Technology Helps Drive Access, Adherence and Affordability

With CoverMyMeds’ technology, our continuum of solutions assists in clearing the path of time-consuming, unnecessary obstacles for improved patient medication access throughout the brand lifecycle.

Prior authorization

While prior authorization (PA) can help ensure appropriate access to therapy, the traditional, paper-based PA process can delay therapy start or lead to abandonment. In a recent survey, one in four patients said they experienced delays in getting medications due to PA.^{[0]CoverMyMeds Patient Survey, 2020}

More than a third of providers reported having less face-to-face time with patients due to PA management — during which meaningful conversations about affordability, access or social circumstances could occur.^{[0]CoverMyMeds Provider Survey, 2020}

As a leader in electronic PA (ePA) support, CoverMyMeds automates the PA process for our provider network. By creating efficiencies and aiding providers with brand-specific PA support, our solutions can help reduce time to therapy and decrease switching and abandonment for brands on program. Between CoverMyMeds' provider network and brand target NPIs, there is a 91 percent average overlap for sponsored brands.^{[0]CoverMyMeds data on file, 2021}

In addition to our decade of success with ePA solutions, we’re dedicated to continually uncovering new and innovative ways to improve the PA process for providers prescribing sponsored brands.

Led by technology with the assitance of human intervention, our enhanced ePA solution improves workflows through increased PA visibility and support. This combination helps to increase the likelihood PA requests for a patient’s originally prescribed therapy make it to the health plan for a determination. Due to increased submissions, health plans approve an average of 93 percent more PA requests.^{[0]CoverMyMeds data on file, 2020}

__Converting PA-related rejections at the pharmacy __

CoverMyMeds provides additional opportunities to improve patients’ access to therapy if PA remains a barrier. For qualified prescriptions that receive a pharmacy rejection linked to PA, our solution converts rejected claims to paid claims, allowing patients to leave the pharmacy with their medication in hand. To accomplish this, CoverMyMeds automatically generates and sends a PA request to the provider for completion which can help establish the patient on insurance to cover subsequent fills.

Patient support services 

While the high cost of specialty medications can feel like a staggering barrier, simply accessing therapy can prove even more difficult. After receiving a diagnosis and prescription for a complex therapy, many patients are often left to manage their own care. This includes coordinating care among healthcare entities, which 82 percent of patients prescribed specialty therapies reported doing for at least an hour on the phone after prescription.^{[0]CoverMyMeds Patient Survey, 2019}

CoverMyMeds patient support solutions span the therapy continuum — from novel therapies for rare diseases to broad therapy categories with varying degrees of patient needs — we can help carry a brand through the access journey.

__Technology-driven support __

CoverMyMeds’ single-platform, tech-driven patient support solution connects providers with patient support services and programs. With visibility into the entire patient journey, spanning from enrollment to adherence, our end-to-end solution transforms how patients access, afford and adhere to complex therapies by connecting stakeholders within one location. Through this patient support solution, patients receive therapy an average of 34 percent faster than the industry standard, in some cases.^{[0]CoverMyMeds data on file, 2020}

Brands on program integrate with our expansive provider network, promoting widespread patient support services adoption. Additionally, a centralized portal allows real-time visibility into the patient journey for consistent information sharing among stakeholders and the patient.

Extensive patient support capabilities for sponsored brands include copay solution support, behavioral coaching, care team clinical services, field reimbursement services, a dispensing pharmacy connection and sales force enhancement.

Highly complex therapy support

For highly complex or niche therapies and patient populations requiring intricate access and reimbursement support, a more robust hub solution is also available. This solution supports over 30 diverse programs representing nearly 180 brands.^{[0]CoverMyMeds data on file, 2021}

By anticipating the challenges patients face — from reimbursement issues to financial constraints to adherence barriers — we proactively develop and deploy flexible solutions to help remove or decrease obstacles that may prevent the best health outcomes for the patient. This solution reaches patients where they are in their journey and through their preferred channels. For additional layers of support, patients have the option to access a team of registered nurses and pharmacists.

Innovation spotlight

With the increase in digital and remote medical communication, heightened by the COVID-19 pandemic, brands face growing challenges to reach target provider offices. Traditional sales representative interactions remain restricted while critical brand-specific communication to care teams remains a necessity. Half of providers surveyed by CoverMyMeds indicated they prefer digital communication from brands when business returns to pre-pandemic operations.^{[0]CoverMyMeds COVID-19 Provider Survey, 2020}

CoverMyMeds is creating unique ways to extend and tailor brand reach to provider care teams, helping build medication awareness while supporting the prescribing process throughout the patient journey. Our continued innovation helps enable access to critical brand resources and reaches CoverMyMeds’ existing provider network with an in-workflow, self-service solution.

