A true patient-centered environment requires care team collaboration and empowerment

A Team Approach to Dissolving Medication Access Barriers

February 14, 2020  |  Audrey Carson

When three out of four patients feel it’s important to discuss choices for affording their medications, providers need to be equipped with answers. 1

Many high-performing health systems and practices recognize the rise in patient consumerism and the demand for medication options, with affordability top-of-mind for most patients.2 By tapping into an abundance of data available through prescription decision support solutions, they’re empowering care teams to provide patients with what they need most: options.

“People on these care teams want to advocate for and help patients, but they may not have all the information, and they may not have visibility into all the choices available. So, some patients may be left behind,” says Dustin Eubanks, director of business development at CoverMyMeds. “Meanwhile, there are certainly patients that would step up and advocate for themselves, but they don’t have access to these choices either.”

Earlier this month, Eubanks presented a webinar hosted by Becker’s Hospital Review and sponsored by CoverMyMeds that highlighted access barriers and the ways leading health systems and practices are breaking through these to reach patients where they are. The discussion focused on barriers including the prior authorization (PA) process, lack of price and benefit transparency, poor or delayed communication methods and social determinants of health.

One of the key solutions discussed is point-of-care to point-of-dispense technology that can help patients avoid surprises at the pharmacy— such as PA requirements or sticker shock.

“We want to drive more prescriber-initiated PA requests — over pharmacy-initiated PA requests — so we can set better expectations before the patient shows up at the pharmacy,” Eubanks says. “We can more successfully ensure patients are guided and coached through this process when a PA request is initiated proactively.”

Of course, even with solutions in place, health systems and practices get bogged down with PA volume. In a recent survey, a nurse described herself feeling more like a ward clerk, as her time is taken up with PA management.3

Many health systems and practices are now redistributing and rethinking their employee structure, centralizing the PA process to an individual or team of experts to handle medication access barriers.

These centralized teams, Eubanks has found, are focused on more than just PA — they’re handling benefits verification, processing claims through their health systems’ pharmacies and ensuring financial assistance and other foundational programs are in place so that patients can get on therapy sooner.

A study by a leading medical center found that health systems with centralized groups processed PA requests nearly 6.5 days faster, on average, than non-centralized groups, and reported a 25 percent higher approval rate.4 This indicates patients receive providers’ first-choice prescription and have it dispensed faster – improving the likelihood of adherence.

Yet, even with administrative barriers removed, patients surveyed said the most important factor when considering their prescription medication is paying the lowest price.5

With high-deductible plans rising — and 75 percent of patients never seeing the other side of their deductible — price transparency is more important than ever.6 The right price transparency tools leverage an open network, free of bias, so patients can work with the provider to find the best option. This may mean working within a deductible or pharmacy shopping outside of insurance to find the best cash price.

“When we think about the care teams who are stepping in and filling gaps around medication access, who are guiding patients on how to act as a consumer in their own healthcare, we need to make sure they have access to all the information possible,” Eubanks says. “These technologies and solutions must be linked end-to-end so that expectations are set appropriately throughout the entire process, ensuring the patient knows exactly what they’re getting into.”

For more about dissolving medication access barriers, watch a replay of the webinar.

Sources

  1. ‘CoverMyMeds Patient Survey, 2019’

  2. ‘CoverMyMeds Patient Survey, 2019’

  3. ‘CoverMyMeds Nurse Survey, 2019’

  4. “Cutler, Timothy, et al. “Impact of Pharmacy Intervention on Prior Authorization Success and Efficiency at a University Medical Center.” Journal of Managed Care & Specialty Pharmacy, vol.22, no. 10, Oct. 2016, pp. 1167-1171. NCBI”

  5. ‘CoverMyMeds Patient Survey, 2019’

  6. “Devane K, Harris K, Kelly K. Patient Affordability Part Two: Implications For Patient Behavior & Therapy Consumption. Plymouth Meeting, PA: IQVIA; 2018”

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