More Than Ever, New Therapies Require Reimbursement Support


Biopharma companies are investing in field reimbursement staff to reduce patient barriers to therapy by guiding prescribing physicians through specialty therapy access and adherence challenges

(sponsored by RxCrossroads by McKesson)

Reimbursement in the specialty therapy arena is complex. In this current environment of heightened competition, rising prices and the growth of highly specialized, complex therapies, biopharma companies need assistance maneuvering the ever-changing landscape of reimbursement strategies.

This assistance ensures prescribing physicians can effectively navigate the considerable twists and turns of gaining patient access and adherence for different therapies with varying reimbursement models. This will become increasingly necessary as biopharma companies introduce more injection- and infusion-based therapies and as more therapies move from pharmacy to medical benefit management. This transition requires prescribers to adjust to the intricacies of billing and coding, as well as obtaining prior authorization and receiving payment for these drugs.

The complexity of the reimbursement process for many specialty therapies has created a need for dedicated support services in the form of field reimbursement managers (FRMs) and inside reimbursement teams.

At RxCrossroads by McKesson, these specialists have detailed knowledge of national reimbursement processes and trends. And, because they work regionally, they understand and can help prescribers navigate the idiosyncrasies of specific local, state and regional payment requirements.

The process begins with RxCrossroads’ reimbursement specialists making an initial phone call to the prescriber via the hub. They can proactively identify a patient’s need based on hub data indicating prior authorization delays, denials or other holdups.

Reimbursement specialists can also preemptively contact prescribers and appropriate office staff based on discussions with the company regarding potential reimbursement challenges prescribers may encounter and ways they can help. For example, prescribers may not be aware of manufacturer-funded co-pay or patient-assistance programs, which can help patients gain early access to a drug, overcome process barriers and secure available options while their insurance information is processed.

A smooth, efficient process benefits all stakeholders in their goal of getting patients on the therapies they need. Patients can access therapy faster and more easily when prescribers can obtain prior authorization and receive reimbursement in a timely manner.

In addition to the patient benefits, RxCrossroads collects impactful, advantageous data for biopharma companies. Often, this data includes information such as turnaround times for prior authorizations, reductions in the number of incomplete enrollment forms submitted, reductions in time to therapy and many other aspects of access, adherence and reimbursement. Ultimately, the data collected can help companies improve the patient journey and reduce adherence barriers on their therapy.

Every specialty therapy presents its own set of reimbursement-related challenges. Reimbursement support services can help patients and providers through these challenges.

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