Support patient access in pharmacies by addressing affordability issues and coverage complexity

Patient out-of-pocket responsibility is a major factor leading to prescription abandonment, which can limit a biopharma company’s success with a new therapy. Studies suggest, for instance, that abandonment rates for expensive new prescriptions are as high as 53% and as many as 1 of every 4 prescriptions is abandoned prior to first fill.¹

Pharmacists are among the most trusted members of the healthcare team and have a tremendous opportunity to highlight the resources available to patients to support access.² In fact, 79% of recently surveyed patients think their pharmacist is a trustworthy source of care.³ Helping pharmacies understand the patient access support offered by biopharma companies can help them better assist patients with starting and staying on needed therapies.

Two of the primary challenges that pharmacies face:

Insurance coverage

Challenges with health insurance can directly impact patient outcomes. Research shows, for example, that 17% of adults experiencing problems with their insurance — such as denied claims, provider network problems, and pre-authorization problems — don’t receive recommended care as a result, while 15% experience declining health.⁴

As pharmacies help patients navigate access barriers, they need to understand how to address a range of issues, including:

Prior authorization and other utilization management requirements
Cost-sharing mechanisms like copayments and coinsurance

Furthermore, the prior authorization process is not uniform among payers and complicated submission requirements can delay coverage or result in denials.

With a better understanding of local payer specific prior authorization, and other utilization management requirements, pharmacies may be able to help providers and patients through these challenges so patients can get timely access to therapies.

Patient affordability

Cost is one of the biggest issues that pharmacies could help patients address. Out-of-pocket costs are the primary driver of prescription abandonment. And abandonment rates for new prescriptions are on the rise.⁵

A variety of biopharma-sponsored resources are typically available to address affordability issues, including:

Bridge or starter programs
Copay assistance such as copay cards

Specialty pharmacies can play an important role in educating patients about these options. Yet it can be a struggle for pharmacy staff to stay on top of the many programs that exist and their eligibility requirements. Copay assistance programs are also changing constantly, especially for new products. Keeping up with these changes makes it more challenging for pharmacies to help patients appropriately utilize them.

How Pharmacy Account Managers can support your biopharma company

Biopharma companies can address these challenges at the pharmacy level by working with Cencora’s Pharmacy Account Managers (PAMs). PAMs are experts in navigating the complex insurance coverage challenges and addressing affordability education. They serve as liaisons between you and your key pharmacy stakeholders in the patient’s journey.

Unlike traditional field reimbursement and access teams, PAMs engage directly with your pharmacy network. Their role is to help pharmacies understand how to help patients overcome coverage and affordability issues that occur at the site of dispense.

Working directly with pharmacy network leaders, PAMs:

Serve as liaison between your designated internal stakeholders and pharmacy account professionals to communicate key issues or challenges related to your product(s)
Raise awareness of your patient and financial assistance programs
Provide knowledge about payer policies, prior authorization requirements, and payer policy changes
Review and monitor pharmacy utilization and the impact on patient access to inform pharmacy actions to improve access

PAMs offer much more than pharmacy and product knowledge and expertise in drug coverage and access. Using tools and resources approved by you, they can also:

Maintain communication with their key pharmacy contacts, providing them with relevant information, and sharing data to enhance their understanding of market dynamics and product access.
Review key business insights, such as:
- The pharmacy’s overall prescription utilization and trends The drivers of abandoned prescriptions
- The top reject codes pharmacies are experiencing
- The payers that contribute to a higher abandonment rate and why

PAMs can help your company develop and maintain strong relationships with your pharmacy network while enhancing your market presence. Learn more about PAMs and the value they can bring to your company by setting up a consultation with our team.

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