Team Finds Funding for Specialty Patients

Oct 11, 2013
Patient Access team provides dose of good news and empathy to those facing tough diagnoses and mind-boggling expenses.

While specialty medications help patients with chronic, life-threatening illnesses, these drugs are the most expensive in healthcare’s arsenal.

The costs for drugs that treat conditions such as pulmonary arterial hypertension and immune disorders can be thousands of dollars per month per patient. Even with health insurance, costs can put treatment out of reach – unless patients get help.

That’s the job of the Patient Access team at Accredo, Express Scripts' specialty pharmacy. The Patient Access team is made up of 186 specialists located around the country.

Assess the Situation

The team’s primary responsibility is to ensure that patients in need have some avenue for payment. They review every patient that comes to Accredo for therapy, which can be several hundred on any given day.
After determining whether the patient has health insurance or Medicare or Medicaid, the team looks into the patient’s out-of-pocket costs, including copayments and deductibles. Where there’s a shortfall, they get to work making up the difference.

Many manufacturers of specialty drugs are generous in their Patient Assistance Programs. These help patients without insurance or help to fill the gap between insurance coverage and their costs.

The Patient Access team also works with charitable foundations set up for this purpose, such as the Caring Voice Coalition, which provides grants to assist patients with select conditions, and the Chronic Disease Fund.

The team refers and assists more than 6,000 patients yearly in receiving financial assistance from manufacturers, foundations or both. However, the need for alternative funding continues to grow, and Patient Access now has a dedicated team for research and knowledge of new sources.

Educate the Patient

The Patient Access specialist typically speaks to the patient numerous times when he or she is first diagnosed. They have a challenging job of explaining the healthcare benefits and out-of-pocket costs. This requires a specialist in reimbursement who also understands the disease state and the life-sustaining nature of the medications.

The team must be prepared to speak to a wide range of patients and caregivers who could use a strong dose of good news after receiving a diagnosis of a life-threatening condition associated with mind-boggling expenses.

The Patient Access team has found that the outlook of patients improves noticeably when they receive a list of alternative funding sources with a side of sincere empathy.

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Lab Staff
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