Enabling Medication Access Through Technology

CoverMyMeds is the nation’s leader in electronic prior authorization (ePA). The vast majority of pharmacies, payers, PBMs and over 750,000 providers rely on the convenience, speed and efficiency of our electronic solutions.

The industry’s largest network, coupled with our technology, creates efficiencies throughout the prior authorization (PA) process for brands on program. Through improved workflows, CoverMyMeds can help increase the likelihood PA requests for a patient’s originally prescribed therapy make it to the health plan for a determination. This may reduce the number of times patients switch to an alternative therapy.

Even as healthcare shifts due to current events, our technology and expert support provide a consistent prescribing experience, helping to minimize disruptions for patients.

Consistent and Streamlined Provider Support

CoverMyMeds’ resilient technology helps support patients and providers through some of healthcare's toughest challenges — including the COVID-19 pandemic. In a survey of over 2,700 CoverMyMeds users, 92% indicated COVID-19 has impacted their work in some way, including large shifts to telehealth.^{[0]CoverMyMeds COVID-19 Provider Survey, 2020} Nine out of 10 providers also said COVID-19 hasn't changed the way they process PA requests, indicating a consistent experience despite phenomenal industry shifts.^{[0]CoverMyMeds COVID-19 Provider Survey, 2020}

When a script for a CoverMyMeds program brand is rejected at the pharmacy due to PA, messaging is displayed that supports the initiation of a brand-specific PA request that can be sent to the provider for electronic submission to the plan. This streamlines the provider’s workflow and helps reduce the risk of switching or abandonment due to PA. With this added support, the patient can remain on their originally prescribed therapy. As CoverMyMeds helps improve the prescribing experience over time, the number of PA requests sent to the plan for determination per provider can increase.

With enhanced CoverMyMeds support, providers submit three times the number of PA requests, on average, for sponsored brands.^{[0]CoverMyMeds data on file, 2020}

Enhanced Prior Authorization Support

Through expert pull-through support, CoverMyMeds can further amplify automated ePA technology to send more PA requests to the health plan for review. On average, the number of approved determinations can increase by 93% due to more submissions to the health plan.^{[0]CoverMyMeds data on file, 2020}

Supporting Patient Adherence

CoverMyMeds helps support patient medication adherence for brands on program by auto-starting PA renewals when they are due to expire. Initiating renewals helps reduce gaps in therapy and creates a seamless patient experience.

On average, the approval rate for renewals is 24% higher than initial PA requests for the same brand.^{[0]CoverMyMeds data on file, 2020}

Specialty medications offer hope to patients with rare or chronic diseases, but their high cost and access complexity create distinct medication access challenges. Attempts to manage specialty therapies create healthcare challenges that can keep patients from the medications they need.

Healthcare Impact of Specialty Medications

Compared to traditional retail medications, specialty therapies are typically more complex and treat narrower patient populations. When navigating these complexities on their own, patients have described starting specialty therapies as a full-time job.^{[0]Specialty Drug Spend Soars. Can Formulary Management Bring It Down to Earth?, Managed Care Magazine, 2019},^{[0]The Impact of Disease-Modifying Therapy Access Barriers on People With Multiple Sclerosis: Mixed-Methods Study, Journal of Medical Internet Research, 2018}

A recent survey of over 500 patients on specialty medications revealed three out of five encountered difficulties while trying to start therapy for the first time.^{[0]CoverMyMeds Patient and Provider Surveys, 2020} Roughly one in ten of these patients also reported waiting eight weeks or more to receive their first dose.^{[0]The Impact of Disease-Modifying Therapy Access Barriers on People With Multiple Sclerosis: Mixed-Methods Study, Journal of Medical Internet Research, 2018} During the waiting period, some patients even reported a decline in their health.^{[0]CoverMyMeds Patient and Provider Surveys, 2020}

Specialty medications can also place a significant burden on providers. In a recent survey of 400 providers, four out of five expressed difficulty in starting patients on specialty therapies.^{[0]CoverMyMeds Patient and Provider Surveys, 2020} About three out of four providers also reported spending at least one hour per patient per week to complete required work for starting patients on specialty therapies.^{[0]CoverMyMeds Patient and Provider Surveys, 2020}

60% of patients have difficulty trying to start specialty therapy and 80% of providers experience difficulty in starting patients on specialty therapies.^{[0]CoverMyMeds Patient and Provider Surveys, 2020}

Evolving Patient Support Services

Vendors providing patient support services (i.e., hubs) and over 900 specialty pharmacies assist providers and patients by locating financial assistance, completing complicated administrative tasks and helping with adherence challenges. However, patient and provider awareness for these services is low: 40% of providers and 80% of patients are unaware of available services according to survey data.^{[0]CoverMyMeds Patient and Provider Surveys, 2020},^{[0]Patient Services – Pharma’s Best Kept Secret, Accenture Life Sciences, 2016}

