The economic ripple effect of the COVID-19 pandemic is expected to have a significant impact on patient access to critical therapies, particularly for those managing chronic illnesses. As the industry navigates the road ahead, all stakeholders have a responsibility to support patients in getting the care they need. This includes taking steps to reduce instances of financial toxicity, which refers to the direct and indirect effects induced by the cost of managing a serious diagnosis, such as psychosocial distress, diminished patient outcomes, and poorer quality of life.
Today’s Economic Environment
In the weeks and months following March 11—the day the coronavirus was declared a pandemic by the World Health Organization (WHO)—and the subsequent shelter-in-place orders, the U.S. began to experience record numbers of unemployment claims. More than 44 million people filed for initial unemployment benefits between mid-March and June of this year.1 Based on past events that led to unemployment, this has the potential to cause a significant spike in the uninsured rate, both from a short- and long-term perspective, as newly laid off workers lose employer-sponsored health insurance or lack the resources to afford a health plan on the individual market. As a point of comparison, the number of uninsured adults increased by 5.6 million during the 2007-09 recession.2
Going further, an unstable economic environment may also reduce overall disposable income and purchasing power for individuals and families with commercial insurance, making it harder for these patients to pay for medications. At the same time, Medicare beneficiaries living on a fixed income may see retirement savings dwindle, therefore inducing financial hardship in affording out-of-pocket expenses under Medicare Parts B and D.
Given this potentially substantial impact on patient access to critical care, it is increasingly important that manufacturers understand the level of financial support their patient populations will need going forward and ensure they are equipped with the resources to meet that demand.
Activating Patient Support Programs
The pandemic has created affordability and adherence challenges for patients across nearly all therapeutic areas and led to a mounting need for financial services and copay support. Today, it is essential for manufacturers to consistently and effectively gauge this emerging need in order to have the resources on hand to ensure patients have the tools to access and afford their therapies.
Patient support programs may help improve access and affordability for patients through patient assistance programs (e.g., free goods generally for uninsured patients) or copay assistance (e.g., direct financial assistance to pay out-of-pocket expenses for commercial plan enrollees). Depending on the therapeutic area and patient ability to physically access treatment during the pandemic, the demand for the financial assistance afforded by these programs could rise in light of COVID-19. Manufacturers without effective and appropriate programs in place for their products should consider engaging an external partner to support the development and launch of custom support programs designed to serve their patient populations and weather changing conditions.
External partners absorb the research and administrative burdens from the manufacturer’s patient access teams by leveraging their experience to determine the most effective strategies for program design, launch, and delivery. Ideal partners are equipped with state-of-the-art technology ecosystems to simplify and streamline the patient experience, as well as on-demand data reporting capabilities to provide manufacturers with actionable insight to inform patient-centric program decisions. Furthermore, partners can perform ongoing financial exposure analyses to project the future need for a product and estimate the dollar amount that will be necessary to provide assistance for patients on a given drug. This type of analysis gives a manufacturer foresight into external factors that may impact patients and require individualized support.
Supporting Patients’ Emotional Needs
In pursuit of holistic, patient-centered care, manufacturers can also deploy telehealth services as part of their support programs. Nurses, and in some cases, social workers, act as the primary point of contact for patients and their caregivers, getting to know them on a personal level to identify individual barriers and challenges that affect their experience on treatment. Understanding that managing a serious or chronic illness takes both a physical and emotional toll on patients, nurses conduct routine outbound calls to check in on treatment plans, offer medication reminders, and are also available for inbound calls to listen to patients’ concerns, help navigate access hurdles, and provide comfort in often chaotic times.
Another way telehealth nurses can alleviate unnecessary stress for patients and their families is by coordinating directly with the larger care team to file insurance appeals or identify options for financial support. Beyond connecting patients with financial resources, nurses and social workers can share information and recommendations on mental health services to help patients cope with the psychological impact of managing a diagnosis.
With a telehealth nurse or social worker providing the right blend of empathy and expertise throughout the treatment journey, patients can have peace of mind knowing that support—whether clinical or emotional—is just a phone call away.
