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Preparing Patients for Open Enrollment

By AmerisourceBergen

Improving access and adherence with coverage transition assistance.

Open enrollment for the health insurance exchange marketplace is here. For pharmaceutical manufacturers, it’s an opportunity to reach new patients and ensure existing patients are equipped with coverage to continue their therapies. But millions of patients remain uninsured and confusion continues around eligibility, affordability and benefits—an issue that can create a critical barrier to therapy.

While patient assistance programs (PAPs) are essential tools for helping patients access and adhere to critical therapies, empowering patients to be informed healthcare consumers is an important component of a patient-centric support program. Manufacturers can help patients navigate their coverage options in a way that complements and extends PAP offerings by focusing on outreach, education and assistance.

Understanding Patient Needs During Open Enrollment

Years into implementation and amid significant changes to the initial law, many patients are still unfamiliar with the Affordable Care Act (ACA) and struggle to understand their coverage options and benefits. In fact, only about nine percent of Americans understand the four most basic health insurance terms (health plan premium, health plan deductible, out-of-pocket maximum and co-insurance).1 What’s more, they may be concerned about their ability to afford coverage, or they may not be aware of their eligibility at all.

Patients' questions during this important time may include:

  • What are my coverage options?
  • Am I eligible for Medicaid?
  • Will my treatment lapse during the transition?
  • How do I apply for coverage?

"By developing a team of coverage and enrollment experts, manufacturers will be better able to reach, engage, empower and, ultimately, enroll patients." 

Education and Outreach

Effective outreach is the first step toward educating and empowering patients to overcome challenges surrounding open enrollment. PAPs may be able to provide vital data to help manufacturers determine eligibility, such as patient demographics and financial information.

Manufacturers should leverage partnerships to help provide answers and fill in the gaps for patients. One solution is to form an open enrollment center of excellence, staffed with trained experts who can answer patient questions and help them understand their coverage options. Alternatively, manufacturers can produce educational materials that answer these questions at a high level and provide resources where patients can find further information.

Manufacturers should also consider investing in an outreach team. By developing a team of coverage and enrollment experts, manufacturers will be better able to reach, engage, empower and, ultimately, enroll patients. This team can also help determine the most effective outreach method in their area, whether it is an inbound or outbound hotline, door-to-door soliciting, brochures and posters strategically placed in health centers or coverage and financial aid information mailed directly to patients’ homes.


After identifying a targeted patient population and clearly identifying coverage awareness, pain points and questions, manufacturers can begin to craft an assistance solution that actively helps patients understand coverage opportunities, overcome challenges and navigate open enrollment. The most effective assistance programs are a blend of high-tech and high-touch. They balance providing information and self-service programs with personalized support. 

This year’s enrollment period may be the toughest the ACA has seen, as outreach and enrollment campaigns face their biggest budget cuts yet.2 Ensuring patients are aware of their coverage options during open enrollment is essential for avoiding treatment lapses and improving outcomes.

1. United Healthcare Consumer Sentiment Survey. October 2017. Available online at
2. Keith, Katie. CMS Announces Even Deeper Navigator Cuts. Health Affairs. 12 July 2018. Available online at

Coverage expansion support from Lash Group

ACE Service Center

Extend the reach of patient support programs with coverage transition assistance.