Industry Insights

Considerations for Patient Access and Support Investments in 2022

Jeff Spafford

It’s that time of year when we reflect on our successes and lessons learned throughout the past 12 months. Many life sciences organizations are evaluating their brands’ performance in 2021, as well as innovations that can optimize their programs in 2022. 

While every specialty product has different needs requiring unique solutions, here are several innovations impacting access, adherence and affordability and what life sciences organizations should consider before investing in them. Below is an AssistRx blog post summarizing takeaways from my presentation on specialty medication insights, as well as our recommended considerations.  

Access: The impact of tools such as e-benefit verification

In a recent presentation on specialty medication insights, AssistRx President and CEO Jeff Spafford shared, “Our healthcare providers and patients want information at the point of care. They want to understand the requirements, what’s needed and next steps at the point of prescribing. Ensuring providers have all the information they need to make the right decision upfront is critically important.”

Solutions such as e-benefit verification empower healthcare providers with the right information to make the right decision upfront. For life sciences organizations seeking solutions for 2022, it’s a must to understand what data e-benefit verification returns and how.

Within e-benefit verification for pharmacy benefit products, the various market options return different depths of information. Using just five patient identifiers (first name, last name, date of birth, gender, zip code), Advanced Benefit Verification (ABV) returns comprehensive coverage information in under 30 seconds. Data includes deductible amount, remaining and exemptions; out-of-pocket maximum, minimum and remaining; formulary tier status; drug access restrictions, such as prior authorization (PA) required; and more.

As for e-benefit verification for medical benefit products, there is much catching up to do, but some innovations have farther reach and higher accuracy than others. The AssistRx e-MedBV solution leverages the same five patient identifiers as ABV to return comprehensive results for 50% more payer-covered lives than other e-medical benefit tools in the market. Results include payer/plan name and type; member ID and group ID; effective and termination dates; family/individual deductible, year to date, per year and remaining; and family/individual out-of-pocket cost, year to date, per year and remaining.

One final consideration is how the information is delivered. As Spafford shared about the AssistRx platform during the interview, “We understood that its true value is to connect all stakeholders onto one common platform. And adoption and utilization depend on meeting patients and healthcare providers where they’re in their lives and workflow. That’s why the ability to embed our technology solutions is essential.”


Adherence: Engaging patients with solutions tailored to them

Spafford also shared his insights on using a patient-first mentality when designing adherence programs: “As an industry, we need to align on that patient-first mentality, understand their needs and develop a highly customizable, personalized approach to help them achieve successful outcomes.”

Engaging patients how they want to be engaged is key to successful treatment outcomes, and life sciences organizations should consider the pros/cons of adherence solutions before investing in them. For example, AI can bring value to an adherence program by leveraging historical data and predictive modeling that guides touchpoints based on a patient’s risk profile. However, AI doesn’t stack up against real-time integrations when it comes to patient access. This is because AI results are based on algorithms and historical data, rather than the up-to-date, from-the-source data.

Patients are also demanding tailored, value-add messages that meet them where they are. While some patient populations may require phone calls due to disease state-related challenges and/or life stage, other patient and caregiver populations may require email, text, live chat, video conferencing and/or telehealth.

Chatbots and virtual assistants have begun to rise in healthcare settings. For life sciences organizations, this could be a tool to reach patients where they are, but it’s worth looking under the hood. For example, are these tools accurately and completely addressing patients’ questions, and triaging patients to access or clinical staff when appropriate? Organizations need to evaluate if these tools provide value to their program beyond that of solutions already in place.


Affordability: Innovations that facilitate timely access

Many of the aforementioned innovations play a role in supporting patients needing financial assistance services. Real-time e-coverage and e-income solutions are key for specialty drug patients who may need to expeditiously start therapy. These solutions must immediately identify patient coverage for the prescribed product, determine eligibility for programs like copay or patient assistance programs (PAPs), and perform real-time enrollment. Through real-time integrations with data partners, AssistRx empowers patients, caregivers, healthcare providers and/or specialty pharmacies to self-serve, performing PAP and copay program screening, enrollment and copay card/voucher generation in real-time.

Innovations like ABV can also perform free drug program reverification to assess in real time if patients have obtained coverage. This supports faster identification of non-eligible patients, as well as conversion to paid script. Solutions like these that deliver assistance to patients in need, as well as cost savings for life sciences organizations – over $20M for one AssistRx client – should be considered when evaluating tools to invest in.

While the industry constantly brings new innovations to market, the onus is on life sciences organizations to decide which innovations are worth the investment for their program(s). Each program should be built with a strategic balance of technology and talent, leveraging innovations when appropriate to better support patients, caregivers and healthcare providers.

Interested in learning more about AssistRx solutions that support access, affordability and adherence? Contact us.