, medication administration, and insurance design, while also demonstrating empathy to address the challenges patients and HCPs face within a complex healthcare system.

In the post-pandemic era, talent shortages and shifts in work models have introduced new challenges for PSPs. Traditional remote work arrangements may result in inconsistent service quality. Therefore, PSP providers must implement clear recruitment, training, and performance management processes, while ensuring that their teams continue to develop in order to meet ever-changing market demands.

The New Role of Professionals: Value Creators in Human-AI Collaboration

In the “technology-first” PSP model, the role of PSP professionals is being redefined. They are no longer merely administrative task executors but have become value creators through human-AI collaboration.

Through automated advanced eServices, PSP personnel are freed from tedious administrative tasks, allowing them to devote more time to meaningful interactions with patients and HCPs. The implementation of patient journey management systems provides real-time access to information such as PSP program details, prior authorization requirements, copay or PAP eligibility. This enables PSP staff to quickly assess situations during interactions and offer timely, empathetic, and professional guidance.

This model not only improves operational efficiency but also allows PSP personnel to focus more on providing empathy and emotional support—core values in home-based care that no technology can replace.

For pharmaceutical companies, partnering with specialized PSP providers like PatientsForce not only helps address payer strategies and regulatory challenges but also enables the creation of differentiated patient experiences, strengthening collaboration among pharma, patients, and HCPs.

For investors, the value of PSPs has gone beyond being a “cost center” to becoming a strategic asset that drives drug accessibility, patient adherence, and sustainable growth for pharmaceutical brands. Understanding the development trajectory of PSPs in a decentralized landscape will be key for both healthcare professionals and investors to stay ahead in the next cycle of healthcare competition.