Support patient access in pharmacies by addressing affordability issues and coverage complexity
References:
1. IQVIA. The Use of Medicines in the U.S. 2023: Usage and Spending Trends and Outlook to 2027. April 2024. Accessed 31 July 2024. Available online at: https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/the-use-of-medicines-in-the-us-2023/the-use-of-medicines-in-the-us-2023.pdf
2. American Pharmacists Association. Most patients see pharmacists as crucial part of their health care team. 21 January 2022. Accessed 8 August 2024. Available online at: https://www.pharmacist.com/Pharmacy-News/most-patients-see-pharmacists-as-crucial-part-of-their-health-care-team
3. Walters Kluwer. The evolving role of pharmacists: Bridging the gap in healthcare access and patient care. 20 October 2023. Accessed 8 August 2024. Available online at: https://www.wolterskluwer.com/en/expert-insights/evolving-role-pharmacists-bridging-gap-healthcare-access-patient-care
4. KFF. Survey of Consumer Experiences with Health Insurance. 15 June 2023. Accessed 1 August 2024. Available online at: https://www.kff.org/private-insurance/poll-finding/kff-survey-of-consumer-experiences-with-health-insurance/
5. PHRMA. Understanding Medicine Abandonment as a Barrier to Health Equity. 2 February 2022. Accessed 1 August 2024. Available online at:https://phrma.org/-/media/Project/PhRMA/PhRMA-Org/PhRMA-Org/PDF/S-U/Understanding-Medicine-Abandonment-as-a-Barrier-to-Health-Equity_2022.pdf
Two of the primary challengers that pharmacies face:
Insurance coverage
- Prior authorization and other utilization management requirements
- Cost-sharing mechanisms like copayments and coinsurance
Furthermore, the prior authorization process is not uniform among payers and complicated submission requirements can delay coverage or result in denials.
With a better understanding of local payer specific prior authorization, and other utilization management requirements, pharmacies may be able to help providers and patients through these challenges so patients can get timely access to therapies.Patient affordability
- Bridge or starter programs
- Copay assistance such as copay cards
Specialty pharmacies can play an important role in educating patients about these options. Yet it can be a struggle for pharmacy staff to stay on top of the many programs that exist and their eligibility requirements. Copay assistance programs are also changing constantly, especially for new products. Keeping up with these changes makes it more challenging for pharmacies to help patients appropriately utilize them.
How Pharmacy Account Managers can support your biopharma company
Biopharma companies can address these challenges at the pharmacy level by working with Cencora’s Pharmacy Account Managers (PAMs). PAMs are experts in navigating the complex insurance coverage challenges and addressing affordability education. They serve as liaisons between you and your key pharmacy stakeholders in the patient’s journey.
Unlike traditional field reimbursement and access teams, PAMs engage directly with your pharmacy network. Their role is to help pharmacies understand how to help patients overcome coverage and affordability issues that occur at the site of dispense.
Working directly with pharmacy network leaders, PAMs:
- Serve as liaison between your designated internal stakeholders and pharmacy account professionals to communicate key issues or challenges related to your product(s)
- Raise awareness of your patient and financial assistance programs
- Provide knowledge about payer policies, prior authorization requirements, and payer policy changes
- Review and monitor pharmacy utilization and the impact on patient access to inform pharmacy actions to improve access
PAMs offer much more than pharmacy and product knowledge and expertise in drug coverage and access. Using tools and resources approved by you, they can also:
- Maintain communication with their key pharmacy contacts, providing them with relevant information, and sharing data to enhance their understanding of market dynamics and product access.
- Review key business insights, such as:
- The pharmacy’s overall prescription utilization and trends The drivers of abandoned prescriptions
- The top reject codes pharmacies are experiencing
- The payers that contribute to a higher abandonment rate and why
Pharmacists are among the most trusted members of the healthcare team and have a tremendous opportunity to highlight the resources available to patients to support access.2 In fact, 79% of recently surveyed patients think their pharmacist is a trustworthy source of care.3 Helping pharmacies understand the patient access support offered by biopharma companies can help them better assist patients with starting and staying on needed therapies.
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