Julia discusses the challenges of both access to therapy and patient adherence, specifically during the COVID-19 pandemic. CoverMyMeds’ technology solutions mitigate these issues and ultimately improve patient outcomes.
To learn more, download the CoverMyMeds case study, Overcoming Medication Access Barriers Caused by Prior Authorization.
Read on for Julia's insights.
Using Technology to Improve Medication Access and Impact More Patients
By Julia Phillips, VP of Pharma Accounts and Enablement, CoverMyMeds
1. INTERACTING WITH THEIR DOCTOR
Patients indicate they trust their providers above all other industry stakeholders to help manage their health conditions. They lean on their expertise before starting treatment, a time during which patients said they experience the most frustration. This is why the initial office visit and point-of-prescribing conversations, can be so critical to medication access and adherence – and a huge opportunity for technology assistance.
2. NAVIGATING PRIOR AUTHORIZATION
After leaving the doctor’s office, many patients receive disappointing news at the pharmacy that their prescribed treatment was denied due to prior authorization (PA). Not only can PA delay time to therapy, it can also leave patients feeling frustrated and confused. Unfortunately, such situations are common. On average 66 percent of rejected prescription claims at the pharmacy require PA and 37 percent of these prescriptions are abandoned by patients. (CoverMyMeds data on file, 2019)
PA is also a burden on providers, who report spending nearly 2 business days a week completing PA requests. In a survey by the American Medical Association, 91 percent of respondents reported that PA results in delayed access to necessary care for patients.
The burden has increased due to the effects of the COVID-19 pandemic. In a recent survey to providers using CoverMyMeds, 92 percent reported changes in their office due to the pandemic. Nine out of ten respondents confirmed that despite these office changes, the PA process had remained the same. (CoverMyMeds Provider Survey, 2020)
With the support of technology and the industry’s largest network, CoverMyMeds has helped solve medication access challenges for patients more than 200 million times. As leaders in electronic prior authorization (ePA) technology, we support a broad spectrum of life science products, from traditional retail to complex specialty therapies. With the support of CoverMyMeds, 65 percent of prescriptions with a completed ePA request were dispensed within 1 hour, helping patients obtain therapy faster. (CoverMyMeds data on file, 2019) Read our case study to learn more about how we make a difference.
3. PATIENT AFFORDABILITY AND ADHERENCE
Beyond comprehensive PA support, our solutions further help patients with affordability options and medication adherence. To support the increasing number of under- and un-insured patients, we’re offering new affordability option where brands can buy down prescriptions and pass cost savings to patients paying out of pocket at the pharmacy, helping reduce abandonment. Adherence programs for specialty medications allow patients to better adhere to their prescribed therapies – potentially helping reduce adverse outcomes. We continue to develop innovations to help patients start and stay on therapy.
When we connect all areas of the healthcare network and identify a problem, we can find solutions to achieve our common goal: helping patients.
Our vast network includes over 750,000 health care providers, payers representing 94 percent of prescription volume, 96 percent of pharmacies, integration with 75 percent of EHRs and over 200 life science brands. These connections enable our solutions to help patients access any prescribed medication, on any health plan.
BOTTOM LINE: TECHNOLOGY HELPS PATIENTS GET THEIR MEDICATION
CoverMyMeds supports patients at crucial moments in the prescription journey to streamline processes and help them obtain therapy. For example, within several top therapeutic classes by number of prescriptions, average claim rejection rates can reach 18 percent or more (CoverMyMeds data on file, 2019), which could lead to patients abandoning their prescriptions.
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When a brand is supported by CoverMyMeds, a brand-specific PA request auto-starts at the pharmacy and is sent to the provider for completion. When providers and pharmacists have a streamlined PA process, patients are more likely to remain on their originally prescribed therapy.
Our ePA technology, combined with live support, can help improve the likelihood that PA requests make it to the health plan for determination. For brands with CoverMyMeds support, we see PA request submission rates per provider increase by 46 percent, on average, for pharmacy-initiated requests. (CoverMyMeds data on file, 2020)
As a result of more PA requests submitted to the health plan for determinations, approved PA requests by the health plan nearly double, on average, when looking at a mix of retail, specialty and mixed distribution brands. (CoverMyMeds data on file, 2020).
The healthcare system can be difficult to navigate – even for those of us with experience. Discovering new ways to bring together healthcare stakeholders will continue to make a difference for patients. Learn more about how CoverMyMeds is helping patients get the medications they need by downloading our ePA case study.
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