Field Access and Reimbursement Managers Minimize Disruption in Specialty and Rare Disease Therapy During Reverification

The annual reverification of prescription benefits often leads to a change in benefit coverage for many, but for patients receiving critical therapies in specialty or rare and orphan diseases, a change can easily wreak havoc. To minimize disruption in care, it’s essential to proactively address the impact of any changes by educating Healthcare Professional (HCP) offices and their patients on how to navigate access to these critical medications. This is a tall order considering the difficulty of obtaining coverage in the first place, and the many payers, patients and HCP offices involved with annual reverification each year.   

Our FRMs are uniquely positioned to minimize the impact of annual reverification.   

Over a few short weeks, countless payer and provider touchpoints need to be addressed to assess how benefits might change for your medication because of annual reverification. Many times, this overwhelms existing Hub and internal teams. Our Field Access and Reimbursement Managers can leverage their payer expertise and our Trak360 technology platform to assess coverage and reimbursement changes before, and as they are happening, then work with HCP offices to educate patients on the updated policies.   

Through education, our FRM services facilitate timely access to medication for specialty and rare & orphan disease patients who often face significant hurdles in gaining access. The FRMs utilize their payer expertise and our proprietary technology platform with local, regional and national payer requirements, medical and prescription claims data and coding (ICD-10, HCP5 and NDC), to educate the HCP office. They address the administrative burden of prior approvals and appeals through education on current payer policies, while partnering with HUB services for these specialty and rare & orphan disease patient groups. Based on these experiences, they are in the best position to address initial and reverification coverage options and assist in educating offices on these sometimes-complex policies.  

Although annual reverification occurs over a few months, it is important to draw on the year-round management of patient access to properly address its impact. With the right field access and reimbursement partner working with you throughout the year, you are in the best position to strategically plan for annual reverification’s impact. Your FRM leadership team can help you understand when reverification changes may occur and can advise where to staff up to best navigate the rush through both live and virtual solutions. Having a partner who can offer the flexibility and technology needed to maintain patient access throughout the year is key.   

Supporting patient access throughout the disease and treatment experience  

Specialty and rare & orphan disease patients face a difficult road to diagnosis and subsequent treatment. To encourage adherence and support health outcomes, it is important that they not only obtain access to their treatment, but that they find the empathetic support and education needed to maintain adherence throughout their disease and treatment experience.    

Finding a strategic partner who understands the total needs of the patient is critical. Our Patient Access program offers FRMs and Treatment Navigators to support the patient with disease and treatment information. They provide education on possible side effects, assist with copay eligibility, explain the prior authorization process, and offer educational support to HCPs during the appeal process for denied authorizations. They provide a single source of contact to patients and care partners, minimizing the stress and confusion that patients with specialty or rare and orphan disease experience.    

Our Clinical Educators deliver top-tier supplemental disease education and treatment administration support, in-person and/or virtually when needed. They also provide behavioral health skill building and nutrition guidance to patients and their care partners and offer HCPs education on the disease state, its treatment, and how to administer it.  

To deliver a comprehensive access partnership that addresses the total patient, it’s essential to have a management team with payer expertise and an understanding of the specific needs and concerns that specialty and rare & orphan disease patients face. Additionally, a tailored technology platform must be developed to support engagement efforts and meet client needs. To that end, we sought those who could deliver on these requirements to create the quality, compliant access services supported by the requisite technology platforms and technological skills.   

Meet the team:   

Led by Steve Fields, Vice President of Field Access and Reimbursement, our FRM program is a year-round, vital complement to our Patient Access Services, playing a significant role during this critical annual reverification period. Steve joined the Patient Access team in April 2023 and was tasked with developing and implementing an FRM program to complement other Patient Access Services. Steve draws upon over 16 years of leadership experience in field access and has implemented effective FRM strategies, developed go-to-market models, and achieved launch excellence. Throughout his career, he has specialized in a collaborative and innovative approach and demonstrated an ability to align FRMs with broader commercial strategies, characteristics well-aligned with Patient Access strategic objectives to serve pharma clients and its patients.  

Jack Beard, Vice President   

Jack joined the Patient Solutions team in November 2022 to help design and build the Patient Access Services capability. He draws upon his extensive experience working in access to treatment with a focus on HUB services and reimbursement. His rich work history in these areas brings significant strength to the team where he can draw upon experience from his previous roles building and leading HUB and patient services programs.   

Meghan joined the Patient Solutions team in December 2022 tasked with overseeing the creation of an enhanced Trak360 platform for Patient Access Services that would seamlessly and securely link engagements, simplifying the intricate aspects of the patient treatment journey. Her technical expertise in patient access programs provides the necessary tools to successfully guide quality platform development to best meet patient needs.   

Joi brings a strong leadership skill set in HUB operations, call center management, client relations and quality and compliance to the Patient Access leadership team, which she joined in 2023. Joi has worked in the pharmaceutical/biotech industry supporting both the patient and provider side for over 20 years and has led cross-functional teams through the implementation of state and government regulations, procedures and processes and managed the process of HUB offerings pre-and post-launch for biologics and rare and orphan disease products. A dynamic program leader with an attention to detail, Joi will ensure that quality and compliant services are provided to all clients and their patients.  

“We are thrilled to have such strong talent on our leadership team for our Patient Access services,” notes Nareda Mills, Patient Solutions Global President. “Their expertise in this challenging area of healthcare will allow us to provide these rare and orphan disease patients the support they need and deserve to navigate their diagnosis and treatment successfully.”  

The partner you need to navigate specialty and rare & orphan disease patient access to treatment  

Minimizing the impact of annual reverification on patient access and providing the much-needed support and education that these specialty and rare & orphan disease patients need year-round, is paramount to patient adherence and improved outcomes. Choosing a partner with the payer, technology, disease and patient expertise to deliver on your medication’s promise is critical to your ultimate success. As your partner, you will gain the expertise, technological support, flexibility and customization of quality services that your brand deserves. Contact us to start the discussion.