Rising patient financial obligations have led to increased patient consumerism, changing the game for brands offering patient support and reimbursement access programs. Delivering a consistent experience through all patient support programs throughout the patient’s journey is increasingly important to maximize patient impact.
Many brands have different decision makers leading these initiatives, which can result in divergent goals and a lack of integration between various hub services and patient support initiatives, such as financial off-set programs (including copay and PAP), mobile outreach, behavioral coaching, and targeted interventions. Integrating reimbursement access with adherence support throughout the patient’s treatment journey is crucial to their success. The coordination of that support, inclusive of data integration and a seamless patient experience, increases patient success.
In a three-part series, experts from McKesson Specialty Health will provide actionable insights into how brands can remove silos to integrate comprehensive hub services and patient support programs to support patients throughout their treatment journey. This includes how end-to-end reimbursement services can accelerate the appropriate access to therapy for patients, the evolution of e-services, and the behavioral coaching solutions to get and keep patients on their therapies.
Addressing Access and Affordability Issues
Utilization of specialty pharmaceuticals to treat patients with complex conditions in the areas of oncology, rheumatology, and endocrinology is rapidly increasing. According to the National Center of Biotechnology Information, specialty drugs make up 67% of the total drug spend, with an average annual increase of 20% over the next three years. However, there can be significant affordability issues with specialty drugs.
As out of pocket costs increase, patients are more likely to abandon their prescription, despite the fact that their overall health may be dependent on being adherent. Even among patients who can afford their specialty medications, many experience fill delays of up to 30 days due to confusing prior authorization processes. Prior authorizations vary by brand and by payer, making it difficult for patients or clinicians to know what documentation is required.
Additionally, ensuring that patients can gain access to some specialty drugs can be a challenge for physician practices. Distribution may be restricted to specific channels, reducing access for the practice’s in-office dispensing pharmacy. In cases where the drug can be obtained by the practice, getting reimbursement from payers can present a problem, as the payer approved pharmacy network may also be restrictive.
To help patients avoid delays in starting treatment, patient on-boarding, prior authorizations, medication benefit investigation, and resolution are critical administrative tasks to ensure patients have access to the treatments they need—and the practice is reimbursed properly. This is an opportunity for brands to work with a full-service specialty pharmacy partner to provide comprehensive practice management resources designed to help alleviate practices’ administrative burden so they can focus on delivering high-quality patient care.
Many service providers can perform primary access support services, but it is important for brands to deploy an integrated set of solutions that deliver patient-centric services to drive better outcomes. Brands—and their prescribers and patients—need an access support partner that can provide the skill, expertise, and resources to understand and help manage the clinical, financial, and emotional complexities associated with disease state specific treatment. In this model, patients receive support throughout their treatment journey from highly skilled professionals who efficiently coordinate medication access and availability.
In-office reimbursement support, where field-based reimbursement experts work with doctor’s offices to provide education, training, and case pull-through is another example. As access issues continue to mount, from the rise in denials and reverification, to potential risk evaluation and mitigation requirements, to the rising tide of patient deductibles, end-to-end support for patients is critical to avoid treatment delays and interruptions. With real-time Hub database access, the field team can help advocate for the patient, quickly overcoming payer objections and speeding authorizations and delivery.
Geographically aligned field teams gain a plan-year mastery of payers in their territories, enabling them to partner with case managers to establish regional expertise, allowing for 360° support of each prescriber and their patients. Programs should function in unison with Hub teams to address access challenges by providing real-time, HIPAA-compliant patient information to support benefit investigations, claim status, escalate claim challenges, communicate copay assistance offering, and educate on foundation assistance. This approach has shown a capability to streamline and reduce issue resolution from one to two days to five to 10 minutes.
Reimbursement Access is Just the Beginning
With the complexity of specialty pharmaceuticals, access is only the first step to having a positive impact on patient adherence and health outcomes. Hub services are evolving to incorporate longer term adherence solutions and overcoming barriers that contribute to abandonment. To be successful in this evolution in focus on health outcomes, brands need to meet patients where they are within their therapeutic journey, building a comprehensive strategy, starting with access, and building to surround the patient with ongoing support to help them start and stay on therapy.
While rising financial obligations increases the likelihood of medication non-adherence by patients, it is important to realize that most non-adherence is the result of behavioral barriers, such as low self-efficacy, lack of engagement, or medication concerns and addressing these is critical to improving compliance to a course of therapy. Live agent support can be used to identify adherence barriers and be paired with financial assistance or educational support programs. By leveraging a full-service contact center that employs behaviorally trained agents, brands can enhance the patient experience while optimizing their investment.
Pharmacists, certified pharmacy technicians, and behaviorally trained contact center agents strive to build a strong relationship with the patients they serve, helping them understand complex dosing instructions as well as addressing side effects, easing the burden on practice clinicians. McKesson Specialty Health conducted patient research to assess support programs and their potential impact across 10 therapeutic areas. Three out of four patients indicated that the need for live support delivered in a way to meet their needs, through a trained and educated agent, was important to their successful patient journey. Supporting patients in a personalized manner requires connecting with live two-way communication to better understand their attitudes, beliefs, and barriers.
Pairing Access with Behavioral Coaching
The next article in this series will discuss how leveraging behavioral coaching across communication channels, Hub services, and pharmacy channels allow brands to reach patients where they are within their treatment journey to build an integrated patient experience, drive positive health outcomes, and increase medication adherence.