Maintaining adherence after overcoming medication access barriers is critical to helping improve patient outcomes when a brand is prescribed. CoverMyMeds seamlessly integrates technology solutions to encourage patient and provider brand loyalty.

Specialty drugs are particularly prone to adherence barriers. With high costs and complex paths to access, patients are more likely to abandon specialty medications than any other drugs during their deductible period.^{[0]Medicines Use and Spending in the U.S. A Review of 2016 and Outlook to 2021, IQVIA, 2017}

Specialized patient support services can bridge barrier gaps to improve patient adherence through automated and expedited processes and improved education. Our experienced adherence team training and tools are available to help patients stay on therapy and continue living healthier lives.

Patient behavioral coaching

Through CoverMyMeds, patients can have remote access to a field of 3,000 nurses who will act as their partners along their treatment journey, providing treatment planning education and empowerment as well as side effect and condition management when prescribed a brand. Nurses are specifically trained on the nuances of administration, treatment, side effects monitoring and additional program support for each specific brand.

Patients receiving behavioral coaching for their medications experienced 25 percent increase in therapy adherence and 31 more days on therapy.^{[0]Symphony Health Analytics, 2016}

Care team clinical services

Clinical services for patients and prescribers deliver training and education customizable to a therapy's needs. From field-based product training and side effect management to treatment planning, these services can fill any educational and practical gaps to improve brand adherence.

To access and remain adherent to prescribed medications, affordability solutions are key for patients. CoverMyMeds offers a suite of flexible affordability solutions to optimize access to a brand.

Patients can face many affordability challenges, such as rising deductibles, more patients on these high-deductible plans and some still facing job reduction or loss due to the COVID-19 pandemic. Two-thirds of patients surveyed went to pick up a prescription only to find it cost more than expected, which could lead to abandonment.^{[0]CoverMyMeds Patient Survey, 2020} Abandonment rates reach 45 percent when the patient out-of-pocket cost is over $125 and 56 percent when the cost is over $250, which can heavily impact specialty medications.^{[0]Medicine Spending and Affordability in the United States, IQVIA, 2020}

CoverMyMeds’ holistic set of solutions further provide patients options and choice, even for the uninsured and underinsured, helping them adhere to their originally prescribed medications.

Enhanced copay coupon strategy

In 2018, the average copay coupon value per claim was $229.33.^{[0]Prescription Drug Coupon Study, Commonwealth of Massachusetts Health Policy Commission, 2020} If patients were responsible for this cost out of pocket, nearly 50 percent would likely abandon these prescriptions.^{[0]Medicine Spending and Affordability in the United States, IQVIA, 2020} CoverMyMeds’ technology can help connect patients to copay coupons in real-time at the point of dispense, to help lower the prescription cost and help get patients on therapy through our network of over 50,000 pharmacies. By providing lower copay amounts, this solution can help reduce drug switching and non-adherence for a brand.

Some patients may need additional medication support from the biopharma brand but lack awareness of such programs — 37 percent of patients in a CoverMyMeds survey were unaware of any brand affordability programs.^{[0]CoverMyMeds Patient Survey, 2020} A multi-channel support option can cater to patient needs and promote brand loyalty through activity-informed tailored messaging around discounts, adherence coaching, real-time support and educational materials.

To further support patient brand loyalty, non-reimbursable claims for a qualified National Drug Code can be automatically converted to a paid response while surfacing patient savings information. This can establish the patient on therapy at the specified copay card amount, while mitigating access barriers and dispensing the medication as prescribed.

Patient Assistance Programs

Patient Assistance Programs (PAPs) are a critical safety net for millions of patients with financial hardship. RxCrossroads by McKesson, in collaboration with CoverMyMeds, implements comprehensive PAPs to provide medication to eligible patients being treated at hospitals (CAH, ACH, academic centers), in their community care settings and at home. In 2020, 455,000+ PAP applications were processed and 2.1 million prescriptions were dispensed for enrolled patients.^{[0]CoverMyMeds data on file, 2021}

Cash Pay Alternatives

Leaning on our direct biopharma connections, CoverMyMeds’ unique cash pay alternative solution allows patients to proactively participate in their care plan through price visibility — including options outside of insurance — and choices of where they access their medication.  

Through this program, funds typically paid through rebates can be passed to the patient in the form of savings through biopharma brands. This can mean significant cost reduction for patients and improved access to their originally prescribed medications. Within 18 months of product launch, CoverMyMeds helped sponsored brands by providing 5.7M discount cards to patients, saving them over $18M in prescription costs.^{[0]CoverMyMeds data on file, 2021}