Starting or refilling a specialty medication can be a long and winding road with unexpected detours. Patients and prescribers can face delays due to extra administrative steps, while life sciences companies and pharmacy benefit managers (PBMs) grapple with outdated processes such as relying on phone calls and faxes to verify coverage.
Every traveler on the healthcare road is seeking the same destination: Improved health. Like preparing for a road trip with tires, gas and maintenance, patients need faster service, improved care quality and affordability. Surescripts Electronic Benefit Verification helps them get there by delivering secure, patient-specific pharmacy benefit intelligence in seconds.
Speed Past Prescription Wait Times
Once a treatment is prescribed the clock is ticking. Waiting hours, days or weeks to receive a prescription that is delayed by complex processes can significantly impact patient health, especially for those managing chronic diseases such as cystic fibrosis or asthma.
When asked how long it should take to get a patient started on a new therapy, 95% of prescribers said it should take no more than six days. In practice, however, 18% reported that it typically takes a week or more. This is precious lost time that can’t be recovered.
Electronic Benefit Verification replaces those calls with a digital solution that works in seconds, getting patients on the road quickly.
Running at Peak Efficiency with Optimized Outcomes
Better quality care is possible thanks to life-changing pharmaceutical treatments. Outdated systems mean access to those medications lags behind.
Take the specific instance of reauthorization of an existing treatment. In this scenario, a chronic disease patient has changed insurance plans, and a new prior authorization is needed. The coverage of the medication by the new plan must also be verified. Meanwhile, the patient travels to the pharmacy to pick up their typical prescription not knowing additional steps are needed, encountering a barrier to care.
Surescripts makes those steps easy on the patient. When only basic patient demographics such as name and birthdate are needed to check eligibility, the patient does not need to find their insurance cards or supply their Social Security Number to achieve a verification from their PBM.
When access to information that doesn’t rely on phone calls and faxes, care managers can continue working with patients to help them begin taking the medications they’ve been prescribed without waiting days or weeks. The path is smoother with accurate and actionable information when bumps are the road are eliminated.
Find Affordability and Avoid Costly Detours
Many life sciences companies offer patient support programs to help eligible patients access their medications. These programs aren’t just about affordability but supporting them through the process and getting them access faster.
According to industry sources, more than 300 drugs have associated patient support programs, and manufacturers spend about $4 billion per year on these programs. Another $5 billion goes towards helping patients with out-of-pocket costs or providing free products.
Yet, 87% of prescribers say patients often ask to delay or change prescriptions due to out-of-pocket costs. In other words, financial support may be available but navigating the road is still uncertain.
Electronic Benefit Verification makes the journey easier. Life sciences companies can instantly know whether a medication is covered and how much it costs — a piece of information that is imperative to patients. Not to mention, administrative costs for life sciences companies are reduced with streamlined intake and enrollment processes.
Arriving at the Destination, Faster
Surescripts is uniquely positioned to assist life sciences companies as we have built a trusted, reliable and secure network that works at a significant scale to improve care. Instead of shifting administrative burdens, burdens are reduced or eliminated.
Too often, case managers at patient support programs must make a phone call to get the information they need to verify and enroll (or re-enroll) a patient. Each additional phone call or fax creates a cost prohibitive marketplace for necessary specialty medication programs while also impacting the likelihood of a patient picking up their medication and getting the treatment they need.
With Electronic Benefit Verification’s patient-specific pharmacy benefit information every traveler on the healthcare road finds what they are seeking.
Learn more about Surescripts Electronic Benefit Verification.
The editorial staff had no role in this post's creation.