David discusses the obstacles and frustrations patients experience as they navigate the patient journey. He describes CoverMyMeds’ technology solutions that have helped solve medication access and adherence challenges for patients.
To learn more about technology-enabled patient support, download this new case study: Comprehensive Prior Authorization Support to Help Impact More Patients.
Read on for David’s insights.
Improving Medication Access Through Network Connections to Impact More Patients
By David Holladay, President, CoverMyMeds
In those stressful and uncertain moments, patients rely on their health care provider to help understand their diagnosis and available treatment options. Such shared experiences highlight why patients trust their providers above all other industry stakeholders.
After leaving the doctor’s office, patients often receive more disappointing news at the pharmacy if their prescribed treatment is denied due to prior authorization (PA). Not only can PA delay time to therapy, it can also leave patients feeling frustrated and confused. “Wasn’t this the medication that my provider prescribed? Could an alternative medication be less effective at treating my condition or have other side effects?” These scenarios are even difficult for those of us working in the health care industry, so how much more are inexperienced patients affected? Unfortunately, such situations are all too common. On average 66% of rejected prescription claims at the pharmacy require PA and 37% of these prescriptions are abandoned by patients.
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Providers feel the burden of PA as well. In a survey by the American Medical Association to 1,000 practicing physicians, over 80% agreed that PA is burdensome and more common than ever. Outdated, paper-based PA processes lengthen time to therapy for patients and have a negative impact on clinical outcomes as reported by 92% of physicians.
At CoverMyMeds, our technology has helped solve medication access challenges for patients more than 140 million times. As pioneers in electronic prior authorization (ePA), we support a broad spectrum of life science products, from traditional retail medications to complex specialty biopharmaceuticals. This technology contributes to a 35% decrease in turnaround times for PA request determinations that can shorten time to therapy for patients. Read our new case study to learn more about how we make a difference.
Beyond comprehensive PA support, our solutions now span the entire patient journey from the point of prescribing to medication adherence. Prescription decision support tools at the point of prescribing increase price transparency and available options for patients to help them make more informed health care decisions with their doctors that consider both clinical and financial factors. Adherence programs for specialty medications allow for patients to better adhere to their prescribed therapies – potentially helping to reduce any adverse outcomes they may face.
When we connect all areas of the health care network and identify a problem that they didn’t know existed, we can find a solution that connects us to the common goal of helping patients. As a result, we are positioned to continue developing innovations that help patients start and stay on their therapies.
Our vast network is the strength behind our solutions and includes over 700,000 active health care providers, payers representing 96% of prescription volume, 96% of pharmacies and over 200 life science brands. Through these extensive network connections, our solutions can help patients prescribed any medication and covered by any health plan.
HELPING PATIENTS GET THEIR MEDICATION
Through our network connections, we can support patients at crucial moments in their journeys to streamline processes and help them get their medications. For example, within several top therapeutic classes by number of prescriptions, average claim rejection rates can reach 18% or possibly more (based on CoverMyMeds data on file, 2019), which could lead to many patients abandoning their prescriptions. This is where CoverMyMeds can make a difference. Through our prescription decision support technology, providers are notified when a PA is required at the point of prescribing and choose to begin an ePA request immediately or consider therapeutic alternatives – leading to a ~20% increase in patients picking up their medications from the pharmacy.
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When a PA request is started, whether at the point of prescribing or at the pharmacy, our ePA technology can help improve the likelihood that it makes it to the health plan for a determination, instead of being potentially delayed or forgotten which leaves the patient without their medication. In fact, for the same highly-prescribed therapeutic classes, CoverMyMeds improves the percent of requests sent in for determination by over 14% on average (based on CoverMyMeds data on file, 2019). This positive impact partly stems from widespread provider adoption and utilization of our solutions.
The health care system can be difficult to navigate – even for those of us with experience. Discovering new ways to bring together health care stakeholders will continue to make the most difference for patients. Learn more about how CoverMyMeds is helping patients get the medications they need and how you can impact more patients at go.covermymeds.com/solutions.
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