Speeding access to therapy with pharmacy eBV

As the payer landscape grows increasingly complex, manufacturers have to navigate new requirements at every juncture of the drug commercialization process—from negotiating with payers for formulary additions to learning new rules for medical and pharmacy plans. How manufacturers handle the increasingly intricate healthcare landscape could have a significant impact on if and when patients can access the therapies they need.

Enthusiasm to adopt electronic benefit verification (eBV) services has been swift and widespread. Many medically covered therapy brands use eBV technology to remove barriers and increase speed to therapy. And as technology continues to advance with automation, there are new opportunities to provide a comparable level of detail for electronic pharmacy benefit verification.

Pharmacy benefits will become an indispensable and critical function of eBV, essential to completing the access puzzle. But not all patient support providers can deliver that complete picture.

That's why it's so important for manufacturers to work with a partner that can help anticipate changes in the marketplace and pioneer new solutions for accelerating patient access to therapy. The right hub services provider has a comprehensive, flexible eBV solution that delivers both medical and pharmacy benefit information and allows for expert guidance.

“Lash Group has, once again, stretched what's possible for patient support by leveraging our proven artificial intelligence (AI) engine to provide critical pharmacy coverage information faster so providers can better remove barriers for patients starting or continuing therapy," says Stephanie Rompot, Senior Director of Product Management at Lash Group. “Our innovative electronic pharmacy eBV solution reduces the investigative work previously required to provide patients their cost share position plus identifies prior authorization (PA) requirement details for their office."

The value of pharmacy eBV

Pharmacy eBV is immensely important because it provides a complete look into a patient's pharmacy coverage for a specific medication at any point in the benefit cycle. With pharmacy eBV, the provider can now instantly access a full prescription-related explanation of benefits (EOB), including any prior authorization (PA) requirements. This means patients will now have the cost information they need. They'll also be aware of any other hurdles that might stand in the way of getting their medication.

This is particularly helpful for patients managing a specialty or rare disease diagnosis, where there may be more barriers for patients to navigate before accessing the prescribed therapy. Capturing PA requirements up front reduces additional follow up needed to satisfy those requirements helping patients access therapy faster.

In contrast, common eligibility checks stop short of providing the details to inform providers and patients of point-in-time cost information along with specifics on additional prior authorization requirements. This leads to additional steps, slowing down or even disrupting the path to therapy. Without a comprehensive pharmacy eBV, providers risk having outdated information or manual processes that delay patients' access to medication. Such impediments can impact both patients and brand perception when many manufacturers already face increased pressure from competitive drugs and generics.

The ability to access instant information is even more pressing during the COVID-19 pandemic, when patients are postponing appointments and care. It is important for providers to have the most complete information during the scheduled patient appointment.

Finding the right pharmacy eBV partner

Today, more and more vendors are offering electronic benefit verification solutions. But not all of them are the right match for your therapy. In seeking the right partner, manufacturers should consider these factors:

• Innovation paired with expertise: Look for a partner who offers sophisticated technology such as artificial intelligence and machine learning to automate verification workflows, and has industry expertise to continuously support patients with skilled counselors while the scientific algorithms adapt to changes such as payer rules, regulations and social/economic factors.
• Holistic approach to change: Look for a partner familiar with how programs should adjust over your therapy's lifecycle – one that has a variety of technologies and program components and can shift to meet evolving needs.

Pairing automation with human expertise is key. “With the variety of technologies available and being developed, it's difficult for manufacturers to know which technologies are the best match for their products," says said Myra Reinhardt, Vice President of Product Innovation and Analytics at Lash Group, “Success factors for knowing which is the right technology and how to implement it within their programs can be complicated, which is why we built our system with simplicity in mind."

“Ours is a solution that provides manufacturers access to the most comprehensive technology portfolio, industry expertise and the most skilled, compassionate program teams," she adds. “We will partner with manufacturers to design an effective program initially and then recommend future adjustments to accommodate market and patient population changes."

Indeed, the healthcare landscape will continue to grow more complex, regulations and all. But with the right benefit information delivered on demand as part of a comprehensive, flexible eBV solution, stakeholders across the continuum can navigate complexities to expedite patients' pathways to care.