Friday, November 17, 2023

Simplify and Accelerate Benefits Verification with a Fully Integrated, Adaptable Platform

Today’s guest post comes from Maria Kirsch, President of Patient Services at EVERSANA.

Maria discusses the challenges patients and healthcare providers face accessing specialty therapies. She introduces us to ACTICS® eAccess, EVERSANA’s technology platform for electronic prior authorization and benefits verification that can be used for both the pharmacy benefit and the medical benefit.

To learn more about EVERSANA’s technology solution, schedule a live demo here.

Read on for Maria’s insights.

Simplify and Accelerate Benefits Verification with a Fully Integrated, Adaptable Platform
By Maria Kirsch, President, Patient Services, EVERSANA

Verifying a patient’s insurance eligibility is often a painstaking process for patients and providers and causes significant delays in treatment initiation. Current electronic benefits verification (eBV) tools estimate a patient’s financial responsibility with mixed results primarily due to the widespread industry practice of relying on algorithms for estimation. This high rate of inaccuracy has resulted in financial barriers for patients, increased burdens on Patient Assistance Programs and Hubs, and hesitance among HCPs to prescribe therapy.

Despite all the efforts over the years to “digitize pharma” or treat “patients as consumers,” not much progress has been made to improve the experience of benefits verification or electronic prior authorization (ePA) submissions that provide patients and HCPs with the tools to navigate insurance coverage and out-of-pocket costs.


In this arena of high-science brands, or high-stake, complex therapies, time is not a luxury that patients, providers or pharma manufacturers have on their side. Patients with diseases requiring specialty drugs need access to those life-saving therapies without delay. Providers with such patients must understand the intricacies of the system and support their patients in navigating the complexities of obtaining access, reimbursement and affordability for them to receive life-saving treatments in a timely manner.

The good news is, while physicians, patients and caregivers fight these diseases, a growing number of drug manufacturers are fighting the accessibility battle and leveraging technology to provide the tools needed to increase speed to therapy.


The Patient Services Team at EVERSANA is passionate about solving complex problems in healthcare to improve the lives of patients. Serving patients drives our innovative spirit and we are proud and privileged to bring a differentiated offering to the market that will accelerate patients’ speed to therapy.

Introducing ACTICS® eAccess, EVERSANA’s proprietary eBV and ePA platform leveraging first-to-market technology to give patient services teams nearly immediate insight into:
  • patient coverage from both pharmacy and major medical plans,
  • the potential need for prior authorization support, and
  • any financial responsibilities impacting patient access and speed to treatment.
By representing 90% of covered lives, ACTICS eAccess delivers more than 90% accuracy for pharmacy benefits verification and 85% accuracy for major medical coverage.

By leveraging digital connections to 1,400 payers rather than algorithms, highly accurate coverage can be confirmed in seconds rather than days with as few as five simple data points. The eBV tool offers multiple workflow integrations within:
  • Existing Hubs
  • Patient or HCP Websites as a Self-Service Tool
  • HCP Portals
Insurance coverage is just one part of a complex healthcare journey, especially for patients seeking specialty therapies like infusions for oncology and rare diseases. Through ACTICS eAccess’ integration of major medical plans, patients and providers can now determine the benefits and out-of-pocket costs for physician administration, surgical procedures, nursing support, transportation and lodging.

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As a result, ACTICS eAccess will be especially beneficial for patients in need of specialty drugs covered as a medical benefit rather than a pharmacy benefit. Many traditional platforms cannot correctly verify this type of coverage, but ACTICS eAccess uniquely outperforms other solutions through its capability to verify both medical and pharmacy benefits instantly and accurately.

ACTICS eAccess supports greater price transparency through patient access to an online self-service platform, reduces patient wait times and delays in therapy initiation, and delivers real-world efficiency to patients and providers.


Learn how EVERSANA’s proven track record of accelerating speed to therapy is setting new industry benchmarks. Schedule a live demo today to see firsthand how patient benefits are verfied in seconds—not days.

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