Friday, June 16, 2023

Technology’s New Approach: One Gateway to Deliver Comprehensive Patient Support Services

Today’s guest post comes from Derek Berven, Senior Director of Software Engineering at AssistRx.

Derek explains how to streamline patient support services with a modular, scalable technology solution. He then discusses Advanced Gateway, a technology that integrates patient, provider, and manufacturer services.

Click here to learn more about how AssistRx’s Advanced Gateway can impact patient support programs.

Read on for Derek’s insights.

Technology’s New Approach: One Gateway to Deliver Comprehensive Patient Support Services
By Derek Berven, Senior Director, Software Engineering,AssistRx

As the market access landscape evolves alongside industry, regulatory and technology changes and advancements, so has the role of the patient support program. Higher patient cost sharing, paired with increasing numbers of access barriers has redefined the role of patient support services and how critical they are to the viability of specialty products.

Studies show a correlation between rising cost and utilization restrictions and diminishing fill rates and adherence. According to the 2021 KFF Health Tracking Poll, “Among those currently taking prescription drugs, one in four say they have difficulty affording their cost, including about one third who take four or more prescription drugs.”

Higher out-of-pocket costs, according to one study published in the Journal of Clinical Oncology, are associated with higher rates of prescription abandonment and delayed therapy initiation. Meanwhile, utilization restrictions are so cumbersome that states and the federal government are taking steps to require prior authorization (PA) responses from payers within 48 hours (Oregon) or seven days (CMS-0057-P) (CNN Health) .

Robust patient support programs can help patients and healthcare providers (HCPs) overcome these barriers. However, because these support programs need to provide services ranging from benefit verification (BV) and PA support, affordability program screening and enrollment, free drug dispense, clinical education and more, many life sciences organizations utilize multiple vendors – each specializing in one piece of the patient journey. Often, this results in a disjointed and frustrating experience for both patients and HCPs. Using multiple vendors can also result in non-standardized and incomplete program data that makes gaining visibility into actionable insights an uphill battle.

Picture This: The Ideal Patient and HCP Experience and Usable Program Data

Imagine standing up patient support program technology in a matter of weeks, not months. Now, picture this technology as modular, scalable, and can be integrated into frontend access channels and backend operations. Specifically, technology that enables patient and HCP self-service through channels like the brand website, while facilitating a talent offramp and program reporting through the CRM.

On the frontend, rather than leveraging multiple vendors, this modular solution allows both HCPs and patients to get the information they need in real time, from one place. HCPs can access e-services like eBV, ePA and eCopay to move the process forward – under the life sciences organization’s brand. On the backend, a single integration enables a talent offramp in which access experts use these same e-services within the CRM to support complex cases. Receipt of consistent, measurable data from frontend and backend operations ensures transparency into successes or opportunities for improvement. This unique combination, which can only be achieved using a single API integration that deploys the right technology-first tools, enables life sciences organizations to deliver upon the growing access, affordability and adherence needs of specialty products.

For solutions like AssistRx’s Advanced Gateway, these tools can include:
  • e-Consent: Digital capture of patient consent obtained at the point of care or virtually at the patient’s convenience through email, text, brand website or
  • Advanced Benefit Verification: Comprehensive pharmacy benefit coverage information delivered in under 15 seconds using just five patient identifiers. Returns include coverage, out-of-pocket (OOP) cost, access restrictions, coverage alerts, formulary status, employer, fill options and more.
  • e-Medical Benefit Verification (e-MedBV): Extensive medical benefit coverage information delivered in under 15 seconds. Returns include plan name; payer name and type; effective and termination dates; and individual/family deductible and OOP year to date, per year and remaining.
  • Patient Coverage Check: Patient-facing pharmacy coverage information delivered in under three seconds. Results include coverage status and access restrictions.
  • Advanced Prior Authorization: Digital tool returns patient plan- and product-specific PA question set and enables real-time PA submission with payer/PBM decisions returned in minutes. Only relevant questions and response options are presented, and LOEs/LMNs can be included.
  • Advanced Clinical Documentation: Comprehensive patient-specific clinical summary data pulled and delivered in real time to drive efficiencies related to drug utilization reviews and PA support.
  • e-PAP and e-Copay: End-to-end, technology-first solution that enables real-time automated consent, BV, eligibility screening, enrollment and card/voucher download, all in one workflow.
All these services can be kicked off through automated technology, added and removed from the program’s offerings as the product moves through its lifecycle, and supported by intervention from talented patient access specialists and case managers as needed. Life sciences organizations can simplify a complex system for patients and HCPs, gain comprehensive program visibility, improve access and adherence — to create better results from care.

Learn how Advanced Gateway can power your patient support program.

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