With our ePA solution, CoverMyMeds has helped patients get the medication they need nearly 200 million times.1 CoverMyMeds provides brands with medication access support, from electronic prior authorization to specialty therapy services and affordability options. Our digital solutions help create a seamless end-to-end journey for providers and patients.
Medication Access Through Electronic Prior Authorization
CoverMyMeds is the nation’s leader in electronic prior authorization (ePA). The vast majority of pharmacies, payers and PBMs and over 700,000 providers rely on the convenience, speed and efficiency of our electronic solutions.
The industry’s largest network, coupled with our technology, creates efficiencies throughout the PA process for brands on program. Through improved workflows, CoverMyMeds can help increase the likelihood PA requests for a patient’s originally prescribed therapy make it to the health plan for a determination, which may reduce switching to an alternative therapy.
Even as healthcare shifts due to current events, our technology and expert support provide a consistent prescribing experience, helping to minimize disruptions for patients.
Electronic submission of PA requests results in 40 percent more same-day determinations than manual (i.e. fax submission).1 As a result, more medications are dispensed overall and in a shorter time frame. Improved perception of medication access for providers and patients can protect brand reputation while increasing the likelihood that patients will pick up their prescribed medication.
* Data is limited to medications dispensed with a corresponding PA approval from Dec. 2017 - Nov. 2018.
† For electronic PA requests, autodetermination is possible, which can allow for immediate PA determination and medication dispense.
Through expert pull-through support, CoverMyMeds can further amplify automated ePA technology so that more PA requests are sent to the health plan for review and receive an approved determination. On average, the number of approved determinations can almost double due to more submissions to the health plan.1
With the healthcare system under immense strain, providers are leaning on technology to deliver high quality care to their patients. Throughout the COVID-19 pandemic, providers have relied on CoverMyMeds’ help to overcome medication access challenges. Our technology has provided continuous, streamlined support for providers and their staff despite challenging work-from-home transitions. Provider support for brands on program remains consistent, enabling a positive prescribing experience despite a changing environment and lack of in-person support from brand representatives.
In the midst of adversity, CoverMyMeds continues to help providers navigate the complicated PA process: We’ve risen to the challenge for our business partners by reducing response times despite an increase in chat and call volume.
CoverMyMeds has reduced chat and call response time relative to last year — 95 percent of responses occurred within 20 seconds.
Medication Access Through Patient Support Services
Specialty medications offer hope to patients with rare or chronic diseases, but their high cost and complexity create distinct medication access challenges. Specialty medications account for almost half of total pharmacy revenue ($218.6 billion) while representing about 2 percent of prescription volume.2,3 With the majority of product launches over the next few years designated as specialty, associated prescription volume and revenue will likely continue to grow.4 Attempts to manage specialty therapies create healthcare challenges that can keep patients from the medications they need.
Compared to traditional retail medications, specialty therapies are typically more complex and treat narrower patient populations. Associated logistical (e.g., cold-chain distribution) and administrative (e.g., patient eligibility, benefits investigation/verification, prior authorization, etc.) difficulties can also strain the healthcare ecosystem. When navigating these complexities on their own, patients have described starting specialty therapies as a full-time job.5,6
A recent survey of over 500 patients on specialty medications revealed three out of five encountered difficulties while trying to start therapy for the first time.7 Roughly one in ten of these patients also reported waiting eight weeks or more to receive their first dose.6 During the waiting period, some patients even reported a decline in their health.7
Specialty medications can also place significant burden on providers. In a recent survey of 400 providers, four out of five expressed difficulty in starting patients on specialty therapies.7 About three out of four providers also reported spending at least one hour per patient per week to complete required work for starting patients on specialty therapies.7
Vendors providing patient support services (i.e., hubs) and over 900 specialty pharmacies now assist providers and patients by locating financial assistance, completing complicated administrative tasks and helping with adherence challenges. However, patient and provider awareness for these services is low (40 percent of providers and 80 percent of patients are unaware of available services, according to survey data)7 and manual workflows can further delay time to therapy. Efforts to improve patient support services are clearly needed. In fact, 83 percent of manufacturers of specialty medications expressed there is room for improvement in the current hub model.8
CoverMyMeds’ network includes over 700,000 providers who actively use our ePA solutions. About two-thirds of specialty providers from major therapeutic areas have used the CoverMyMeds portal in the last 90 days.1 The reach of our network, along with providers’ trust and familiarity with our technology, promotes widespread adoption of our tech-enabled patient support services solution. This strategy enables us to potentially reach all patients eligible for a specialty therapy.
