Solutions Overview/Updates

Guiding Patients through Open Enrollment and Reverification with a Hybrid Approach


Open enrollment has begun, allowing patients to make health insurance changes, either through Medicare, the marketplace or an employer. For many people, even those not facing a complex condition, there is much confusion about eligibility, affordability and benefits. For patients requiring specialty medications, the process is far more cumbersome, often requiring additional paperwork and phone calls that deal with annual insurance reverification and changes in coverage. Moreover, any lag in the open enrollment or reverification process can potentially delay necessary treatment. For many patients, lapses in treatment can result in a backslide in therapy progress or worse.


Automate the Enrollment and Reverification Process

For patients already on therapy, communication is the first step to ensuring a smooth open enrollment and any reverification process. Automated communications through the patient population’s preferred channel–whether it be text, email, phone call or patient portal–can ensure patients are aware of any changes they can make during this period as early as possible. Once the process is initiated, easy-to-access workflows can inform patients of next steps and move them through any manufacturer- or program-specific requirements in one location. Further, this process can be completed anywhere, anytime to meet patients where they are. Submitting documentation electronically and early can ensure uninterrupted access to life-saving therapy.

Online enrollments via patient engagement sites allow patients to proactively verify their resident status, insurance information, financial information, personal contact information and any other specific needs. By completing these processes online, patients are less likely to experience a delay or interruption in receiving their medications, as illegible or incomplete forms are eliminated. Proactive submissions to these portals also eliminate time-consuming back-and-forth information gathering between manufacturers, healthcare providers, insurance providers and pharmacies.


Complex Therapies Require Human Intervention

While technology enhances access to therapy by automating and speeding up enrollment and reverification, specialty medications requiring benefit verification, prior authorization renewals, patient assistance program reapplications and specific specialty pharmacy fills may require the immediate support of professionals experienced in these areas. For example, products within the rare and orphan space often require human intervention during the reimbursement process, as some payers lack electronic capabilities for those products. Additionally, products with complex therapy journeys and high-risk adherence profiles require the right talent to guide the provider and/or patient through therapy initiation and ongoing education and support. It is essential that patient support team members are up to date on the requirements necessary for the patient population and disease state they serve, as well as experienced delivering empathetic support.


The open enrollment period and any reverification processes can be a significant source of stress for patients already facing complex or life-threatening diseases. Preparing patients for open enrollment, and assisting them through the process, requires the perfect blend of technology and talent to meet every patient where they are.


To learn more about AssistRx’s solutions, contact us.