RTBC & e-PA
In this second installment of our three-part series on creating the right balance of technology and talent, we will cover two hot topics, real-time benefit check (RTBC) and e-prior authorization (e-PA). While these innovations are beneficial for many therapies, there are cases that require a balanced approach of technology and talent. We will dive into these examples and explain how the right balance improves patient access and speed to therapy.
Real-time Benefit Check
Real-time benefit check (RTBC) can deliver price transparency and help patients and healthcare providers make informed decisions at the point of prescription. At a recent conference, AssistRx Vice President of Business Development Kevin Robbins shared feedback from physicians who spoke about their experience with RTBC. While the physicians note that having RTBC available within their workflow is convenient, they still find room for improvement.
One physician described a situation in which he prescribed a migraine product and pulled the RTBC results with the patient. Results presented the migraine drug at more than $400 out of pocket (OOP) and a generic at $25 OOP. The physician asked the patient which they’d prefer, and the patient chose the generic. Yet, RTBC results left out that the migraine drug would have cost $20 OOP with a copay assistance program available through the pharmaceutical manufacturer.
Fortunately, there are now solutions on the market that can pull benefits specific to the patient, product and payer in real-time and within the provider’s workflow. These solutions can also inform PA requirements, life sciences organization-sponsored financial assistance programs and price variances among specialty pharmacies. Thus, the provider gains a more accurate picture of the patient’s OOP at the point of care, which increases the likelihood of the patient’s adherence to their prescribed therapy. While these RTBC solutions move the needle for many products, there are some specialty products that still require human intervention. Products covered under medical benefit and indications with frequently changing formularies are two examples. These therapies may need human intervention to ensure the most clinically effective product is accurately presented and prescribed for the patient.
Like RTBC, while electronic benefit verification (e-BV) and e-PA have many advantages, electronic processes may not be able to fully support products at launch. Depending on how the life sciences organization files, it could take a newly launched product anywhere from six to nine months to be loaded onto formularies. Without an established policy, the product cannot be supported by e-BV and will require manual intervention. The same challenge applies for e-PA for breakthrough products in new disease states, as well as rare diseases where payers may not have policies established. For example, while there are many nonalcoholic steatohepatitis (NASH) products in the pipeline, payers likely have not determined how to cover these products and will need time to establish e-PA solutions for NASH. Thus, additional human expertise would be needed to help navigate a more manual process.
Once the product moves beyond the launch phase, e-PA can be a tremendous tool for providers. For example, AssistRx’s integrated therapy initiation and patient support solution, iAssist, includes e-PA within the e-Enrollment workflow. Through integrations with several partners, PA decisions can be returned within minutes or a few hours, depending on payer capabilities. This not only improves the provider experience by meeting providers where they are, but also speeds patients’ access to therapy.
While technology solutions like RTBC and e-PA can improve access and increase speed to therapy, the human element—or talent—may still be needed to support technology for certain therapies. With the growing number of complex, targeted therapies within the specialty pharmaceutical space, talent will continue to be essential to driving access and better results from care.
To learn how AssistRx combines technology and talent to improve program performance and create better results for today’s patients, contact us.