*For centers of excellence in Neurology the fraction of the neurologists actively using the CoverMyMeds portal in the last 90 days can be as high as 94%
In a recent two-month case study of our specialty solution, we saw 48 percent of providers adopting electronic workflows to begin 1,250 patients on specialty therapy.10 Connecting healthcare stakeholders through technology and integrating electronic steps into traditionally manual workflows can help improve patient support services. Such changes have already contributed to a 27 percent reduction in time to therapy during a preliminary study.10
* Time referred to in business days
† While lab test scheduling is coordinated for patients, time to lab completion largely depends on patient availability – a factor outside of CoverMyMeds control.
Continued efforts to standardize processes and leverage technology at key pain points in stakeholder workflows will further help improve efficiency while best supporting patients who are prescribed specialty medications.
Medication Access Through Affordability Solutions
It’s estimated that 35 percent of Americans lack adequate health insurance coverage and must pay the full cost of their prescription medications.11 These numbers are swelling from job losses and layoffs as a result of COVID-19. Without off-benefit affordability options, these patients can’t access the medications they need to live healthy lives. Affordability solutions from CoverMyMeds help create novel opportunities to lower the cost of prescriptions for patients when insurance coverage is unavailable or makes less financial sense.
When expected to bear the full cost, patients often abandon their prescriptions. During 2017, the average out-of-pocket cost on prescription claims for patients with high deductibles was $270, compared to $29 for those with copayments.12 When cost exceeds $125 per script, 52 percent of patients abandon their prescriptions, and above $250, the abandonment rate increases to 69 percent.12
By discounting prescription prices, and passing rebate savings along to the patient, patients may be more likely to get their originally prescribed medications. A new option is available through CoverMyMeds for patients paying for medications out of pocket, enabling brands on program to better reach more than 116 million patients who are underinsured or uninsured.
Learn more about how CoverMyMeds is solving medication access challenges at go.covermymeds.com/solutions
- CoverMyMeds data on file, 2019
- Medicine Use and Spending in the U.S., A Review of 2018 and Outlook to 2023, IQIVIA Institute, 2019
- The Global Use of Medicine in 2019 and Outlook to 2023, IQIVIA Institute, 2019
- Specialty Drug Spend Soars. Can Formulary Management Bring It Down to Earth?, Managed Care Magazine, 2019
- The Impact of Disease-Modifying Therapy Access Barriers on People With Multiple Sclerosis: Mixed-Methods Study, Journal of Medical Internet Research, 2018
- Make MS Medications Accessible: Recommendations, National Multiple Sclerosis Society
- CoverMyMeds Patient and Provider Surveys, 2020
- 2019 State of Specialty Pharmacy Report: Tracking the Future of Specialty Pharmacy, CSI Specialty Group, 2019
- Patient Services – Pharma’s Best Kept Secret, Accenture Life Sciences, 2016
- End-To-End Electronic Support Improves Patient Access for Specialty Medications, CoverMyMeds, 2019
- Narrative Review of the Literature on Adherence to Disease-Modifying Therapies Among Patients with Multiple Sclerosis, 2013
- Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2026, Congress of the United States, Congressional Budget Office, 2019
- Patient Affordability Part Two, Implications for Patient Behavior and Therapy Consumption, IQIVIA Institute, 2018