Clearing the Patient Path to Medication Access

Kristy is an active mom of two who’s been living with primary myelofibrosis, a rare bone marrow cancer, since 2013. Like many patients with chronic conditions, she faces ongoing obstacles related to medication access challenges, which she’s learned to manage through pregnancies and a global pandemic. She’s had to find ways to overcome drug formulary changes, health benefit complexities and medication side effects.

Patient Support Services

For patients like Kristy, technology-driven solutions with expert human intervention support can help navigate the often-complex specialty medication access journey. Our end-to-end technology solution provides real-time visibility into the patient journey, from patient support program enrollment to adherence, to promote widespread adoption with our provider network. Program efficiencies may help patients receive their complex therapies up to 34% faster in some cases.^{[0]Revolutionizing Patient Access and Support for Multiple Sclerosis, CoverMyMeds, 2019}

Through our robust hub solution, we also support highly complex or niche therapies requiring intricate access and reimbursement support.

Individualized case management ensures therapy- and disease-specific expertise so case managers can understand where patients stand financially, physically and emotionally and find the best support for their situation.

Prior Authorization Support

Though not all medications require high-touch specialty support, patients living with chronic conditions often manage multiple prescriptions that can each present challenges. In fact, 1 in 4 patients experience delays in receiving medications due to prior authorization (PA) requirements.^{[0]CoverMyMeds Patient Survey, 2021}

Kristy has no medication alternative, so if denied access through her insurance benefit, she would have to find other ways to pay for her medication — or go without it.

“I feel like I’ve been through the fire with this medication,” she said. “It’s been really scary not knowing if my medication was going to be covered.”

As a leader in electronic prior authorization (ePA), CoverMyMeds automates the PA process for our provider and pharmacy network. These network integrations allow more care team members to find in-workflow PA efficiencies for brands on program that help patients receive their originally prescribed therapy. Supported brands see an average 91% overlap between their providers and our users, due to our extensive provider network.^{[0]CoverMyMeds data on file, 2021}

In some cases, with enhanced ePA support, increased PA request submissions led to nearly double the number of PA requests approved by the plan.^{[0]CoverMyMeds data on file, 2021}

In 2021 alone, CoverMyMeds helped patients access their medicine more than 67 million times.^{[0]CoverMyMeds data on file, 2022}

Medication affordability challenges can put patients in the face of difficult decisions. Last year, 51% of patients surveyed gave up their medications so they could afford other essential items.^{[0]CoverMyMeds Patient Survey, 2021}

For patients like Patrick, overcoming affordability issues was a key component of managing his condition. After losing most of his eyesight, he was forced to retire early. He was later diagnosed with Type 2 diabetes, and his monthly prescription cost $850. After searching on his own, he found affordability options to bring his medication costs down.

Patients like Patrick shouldn’t have to search when affordability options can be easily applied through care team and pharmacy interventions. Flexible solutions can help brands meet the needs of many patient populations.

Enhanced Copay Program Strategy

To help patients receive their prescribed brands at a cost they can afford, CoverMyMeds helps equip pharmacies with comprehensive affordability solutions.

Our technology helps apply copay coupons in real time at the point of dispense so patients pay a lower prescription cost and avoid spending time searching for copay support — or sacrificing their medications. For example, for qualified commercial rejected prescription claims, our denial conversion solution can convert to a paid claim in real time. By also returning the specified copay and patient savings notification, patients can start therapy at the specified copay card amount. Multi-channel support options can further help patients stay on their trusted brands through activity-informed messaging about discounts, real-time support and educational materials.

Like many patients, Patrick may not always know where to look, but he does know finding medication affordability options should be easier.

“If there’s a way to get all those coupons and savings … and make it … readily available and understood, that'd be great,” he said.

Patient Assistance Programs

Patient assistance programs (PAPs) are a critical financial safety net for millions of patients.^{[0]The Need for Patient Assistance and Access Programs, Patients Rising Now, 2018} CoverMyMeds implements and administers comprehensive patient assistance programs through a program pharmacy that enables access to foundation and other free medication programs to eligible patients treated at hospitals, in community care settings and at home.

CoverMyMeds affordability solutions saved patients $6 billion on their medications last year.^{[0]CoverMyMeds data on file, 2022}

Each patient’s unique set of adherence variables can affect their ability to take medications as prescribed. Enduring adverse side effects is one of these adherence variables, experienced by Jeannine who is living with metastatic breast cancer.

The pains and aches caused by one of her medications became so bad, she stopped taking the medication. “I made the independent decision to stop,” she said. “If I didn’t feel good, I didn’t take it.”

Patients with chronic conditions in particular need a wide safety net of support to both solve adherence challenges when they come up and prevent them in the first place.

Specialist Adherence Support

While technology can automate communication such as prescription administration and refill reminders, adherence is often positively impacted through personalized care team intervention. Ideal adherence solutions connect patients with therapeutic specialists who can help them learn more about their treatment plan and offer hands-on support.

Patients who received this kind of support have seen a 25% increase in adherence which translated to 31 more days on therapy.^{[0]Adherence Solutions for Biopharma Companies, McKesson, 2016}

Care Team Clinical Services

Our clinical services team delivers training, support and education for both patients and providers, with attention to your therapy’s unique needs. From field-based product training and side-effect management to treatment planning, these services are designed to fill educational and practical gaps to improve brand adherence.

Adherence solutions should be able to accommodate inevitable shifts and challenges that surface during the treatment journey to help patients like Jeannine stay on their medications so they can continue life beyond being a patient.

“I have my peaks and my valleys,” Jeannine said, “Days where you ask, ‘Why? … You may never get the answer, but … now, I'm learning how to live.”

In 2021, CoverMyMeds prevented more than 9 million prescriptions from being abandoned.^{[0]CoverMyMeds data on file, 2022}