Kimberley highlghts the crucial roles of field reimbursement managers in removing access and reimbursement barriers. She then identifies the keys to successful implementation of field reimbursement services.
To learn more, register for CoverMyMeds' November 13, 2024, webinar: Specialty Therapies & Field Reimbursement Services: Driving Better Outcomes for Brands and Patients.
Read on for Kimberley’s insights.
How Field Reimbursement Services Help Overcome Coverage Barriers and Improve Patient Outcomes
by Kimberley Chiang, Vice President, Biopharma Commercial Solutions at CoverMyMeds
From carve-outs and plan variability to mandated Medicare negotiated prices, the policy and insurance requirements can be difficult to navigate for specialty medications.
Addressing these complexities requires a multifaceted approach—one that can help extend brand reach and overcome medication access barriers. Below, I’ve highlighted an occasionally overlooked, yet highly effective, solution called field reimbursement services. These services are designed to offer specialized support for healthcare providers navigating insurance coverage and medication reimbursement, particularly for specialty therapies.
For a deeper dive into the benefits of field reimbursement services, join CoverMyMeds for an in-depth discussion during our November 13 webinar.
OVERCOMING MEDICATION ACCESS AND REIMBURSEMENT BARRIERS
A notable side effect of today’s complex and often uncertain healthcare landscape is the increasing number of variables impacting when, if, and how fast patients access their medication. And unfortunately, when things don’t go as planned, this “noise” can make it almost impossible to clearly identify and define the problem.
Field reimbursement managers offer brands a "boots-on-the-ground" perspective by gathering insights directly from healthcare providers that help identify the specific medication access barriers they face, as well as actionable solutions to help overcome those challenges. Field reimbursement managers also help identify the unique needs of the brand and its prescriber base, and often help identify needs of nontraditional prescribers during new product launches. Their comprehensive knowledge also helps to navigate nuanced coverage and other access changes throughout the drug's lifecycle.
In addition to overcoming medication access barriers, field reimbursement managers also play a crucial role in navigating reimbursement hurdles. By understanding the differences in reimbursement processes for both pharmacy and medical benefit medications, field reimbursement managers can educate healthcare provider offices on payer requirements for specific therapy areas to submit more complete prior authorization requests, reduce common human errors and minimize delays.
This specialized support is especially valuable in the buy-and-bill process where providers face significant financial risks. Field reimbursement managers mitigate these risks by working with providers in an effort to ensure proper, complete documentation is submitted—helping to increase the likelihood of timely and appropriate reimbursement.
BUILDING A SCALABLE FIELD REIMBURSEMENT SERVICES FRAMEWORK
Pharma brands often require a team of field reimbursement managers to effectively address medication access and reimbursement challenges. When deciding whether to insource or outsource field reimbursement, it’s helpful to consider a variety of factors including company size, portfolio complexity, internal capabilities, and strategic priorities. A hybrid model, combining an internal core team with outsourced field reimbursement managers, is a common approach for additional flexibility.
When evaluating potential vendors, look for companies that provide:
OVERCOMING MEDICATION ACCESS AND REIMBURSEMENT BARRIERS
A notable side effect of today’s complex and often uncertain healthcare landscape is the increasing number of variables impacting when, if, and how fast patients access their medication. And unfortunately, when things don’t go as planned, this “noise” can make it almost impossible to clearly identify and define the problem.
Field reimbursement managers offer brands a "boots-on-the-ground" perspective by gathering insights directly from healthcare providers that help identify the specific medication access barriers they face, as well as actionable solutions to help overcome those challenges. Field reimbursement managers also help identify the unique needs of the brand and its prescriber base, and often help identify needs of nontraditional prescribers during new product launches. Their comprehensive knowledge also helps to navigate nuanced coverage and other access changes throughout the drug's lifecycle.
In addition to overcoming medication access barriers, field reimbursement managers also play a crucial role in navigating reimbursement hurdles. By understanding the differences in reimbursement processes for both pharmacy and medical benefit medications, field reimbursement managers can educate healthcare provider offices on payer requirements for specific therapy areas to submit more complete prior authorization requests, reduce common human errors and minimize delays.
This specialized support is especially valuable in the buy-and-bill process where providers face significant financial risks. Field reimbursement managers mitigate these risks by working with providers in an effort to ensure proper, complete documentation is submitted—helping to increase the likelihood of timely and appropriate reimbursement.
BUILDING A SCALABLE FIELD REIMBURSEMENT SERVICES FRAMEWORK
Pharma brands often require a team of field reimbursement managers to effectively address medication access and reimbursement challenges. When deciding whether to insource or outsource field reimbursement, it’s helpful to consider a variety of factors including company size, portfolio complexity, internal capabilities, and strategic priorities. A hybrid model, combining an internal core team with outsourced field reimbursement managers, is a common approach for additional flexibility.
When evaluating potential vendors, look for companies that provide:
- Alignment to your brand’s strategy with flexibility in the approach and design
- Comprehensive insights into the patient journey
- The ability to swiftly launch your program nationwide, while assigning the right resources to solve specific problems in specific regions
- Proven knowledge of common payer hurdles
- Expertise in training provider offices on payer processes
- A deep understanding of a wide range of therapy areas
Outsourcing with a reputable vendor also enables brands to have greater access to specialized expertise through trusted and established training programs. And because outsourcing removes long-term financial commitments for employee salaries and benefits, it can be more cost-effective than insourcing—especially for smaller brands or product launches.
THE BOTTOM LINE
The complexity of the specialty drug landscape is driving an increased need for customized support to break down medication access and reimbursement barriers, ultimately leading to faster and more effective outcomes for patients. Through expert education and navigation, field reimbursement services offer not only support for brands and providers, but an important avenue to advocate for better patient outcomes.
To gain a deeper understanding of how field reimbursement services can drive brand success and improve patient access, attend our upcoming presentation at Informa Connect’s Patient Support Services Congress, Maximizing Success—The Role of Field Reimbursement Services in Launch Strategy and Beyond.
In the meantime, join us for a complimentary webinar on November 13, 2024, where we’ll highlight how field reimbursement services can function as an essential tool for managing the complexities and costs associated with accessing specialty drugs. Register now to reserve your spot.
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).
THE BOTTOM LINE
The complexity of the specialty drug landscape is driving an increased need for customized support to break down medication access and reimbursement barriers, ultimately leading to faster and more effective outcomes for patients. Through expert education and navigation, field reimbursement services offer not only support for brands and providers, but an important avenue to advocate for better patient outcomes.
To gain a deeper understanding of how field reimbursement services can drive brand success and improve patient access, attend our upcoming presentation at Informa Connect’s Patient Support Services Congress, Maximizing Success—The Role of Field Reimbursement Services in Launch Strategy and Beyond.
In the meantime, join us for a complimentary webinar on November 13, 2024, where we’ll highlight how field reimbursement services can function as an essential tool for managing the complexities and costs associated with accessing specialty drugs. Register now to reserve your spot.
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).
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