By: David Hilman, Chief Operating Officer
Patient Assistance Programs (PAP) have long been a core strategy for biopharmaceutical companies in their quest to provide support for patients in need. However, the market has changed dramatically since the advent of these programs as a result of payer consolidation, changes in government-sponsored insurance programs, increased plan restrictions and cost shifting toward patients, and the commercialization of highly complex and costly therapies. As a result, many patient assistance programs have experienced a dramatic increase in the number of eligible patients, and some administrators of these programs have fallen behind in their ability to keep up with the rapid changes underway.
As PharmaCord has onboarded patient assistance programs from alternate providers, we have observed significant variability in how these programs are managed. Such irregularities can have a significant impact on the costs of these programs and the average length of time before a qualified patient receives their medication. It is critical to continuously assess your process flow in determining how you and your current provider have adapted to industry changes, regulatory developments and new technologies to ensure your program is optimized and best positioned to meet your goals of supporting patients in need effectively and with high level of efficiency. Your process assessment should begin at the very beginning, with the patient’s application for qualification.
We have found the enrollment form to be one of the most significant barriers to an efficient patient assistance program. Requesting information that is not required, or that can be discovered or completed by your existing program administrator, adds substantial burden to the patient and provider in the application process. Excessive information requests often lead to delays in processing new applications, as this also increases the likelihood of missing information. We find this to be a common reason many programs have a high level of incomplete applications and delays in processing.
Another opportunity to streamline the application process involves integrating the prescription into the submitted enrollment form. By embedding the prescription directly into the application, all the required information is captured up front, enabling the dispensing pharmacy to quickly dispense and ship the medication after the eligibility occurs on the front end. In order to capture the benefits of this improvement to the enrollment process, your program administrator must by the same entity as the dispensing pharmacy such that it is authorized to receive a physical prescription from the healthcare practitioner. Irrespective of whether you are able to take advantage of this particular efficiency, we highly recommend an annual review with your provider to ensure your application form is evolving at the same pace as your program.
The next opportunity area in PAP enrollment is within the financial qualification aspect of the process. We have seen substantial variability in how providers approach this critical step, with some methods being much more efficient than others. Following the establishment of eligibility rules, the provider can utilize a number of different methods, ranging from a simple patient attestation to electronic tools for proof of income information, in determining the patient eligibility. It is imperative that whichever approach you and your provider agree is optimal for your program, it is a method that is highly efficient, fully verifiable and entirely auditable. Within our programs, we have instilled technological integrations with outside data sources wherever possible to ensure this part of the process is tightly managed and highly efficient.
MODERNIZING YOUR PROGRAM THROUGH TECHNOLOGY
With each step in the process, technology should be considered an enabler to make your program more efficient. We routinely assess the landscape of technology tools and data integrations to optimize our process for the benefit of our clients and their programs. Such technology advancements should either result in great efficiency or a better patient experience, or both, but the use of technology should also align with the program rules and goals.
One of the most significant recent technological advancements within patient assistance programs is the integration of omnichannel communications. Your provider should now have the ability to text or chat with patients directly from its system to follow up on incomplete enrollments. Moreover, HIPAA compliant electronic signature platforms are an additional technology efficiency to optimize your qualification process. Gone are the days of sending a hard copy form and hoping the patient signs and returns the completed form. We are now able to simply use electronic signature capture and can complete the process in hours rather than days. These new communication channels expedite the determination of financial eligibility, providing a better experience for both the patient and the healthcare practitioner.
Your provider can also integrate these communication channels into its dispensing workflow and systems. By utilizing SMS messaging and similar communication channels at the point of prescription fulfillment, your provider can notify patients that their medication has been shipped with an appropriate tracking number for anticipated delivery date and time. Utilizing a system that proactively provide this information to the patient reduces the amount of follow up from your patients, which helps your provider remain current on all cases.
The other big area of advancement within PAP technology revolves around connectivity. While your provider is likely utilizing a number of different external data sources to improve the efficiency of its workflow, we find tremendous value in digitally connecting with an income validation provider. In years past, PAP providers would require a substantial amount of paperwork, including a personal attestation and hard copy submissions of financial documents. By integrating with a financial partner, your provider can now obtain an estimated household income in a matter of seconds, significantly improving the turnaround time for financial determination. Additionally, your provider may be able to tap into similar e-Income tools in response to an accuracy audit. A different data set can be used for the audit, which provides seamless validation that your provider is operating at the highest level.
Amid the rapid change that continues to affect the demand for patient assistance programs, it is imperative that you continue to work closely with your provider to identify program efficiencies and quickly modify any applicable rules and program guidelines to achieve your broader goals and objectives. If your provider is unable to keep up with the pace of change, it may be time to consider other providers that are able to bring operational efficiencies and an enhanced patient experience.
PharmaCord is the connector between manufacturers, patients, physicians, and payors. The company provides customized solutions to life sciences companies that span three core areas; patient support, pharmacy services and manufacturer support. These integrated services are designed to increase accessibility, clinical oversight and market acceptance of prescription therapy. Independently owned and organically built, PharmaCord is free from any competing priorities, enabling it to design and implement patient access and support programs that align with the objectives of its life sciences clients. PharmaCord’s experienced team coupled with its proprietary CORscend technology platform optimizes workflow to deliver improved program execution, more rapid therapy initiation and increased patient engagement. To learn more about how PharmaCord improves commercial outcomes for life sciences companies, visit pharmacord.com.