Manufacturer assistance programs are designed to make treatments more affordable, yet only about 10% of these dollars are used by patients. While there are several factors influencing why these programs are underutilized, fixing issues with cumbersome technology and workflows can improve the experience.
The cost of filling a prescription can keep 21% of patients from getting an Rx, and one in ten
patients will modify their treatment plan because of cost, according to recent polling data from KFF. When treatments are missed or reduced, health outcomes suffer.
Pharmaceutical manufacturers know how important adherence to a treatment plan is and to help patients afford medications, manufacturer assistance programs are designed to make treatments more affordable. Coupons, e-vouchers, and co-pay assistance programs can cover up to 87% of out-of-pocket costs and some fully cover patient costs. These programs are vital, especially for patients who require expensive specialty medications and those with chronic conditions. Yet, only about 10% of these dollars are used by patients.
While there are several factors influencing why these programs are underutilized, fixing issues with fragmented and cumbersome technology and workflows can improve the experience for healthcare professionals (HCPs), pharmacists, and patients, ultimately improving the utilization of these programs, patient treatment adherence, and important health outcomes. Weeks-long processes make it difficult for patients, providers, and HCPs to access affordability programs.
When a prescriber or a pharmacist wants to connect a patient to co-pay assistance programs, inefficient manual and digital workflows make it difficult and time consuming to access discounts. The journey from writing the prescription to filling the Rx can take three weeks or more— eating up precious time for patients who need access to affordable treatments.
Prescribers and pharmacists who are already stretched thin must take time to search websites and portals for coupon information. Once a co-pay assistance option is discovered, even more time is spent connecting the patient to the discount. The process involves multiple platforms and manual work from referring patients to hubs, securing patient consent, and program enrollment. There’s no single modality for connecting patients to these programs, with some using physical cards and others requiring multiple phone calls.
Once a match is made, the patient’s eligibility must be checked. Coordination with their benefits provider is needed, and that can sometimes involve getting clearance for prior authorization or step therapy requirements. Clearly, the patient assistance workflow is broken.
Four Ways To Improve Access To Affordability Programs and Essential Treatments
To overcome the fragmented, manual processes preventing patients from accessing co-pay assistance programs, advanced healthcare technology solutions are needed.
HCPs and pharmacists need to be educated in real time Patients can’t access co-pay assistance programs if they don’t know the dollars are available. Life science marketers hoping to increase adherence to medications must start by increasing awareness of affordability programs.
The majority of patients (87%) want to learn about drug affordability programs from pharmacists and HCPs according to a recent survey from Phreesia Report. Yet many HCPs (42%) are not very aware of copay support programs for their patients’ medications. To drive awareness, pharma marketers need to reach this key audience with relevant information through electronic health records and e-prescribing platforms. Leveraging advanced technology, artificial intelligence, and patient-led data in a HIPAA-compliant manner will make it easy to effectively communicate affordability messaging at the prescribing or dispensing moment through point of care platforms. This will enable HCPs and pharmacists to share information with the patient in person, and lower barriers to access.
Messages about affordability programs need to be distributed equally across POC platforms By delivering information about assistance programs at the prescribing or dispensing moment, these messages can be hyper-relevant and drive enrollment. These messaging solutions must be platform agnostic to ensure that information can reach HCPs and pharmacists no matter which software is used by their organization.
The majority of patients (87%) want to learn about drug affordability programs from pharmacists and HCPs according to a recent survey from Phreesia Report.
This will ensure equal access to co-pay assistance information and reduce the number of campaigns and platforms a brand needs to juggle.
Savings cards should be applied automatically to make out-of-pocket impact apparent Seamless integration with pharmacy systems would allow coupons and discounts to be applied when prescriptions are filled. By reducing patient out-of-pocket costs instantly without manual work, brands can remove friction for patients to get onto a new treatment and reduce errors created by manual entry of patient data.
Currently, digital solutions for real time pharmacy benefit checks (RTBC) are not widely available. However, some existing systems require minimal data to verify benefits quickly. To digitize patient assistance access, another key component is integrating electronic prior authorizations. Hubs that rely on call center staff to share information could provide valuable support electronically by completing these forms and tracking submissions digitally.
Creating electronic systems with interoperability is key to fixing broken patient assistance workflows In January, the Centers for Medicare & Medicaid Services (CMS) released the CMS Interoperability and Prior Authorization Final Rule, highlighting that the federal government is focused on streamlining these burdensome and time-consuming systems to ensure more timely decisions and improve patient care. The rule focuses on improving the prior authorization process by utilizing technology and it aims to increase data sharing. Though government health programs are the focus of the rule, improving the electronic exchange of healthcare data will require technology changes that can help fix the broken and fragmented patient assistance workflows seen today. The requirements to make programs communicate with each other, reduce the time it takes to get prior authorizations, and standardized systems will ensure smoother transitions for patients.
Advanced Healthcare Technology Can Improve Access To Affordability Programs
Many patients need help with out- of-pocket costs, and pharmaceutical manufacturers are designing and deploying necessary affordability programs to meet this need. But it is clear that outdated workflows create hurdles that keep the majority of these dollars from reaching patients.
As an industry, many players are impacted and together we must utilize advanced healthcare technologies to remove barriers and improve patient outcomes. It all starts with reaching HCPs and pharmacists across POC platforms with program information at the points of prescription and dispensing. Then, properly connected EHRs and eRx platforms can verify medication coverage, automatically apply coupons, capture patient consent, and secure prior authorization clearance electronically.
Together we can create a future where HCPs, pharmacists, and patients receive important, relevant copay assistance information during in-person treatment conversations.
