Removing Obstacles to Improved Health

Aug 11, 2016
A new suite of digital tools is breaking down barriers that prevent patients from accessing medication.

Jennifer Article

In an instant, a medical diagnosis can change a patient’s life. The time it takes, however, for that patient to receive medication to treat a disease or condition can be anything but fast.

While the causes for delays in fulfillment of a prescription can range from administrative hurdles like prior authorizations to a patient’s financial constraints, we know that an increase lapse in time from when a prescription is written to when it is filled leads to increased prescription abandonment rates.

To help patients access their medications as quickly as possible, United BioSource (UBC) is offering electronically-enabled patient access tools to biopharmaceutical manufacturer clients. Our suite of services, for both the pharmacy and medical benefit, includes electronic enrollment and signature capabilities, real-time eligibility and coverage determination tools, as well as electronic prior authorization and support.

Therapy Delays Often Longest for Patients Who Need Medication the Most

While prescriptions for traditional medications can be quickly filled for patients with appropriate coverage, specialty medications often require more robust benefits investigation, prior authorizations and appeals processing. For patients diagnosed with a rare or orphan disease, wait time to initiate therapy could extend to days, weeks, or longer, depending on the level of administrative and financial hurdles the patient must overcome.

For patients who may have experienced a delay in diagnosis or a misdiagnosis due to the rarity of their disease, additional delays in treatment can lead to further health complications.

Manufacturers of specialty medications often offer the services of a patient access center, or a “hub” that serves as a centralized point of contact and helps patients and healthcare providers navigate the special requirements that may be associated with these higher-cost therapies. These patient access centers may also provide nursing support, patient education and outreach, and refill assistance, among other services which help patients access and adhere to their medication.

Technology and Patient Care Combine to Improve Health Outcomes

When all the services a patient needs are connected through an electronic support system that streamlines key interactions among the healthcare provider, payer, and patient, medication adherence and health outcomes can be improved. Now, I admit, I’m a bit of a technology enthusiast. That enthusiasm turns to passion, however, when I see our patient access teams, including reimbursement specialists, patient care advocates, nurses, and pharmacists all working within one connected network to help ensure their patients receive medication and any clinical support needed in a timely manner.

UBC’s patient access centers now offer advanced electronic processes to determine a patient’s benefit structure, eligibility, deductible balances, copay responsibility, out-of-pocket balances, pharmacy options and any coverage restrictions. This capability often replaces manually collecting information through faxes and phone calls. A process that could take days or even weeks to complete can now be performed within minutes.

As a subsidiary of Express Scripts, UBC is able to further reduce time spent on this process, verifying in seconds the full benefits of Express Scripts’ members, who make up one of every four patients.

The more quickly a patient’s eligibility can be verified, a prior authorization can be cleared and any missing information from a patient or prescriber can be completed, the more quickly a prescription can be triaged to the appropriate pharmacy and additional support services can be put into place.

Keeping Up in a Digital Age

Despite our digital age in which volumes of information are frequently transferred electronically, a large percentage of prescriptions for specialty medications continue to be referred by prescribers to a hub via telephone or fax. In fact, according to an analysis of hub practices, UBC estimates that nearly 95% of referrals are faxed and more than 20% are missing some critical piece of information required to fulfill a prescription. Through electronic enrollment and signature capabilities, patient access centers can collect prescribers’ and patients’ signatures in a matter of seconds, removing a significant time burden from the physician and immediately beginning the process of helping the patient access medication.

In addition, we know that U.S. physician practices spend $31 billion annually interacting with health plans. A significant portion of that cost is directly related to prior authorization and medication formulary requirements. For each payer, physicians are required to locate and complete the appropriate payer form – from thousands available – reach out to the appropriate payer contact, and return a completed form to the payer. In addition, a letter of necessity may also be required.  Phone calls and faxes typically involved in this process can quickly add up to lengthy delays. UBC’s electronic prior authorization service gives physicians automatic access to the information and forms needed for each payer.

Connected Care in Action

When 41-year-old Daniel began experiencing blurred vision, he scheduled a visit to his optometrist, then to his primary care physician. Test results were inconclusive and he was encouraged to schedule a six-month follow-up visit. In the meantime, he began feeling numbness which alternated with tingling in his legs. When he met again with his physician, he was referred to a neurologist who requested additional tests.

Over the course of a year, Daniel met with more than 20 doctors, nurses, radiologists, lab techs and medical assistants. When he finally was diagnosed with multiple sclerosis, blurred vision was affecting his ability to work and the numbness in his legs had worsened. After his doctor prescribed an injectable medication, Daniel enrolled in the drug’s patient access center which coordinated with his health plan to verify coverage, worked with the specialty pharmacy to ship the medication at a time Daniel would be home, and scheduled an in-home nurse to train Daniel to self-administer his medication.

With the help of a UBC patient access center, Daniel received all the assistance he needed through one point of contact and his prescription was triaged to the pharmacy the same day with an approved prior authorization as well as appropriate alternate funding referrals to help offset his medical expenses. Our team maintains contact with Daniel to schedule monthly re-fills and to provide ongoing clinical care.

Thanks to UBC’s services, patients like Daniel are able to quickly receive access to the therapy they need without the burden of navigating a complex healthcare system.

 

Experts from UBC’s patient access centers will be making the following presentations next week:

Revolutionize the Therapeutic Experience with Data-Driven Insights and Engaging Technology

CBI Patient Journey Mapping, Philadelphia, PA

August 16, 9:30 a.m. EST

Ron Lacy, Senior Director, Healthcare Analytics and Technology

 

Living with a Disease is Difficult. The Therapeutic Experience Shouldn’t Be.

CBI Reimbursement & Access, Philadelphia, PA

August 17, 2:35 p.m. EST

Roy Hall, Senior Director, Commercial Product & Service Development

UBC is a leading provider of comprehensive pharmaceutical services, including patient access services, late stage and postapproval research, and safety services. ubc.com

Author Bio

Brett Huselton
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