Breaking Down Medication Access and Affordability Barriers

Today’s guest post comes from Kristina Crockett, VP of Product Management at CoverMyMeds.

Kristina discusses challenges patients face accessing, affording, and adhering to prescribed medications. She goes on to describe how manufacturers can overcome these challenges to improve outcomes for both patients and brands.

Click here to learn more about CoverMyMeds’ technology solutions.

Read on for Kristina’s insights.

Breaking Down Medication Access and Affordability Barriers
By Kristina Crockett, Vice President, Product Management, CoverMyMeds

Access to necessary medication is a fundamental aspect of healthcare. Yet, as many of us have likely personally experienced at some point, there are a variety of barriers that can lead to delays. Unfortunately, these delays may cause providers to switch medications or patients to abandon their therapy entirely.

From claim rejection barriers at the pharmacy to financial constraints, pharma companies need a strategic collaborator that understands the unique challenges their brands face. It starts with experience and expertise to develop a tailored approach for effective, data-informed program designs that can break down the most common access and affordability barriers.

OVERCOMING CLAIM REJECTION BARRIERS

Undoubtedly, claim rejection barriers pose a major hurdle for brands and the individuals relying on their medications. These barriers can understandably frustrate patients, but they can also hinder a brand’s performance.

After significant investments in provider and patient education to demonstrate the clinical value of the therapy, claim rejections should not be a roadblock to patient access. There are opportunities to overcome these access barriers through an optimized mix of solutions that can integrate directly into pharmacy and provider workflows.

For example, in the event of a claim rejection, brands can auto-convert a rejected claim to paid at the pharmacy, helping patients leave with their prescribed therapy at an affordable cost. They can also help mitigate prior authorization barriers for providers so patients can obtain their originally prescribed therapy faster.

We’ve found that when providers have access to in-workflow prior authorization support, the rate of submissions to a plan increases. We’ve also found that when patients are notified of a prior authorization approval, they can access their therapies two days sooner, on average (CoverMyMeds PA Notify data for approved PAs, 2024). And if a prior authorization is denied, our appeal support results in approval for 1 out of every 3 submitted appeal requests, on average (CoverMyMeds ePA program appeal support data, 2023).

But claim rejection and prior authorization hurdles are just a few barriers patients can face when accessing their medicine. Even when a prior authorization request is approved, patients may experience challenges affording their treatment.

Luckily, we can help with that too.

THE CLAIM GETS APPROVED, NOW WHAT?

For many, the price for better health outcomes may be more than they can pay. Our recent survey found that 33% of patients said they’ve stretched out their prescription by taking a lower dose or skipping doses, while 28% said they’ve sacrificed essential items or bills to afford their medications (CoverMyMeds 2023 Patient Survey). As patients struggle with the high cost of medications, addressing affordability barriers is crucial in helping them access necessary treatments and improve overall health outcomes.

By approaching access and affordability holistically through a strategy that supports patients throughout their care journeys, pharma companies can help them afford their medications and help prevent trade-offs for other essential needs.

For example, a comprehensive copay solution—inclusive of an electronic, automatic copay coupon program combined with an enrollment-based copay card program—can bring out-of-pocket costs down for patients. In turn, patients can miss fewer doses and reduce the financial burden of essential medications.

When building a comprehensive affordability strategy, there is significant value in actionable data and insights that can help pharma companies make informed decisions. Our approach and specialized expertise unlock these insights to go beyond traditional copay assistance programs throughout a brand’s lifecycle.

BREAKING BARRIERS, TOGETHER

Breaking down barriers to medication access and affordability requires more than off-the-shelf solutions. That’s why we take a consultative approach, grounded in deep industry knowledge and advanced technology.

For over a decade, we’ve worked with pharma companies to help uncover brand challenges throughout the patient journey and pair them with solutions that can best meet their strategic goals. In fact, in the last year alone, we’ve helped patients save more than $8.8 billion on brand and specialty medications, helped to prevent an estimated 10.7 million prescriptions from being abandoned due to affordability challenges, and helped patients access their medicine more than 94 million times (CoverMyMeds data on file, 2024).

Together, we can break down barriers for patients and unlock the potential for improved health outcomes for all.

Discover how CoverMyMeds can help break down barriers and optimize your brand strategy.

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The content of Sponsored Posts does not necessarily reflect the views of HMP Omnimedia, LLC, Drug Channels Institute, its parent company, or any of its employees. To find out how you can publish a guest post on Drug Channels, please contact Paula Fein (paula@DrugChannels.net).