Real-Time Benefit Check (RTBC) advancements have been a hot topic in the industry as organizations integrate technology to simplify the prescribing process and expedite patient access to therapy. While these technology solutions have many merits, relying solely on technology at the point of prescription could result in several gaps and uninformed decisions. In many cases, human expertise is still needed to complement therapy initiation and patient support technology solutions.
Real-Time Benefit Check Current State
For the most part, RTBC solutions support practices by presenting the requested and alternate therapies available and cost and access-related prescription details to prescribers and patients at the point of prescription. Yet, several important data points can be inaccurately represented for the product requested or altogether missing from the information presented via RTBC. As such, many industry stakeholders have voiced low confidence levels in the information presented by RTBC solutions.
RTBC solutions present coverage details, patient out-of-pocket costs, PA requirements and more. However, most solutions do not include major medical benefit options, manufacturer-sponsored financial assistance programs, quick start/bridge programs or patient therapy history. Thus, the pricing presented is often incorrect, and coverage options, avenues to start therapy sooner and tried-and-failed therapy history may be missing. As a result, prescribers lack the information they need to prescribe a product that is most clinically effective, at a reasonable cost and accessible through a quick start or similar program.
Real-time solutions can support facilitation of an informed clinical decision at the point of prescription—as long as the information presented provides a comprehensive overview of access options. AssistRx recognizes this and offers both real-time pharmacy benefit and major medical benefit visibility to providers and patients through our integrated access solution, iAssist.
iAssist includes formulary status, patient out-of-pocket costs for the selected specialty pharmacy and PA requirements. This solution also features manufacturer-sponsored programs, such as copay and financial assistance programs—with real-time patient approvals at the point of prescription. iAssist can also pull medical benefit verification, an element that is essential to providing a holistic picture of pricing and access options for specialty products that may vary by payer for each patient.
A Need for the Perfect Balance of Tech and Talent
AssistRx also recognizes the importance of the human element to pull information not yet available at the point of prescription. For example, while automated solutions are commonplace among payers, there are certain disease states in which the patient population is too low or therapies too new for payers to have established automated solutions. Integrations and human expertise are needed in these cases to ensure the access information presented to the prescriber is accurate.
There is no uncertainty in the market that prescriber-facing, therapy initiation processes must adopt technology-enabled solutions to increase efficiency and improve access and speed to therapy. At the same time, human expertise is also needed in certain instances to ensure the prescriber can make a fully informed clinical decision.
AssistRx solutions advance patient therapy more efficiently and effectively through the perfect balance of technology and industry expertise—delivering informed touchpoints that simplify a complex system to enable better results for today’s patients. Contact us to learn the intelligent way to initiate and advance specialty therapies.