Stacey discusses digital hubs and the affordability advantages they offer both patients on specialty therapies and their health care providers. To learn more, click here to schedule a meeting with AssistRx at Asembia’s Specialty Pharmacy Summit on April 30 to May 4, 2023.
Download AssistRx's free 61-page eBook here: Specialty Drug Patient Support Programs: 2022 Progress Report.
Read on for Stacey’s insights.
Taking A Technology-First Approach In Your Affordability Program
By Stacey Little, Senior Vice President, Business Development and Marketing, AssistRx
A technology-first approach can drive differentiated experiences for patients and healthcare providers (HCPs), as well as significant efficiencies and cost savings. Digital hubs should have technology incorporated into all patient support services, including affordability programs.
A 2022 study reported that 43% of working-age adults were inadequately insured, including individuals who were uninsured (9%), experiencing a gap in coverage (11%) or underinsured (23%). These alarming numbers only exacerbate the need for life sciences organizations to consider affordability programs for both insured and uninsured patients.
TECHNOLOGY-FIRST APPROACH TO COPAY ASSISTANCE PROGRAMS
For commercially insured patients, a technology-first approach in your copay program starts with enrollment. Through channels such as brand websites and HCP portals, copay enrollment should include options for both patients and HCPs to self-serve. Technology such as AssistRx’s automated Advanced Benefit Verification (ABV) and e-Copay solutions should return patients’ comprehensive coverage information and eligibility for the copay program, enroll eligible patients, and immediately generate the copay card via digital and traditional channels.
The AssistRx ABV solution leverages direct connectivity to payers/PBMs, clearinghouses and other data sources to provide patient coverage results including payer/PBM name and type; employer; BIN and PCN; member ID, group ID, relationship; effective/termination dates; deductible amount, remaining and exemptions; patient out-of-pocket (OOP) cost maximum, minimum and remaining; formulary tier status; drug access restrictions and coverage notifications. ABV returns comprehensive coverage results in under 15 seconds.
The key to a differentiated copay program is accurate, comprehensive patient coverage returns and enrollments in real time and in one workflow, as well as reporting. Your partner should provide comprehensive reporting on copay card usage and funding, copay card abuse guardrails, and proactive, automated measures to mitigate against copay accumulators and maximizers.
TECHNOLOGY-FIRST APPROACH TO PATIENT ASSISTANCE PROGRAMS (PAPS)
Like copay programs, a technology-first approach in PAPs begins with screening and enrolling patients into PAPs in real time. A digital hub should also consult with you on the right PAP technology for your product. For example, buy-and-bill product PAPs may benefit from incorporating proactive e-eligibility check and e-income verification tools deployed before administration of therapy.
Powering the enrollment process with technology not only improves patient and HCP experiences, but also facilitates staffing cost savings. For one AssistRx client, implementation of an e-PAP model drove a 40% reduction in full time employees (FTEs) and projected $9M in savings over two years.
TECHNOLOGY-FIRST APPROACH TO ANNUAL REVERIFICATION
While every patient support program vendor offers annual reverification, few incorporate a technology-first approach. The annual reverification process is commonly referred to as “blizzard season” due to its flurry of activity and new hires. With the right technology, this FTE-approach “season” can be eliminated.
Digital hubs prevent manual, high-cost reverifications by automating reverification efforts. A solution like ABV is optimal for reverification to ensure accuracy of data returned. ABV empowers us to search for insurance coverage, both at time of application and at various times throughout the year, to identify patients who obtain insurance coverage during PAP eligibility and transition them to paid-for scripts.
For example, leveraging our ABV and e-Income Verification solutions to expedite and automate the e-PAP reverification process, one AssistRx client gained roughly $16M in recaptured revenue and about 115 patients converted to commercial product.
THE ROLE OF TALENT IN AFFORDABILITY PROGRAMS
In our last article, we shared that a life sciences organization’s digital hub program cannot, and should not, be 100% digital in today’s complex healthcare environment. The same applies for affordability programs. Digital hubs should have a team specializing in alternative coverage options, such as Medicare Low Income Subsidy (LIS) and third-party charitable foundations.
This dedicated talent is essential in ensuring patients have access to the funding they need, especially as many programs have a narrow window for applications. An AssistRx program having a high Medicare population identified $12.9M in funding over the life of the program and supported 89% of patients in receiving funding in one year.
A technology-first approach will only benefit your affordability program when designed and deployed in the right way for your product. Life sciences organizations need a partner that not only understands when to incorporate technology but also how to balance this technology with talent based on your patient and HCP populations.
A digital hub with proven experience in technology-first affordability programs should be consultative about the right technology to integrate into your affordability programs. Learn more about AssistRx digital hub services, including e-Copay, e-PAP and other affordability programs, by meeting with us at Asembia’s Specialty Pharmacy Summit on April 30-May 4, 2023. Schedule your meeting here.
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