Supporting Patient Adherence Through Electronic Prior Authorization and First Fill Copay Programs

Today’s guest post comes from David Fidler, Senior Director of Product Innovation at ConnectiveRx. David discusses how electronic prior authorization (ePA) and first-fill, buy-down programs can boost patient adherence to specialty therapies.

On November 3rd at 1:00 pm ET, ConnectiveRx will host First Fill, No Wait: How to Make it Happen, a free webinar about copay ePA. Click here to register.

Email inquiries@ConnectiveRx.com with any questions.

Read on for David’s insights.

Supporting Patient Adherence Through Electronic Prior Authorization and First-Fill Copay Programs
By David Fidler, Senior Director Product Innovation, ConnectiveRx

With 51% of physicians reporting that prior authorizations (PAs) for prescribed branded and specialty medications have significantly expanded over the last five years, PA requirements continue to be a major hurdle for patients and healthcare providers (HCPs) alike.

Delaying medication approval by even a few hours impedes patient access to treatment and increases the risk of abandonment. Despite calls to reform our current PA system in order to reduce administrative burdens on HCPs and staff and lessen patient waiting time, there is little indication that changes will happen any time soon.

So how can pharma brands help overcome this roadblock in order to better support patient adherence and keep their first-choice status with HCPs?

As HCPs and patients know, responses to traditional PAs can take days, even weeks. Conversely, electronic PAs (ePAs) can be determined in just a few minutes when the required information is submitted quickly and the decision is straightforward. As a result, the increasingly widespread use of ePAs is significantly improving adherence.

When approval is not a simple matter, however, things can get tricky. The retrospective ePA process, which triggers the need for a PA upon denial at the pharmacy, all too often leaves patients, pharmacists, and prescribers stuck in a sort of limbo due to uncertainty a PA is even being requested. Any administrative delay in the process - prescribers being unaware that a PA is needed, pharmacies not knowing a PA is being pursued, patients seeing the full cost of the medication, for example - may leave patients with no choice but to walk away without their prescription. In other words, the increasing implementation of the ePA process certainly helps, but it is not enough, alone, to solve the PA dilemma.

A comprehensive first-fill, buy-down co-pay program, in which brands offer to buy down the first fill of a patient’s medication before approval is received, in combination with the ePA process has the potential to solve this problem, based on recent case studies reviewed by ConnectiveRx, helping patients to leave the pharmacy with their prescribed medication.

It is widely recognized that patient savings programs greatly increase access and adherence for branded and specialty medications. In fact, recent market research shows an 11.5% script lift when patient savings options are offered. So when brands are challenged with the task of supporting patient adherence while also maintaining profitability and market share, the answer may lie in finding innovative ways to use the ePA system.

However, most savings programs are generally available for approved medications, not pending ones. If brands offered to buy down the first fill of a medication before approval is received, the approval process could play out behind the scenes while patients are sent home with their medications - giving prescribers the time they need from an administrative perspective to provide adequate information to the payers to help secure approvals. If the process results in approval, the health insurer will reimburse the brand for the first-fill, buy-down cost, and patients are more likely to refill and adhere to their medication, resulting in ongoing revenue for the brand.

ConnectiveRx has tracked ePA initiation status to determine cost vs. revenue. One brand (Brand X) offered a co-pay program that covered the cost of first fills while patients were awaiting PA decisions from their health insurers. Of those, 7,597 refills were subsequently covered as the PAs were approved. Brand X paid out an average of $715.13 for the buy down but just $166.96 for the refills. The buy down co-pay program cost Brand X just short of $10M altogether; the brand was ultimately reimbursed more than $29M from the payers, resulting in a revenue stream of more than $19M on refills alone.

With so many brand launches today focused on specialty medications, the current trends in PA are not going away. The most critical contributor to both patient health and brand revenue is ensuring patients leave the pharmacy with their prescribed medication in hand. Combining ePAs with co-pay programs covering the first fill of medications that require PAs allows sufficient time to overcome administrative hurdles while enabling patients to immediately start therapy. This creates a win-win for brands and the patients who use their medications.

To learn more about ConnectiveRx’s copay ePA program including the latest real-world customer ROI data, we invite you to attend First Fill, No Wait: How to Make it Happen on November 3 at 1 pm ET. For more information and to register, please visit here.

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