Only 1 in 5 patients are aware of available patient support services.^{[0]Patient Services – Pharma’s Best Kept Secret, Accenture Life Sciences, 2016}

Efforts to improve patient support services are clearly needed: 83% of manufacturers of specialty medications expressed there is room for improvement in the current hub model.^{[0]2019 State of Specialty Pharmacy Report: Tracking the Future of Specialty Pharmacy, CSI Specialty Group, 2019}

Many retail brands also seek out hub services to support their patients. While these brands may be less complex to access, a patient-centric tool with visibility for the provider from prescription to dispense is equally valuable for retail-based brands.

Our patient support solution is a single platform that connects providers to patient support services and programs for sponsored therapies. This tech-driven tool allows providers access to all the necessary services and support their patients need throughout their journey to begin therapy. With a centralized dashboard feature, providers and other care team stakeholders have clear visibility into the entire patient journey.

Our solution offers flexibility for healthcare providers to continue completing access steps, like PA, benefits verification and investigation and initiating copay enrollment, without needing to fully enroll a patient into a support program and gather patient consent. Patient access can continue seamlessly within our platform while the provider maintains consistent visibility to their patients’ case status and journey to begin therapy.

Network Connectivity Boosts Patient Access to Support Services

CoverMyMeds’ network includes over 750,000 providers who actively use our ePA solutions. About two-thirds of specialty providers from major therapeutic areas have used the CoverMyMeds portal in the last 90 days.^{[0]CoverMyMeds data on file, 2020}

The reach of our network — along with providers’ trust and familiarity with our technology — promotes widespread adoption of our tech-enabled patient support services solution. This strategy enables us to potentially reach all patients eligible for their therapy.

In a recent two-month case study of our patient support solution, we saw 89% of target providers adopting electronic workflows to begin 1,250 patients on specialty therapy.^{[0]CoverMyMeds data on file, 2020} Connecting healthcare stakeholders through technology and integrating electronic steps into traditionally manual workflows can help improve patient support services. Such changes have already contributed to a 34% reduction in time to therapy during a follow-up study conducted by CoverMyMeds.^{[0]CoverMyMeds data on file, 2020},^{[0]The Impact of Disease-Modifying Therapy Access Barriers on People With Multiple Sclerosis: Mixed-Methods Study, Journal of Medical Internet Research, 2018} Continued efforts to standardize processes and leverage technology at key workflow pain point will further help improve efficiency while supporting patients.

It’s estimated that 35% of Americans lack adequate health insurance coverage and must pay the full cost of their prescription medications.^{[0]Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2026, Congress of the United States, Congressional Budget Office, 2019} These numbers are swelling from job losses and layoffs as a result of the COVID-19 pandemic. Without off-benefit affordability options, these patients can’t access the medications they need. Our solutions help create novel opportunities to lower prescription costs for patients when insurance coverage is unavailable or makes less financial sense.

The Burden of High Out-of-Pocket Costs

When expected to bear the full cost, patients often abandon their prescriptions. During 2017, the average out-of-pocket cost on prescription claims for patients with high deductibles was $270, compared to $29 for those with copayments.^{[0]Patient Affordability Part One, Implications for Changing Benefit Designs and High-Cost Sharing, IQIVIA Institute, 2018} When cost exceeds $125 per script, 52% of patients abandon their prescriptions, and above $250, the abandonment rate increases to 69%.^{[0]Patient Affordability Part Two, Implications for Patient Behavior and Therapy Consumption, IQVIA Institute, 2018}

A New Option to Help More Patients

Enabling patient access to a therapy they typically wouldn’t be able to afford, regardless of insurance coverage, is a driver behind CoverMyMeds’ medication access mission. Through discounted prescription prices, funds that are typically paid via rebate can be passed along to patients in the form of savings. This can mean a significant reduction in costs for patients and improved access to their originally-prescribed medications.

Our new affordability option offers patients visibility into cost and pharmacy choice earlier in the prescribing process to help them access — and stay on — their prescribed therapy. For brands on program, this means the opportunity to reach more of the 116 million patients who are uninsured and would otherwise potentially abandon a therapy due to access and affordability barriers.

In the 11 months since the solution launched, we’ve helped brands establish programs that have saved over 31,000 patients nearly $10 million dollars in prescription costs.^{[0]CoverMyMeds data on file, 2020} Even more, we’ve found these patients are 30 percent more likely to be adherent and refill their prescription.^{[0]CoverMyMeds data on file, 2020}

Learn more about how CoverMyMeds is solving medication access challenges.