Evolving Existing Patient Support Programs
For manufacturers with existing support programs in place, it is critical to consider any necessary adjustments to more effectively address new and emerging challenges facing patients today. This may include expanding the income criteria required to enroll in a program and/or temporarily allowing patients to access the free goods for a period of time. Manufacturers should also closely analyze prescription fill data for patients currently enrolled in patient support programs so they can reposition clinical interventions as needed.
For example, if a patient has stopped filling a prescription, a clinical expert from the program can connect with that individual directly to understand the reasoning and provide them with the tools and services needed to fill the gaps—whether that be financial assistance, telehealth services, etc. Today’s patient support programs should also look to provide patients with research and guidance on alternate coverage options for those who have lost insurance and need help navigating Medicaid or health insurance exchange options.
Finally, manufacturers need to be thinking about ways to evolve their program portals and communications strategies with healthcare providers, their staff, and patients. Before the COVID-19 pandemic, patients typically applied for financial assistance via a patient support program right in the physician’s office. With the move to a more virtual environment, manufacturers must explore digital and online applications via smartphone or computer to meet patients where they are—at home.
In this uncertain climate, it’s important for manufacturers to actively anticipate different scenarios and evaluate contingency plans on an ongoing basis. With this insight, they will be better positioned to ensure they have the resources on hand to maintain access and affordability for their populations, whether that means launching new programs, investing additional funds and staffing into existing ones, or allocating more product to the specialty pharmacy for free goods.
The Path Forward
Even though pharma companies have been presented with this opportunity to mitigate the economic impact of the pandemic through patient support programs, less than one in five patients are even aware such support services are available to them from manufacturers, and only 40% of healthcare providers are “very aware” of manufacturer-sponsored patient programs.3 This gap in both patient education and provider awareness has only been heightened now that patients are having fewer face-to-face interactions with healthcare providers in the wake of COVID-19.
To address this issue, manufacturers should consider engaging field services teams, who serve as a liaison between those who create therapies and the offices that prescribe them. These teams of experts are responsible for helping healthcare providers’ offices manage patient access challenges, while also driving awareness for manufacturer-sponsored programs and educating on their use.
Additionally, as manufacturers evolve their programs in response to economic factors, field teams play a critical role in ensuring practices are informed and up to date on any changes in requirements and criteria, so they can make the right recommendations to patients. Since nearly 50% of provider offices have furloughed staff,4 it has created further difficulties in supporting patient access and reimbursement barriers. These challenges emphasize the need, now more than ever, for external education and support for these healthcare provider offices.
Currently, interactions between field teams and providers have largely transitioned to a virtual support model, enabling field teams to continue delivering outstanding service to provider offices as well as helping connect patients with the financial support they need. Many community provider practices have pivoted and increased staff ability to use web-based support; however, this is often balanced with the provider’s own need to conduct telehealth services. As such, current access and reimbursement services are a mix of web-based and telephony. Given the rise in accessibility and transition to virtual support engagement platforms, this trend may continue to some degree even after social distancing ends. More education, in whatever form, will have a positive impact on patients.
As the long-term implications and residual effects of the COVID-19 pandemic emerge in the months ahead, maintaining patient access and ensuring affordability of therapy should be top of mind for all stakeholders in the industry. While there is no one-size-fits-all approach to patient support, proactive planning and careful data analytics can assist manufacturers in aligning the right resources with the right patients at the right time. Manufacturers who actively prepare for an uptick in uninsured patients through provision of robust patient support programs will be best positioned to serve their populations now and in the future.
1. CNN. “Another 1.5 Million Americans Filed for First-time Unemployment Benefits Last Week.” 2020. https://www.cnn.com/2020/06/11/economy/unemployment-benefits-coronavirus/index.html.
2. Health Affairs. “The 2007–09 Recession and Health Insurance Coverage.” 2011. https://www.healthaffairs.org/doi/10.1377/hlthaff.2010.1003.
3. Accenture. “Pharma’s Growing Opportunity in Patient Services.” 2020. https://www.accenture.com/us-en/patient-services-survey-pharma.
4. MGMA. “COVID-19 Financial Impact on Medical Practices.” 2020. https://mgma.com/resources/government-programs/covid-19-financial-impact-on-medical-practices.