Care Teams

A Team Approach to Dissolving Medication Access Barriers

A true patient-centered environment requires care team collaboration and empowerment.

CoverMyMeds Editorial Team
February 14th, 2020
Nurse talking to a patient

When three out of four patients feel it’s important to discuss choices for affording their medications, providers need to be equipped with answers. CoverMyMeds Patient Survey, 2019

Patient Consumerism Drives Demand For Options

Many high-performing health systems and practices recognize the rise in patient consumerism and the demand for medication options, with affordability top-of-mind for most patients.CoverMyMeds Patient Survey, 2019 By tapping into an abundance of data available through prescription decision support solutions, they’re empowering care teams to provide patients with what they need most: options.

“People on these care teams want to advocate for and help patients, but they may not have all the information, and they may not have visibility into all the choices available. So, some patients may be left behind,” says Dustin Eubanks, director of business development at CoverMyMeds. “Meanwhile, there are certainly patients that would step up and advocate for themselves, but they don’t have access to these choices either.”

Healthcare Technology Can Break Down Barriers

Earlier this month, Eubanks presented a webinar hosted by Becker’s Hospital Review and sponsored by CoverMyMeds that highlighted access barriers and the ways leading health systems and practices are breaking through to reach patients where they are. The discussion focused on barriers including the prior authorization (PA) process, lack of price and benefit transparency, poor or delayed communication methods and social determinants of health.

One of the key solutions discussed was point-of-care to point-of-dispense technology that can help patients avoid surprises at the pharmacy — such as PA requirements or sticker shock.

“We want to drive more prescriber-initiated PA requests — over pharmacy-initiated PA requests — so we can set better expectations before the patient shows up at the pharmacy," Eubanks says. “We can more successfully ensure patients are guided and coached through this process when a PA request is initiated proactively.”

PA Volume Can Slow Down Workflows

Of course, even with solutions in place, health systems and practices get bogged down with PA volume. In a recent survey, a nurse described herself feeling more like a ward clerk, as her time is consumed by PA management.CoverMyMeds Nurse Survey, 2019

Many health systems and practices are now redistributing and rethinking their employee structure, centralizing the PA process to an individual or team of experts to handle medication access barriers.

These centralized teams, Eubanks has found, are focused on more than just PA — they’re handling benefits verification, processing claims through their health systems’ pharmacies and ensuring financial assistance and other foundational programs are in place so patients can get on therapy sooner.

A study by a leading medical center found that health systems with centralized groups processed PA requests nearly 6.5 days faster, on average, than non-centralized groups, and reported a 25 percent higher approval rate.Cutler, Timothy, et al. “Impact of Pharmacy Intervention on Prior Authorization Success and Efficiency at a University Medical Center.” Journal of Managed Care & Specialty Pharmacy, vol.22, no. 10, Oct. 2016, pp. 1167-1171. NCBI This indicates patients receive providers’ first-choice prescription and have them dispensed faster – thus improving the likelihood of adherence.

Yet, even with administrative barriers removed, patients surveyed said the most important factor when considering their prescription medication is paying the lowest price. CoverMyMeds Patient Survey, 2019

Prescription Price Transparency Is High Priority

With high-deductible plans rising — and 75 percent of patients never seeing the other side of their deductible — price transparency is more important than ever.Devane K, Harris K, Kelly K. Patient Affordability Part Two: Implications For Patient Behavior & Therapy Consumption. Plymouth Meeting, PA: IQVIA; 2018 The right price transparency tools leverage an open network, free of bias, so patients can work with their providers to find the best option. This may mean working within a deductible or pharmacy shopping outside of insurance to find the best cash price.

“When we think about the care teams who are stepping in and filling gaps around medication access, who are guiding patients on how to act as a consumer in their own healthcare, we need to make sure they have access to all the information possible,” Eubanks says. “These technologies and solutions must be linked end-to-end so that expectations are set appropriately throughout the entire process, ensuring the patient knows exactly what they’re getting into.”

*To learn more about dissolving medication access barriers, watch a replay of the webinar. *

CoverMyMeds Editorial Team

The latest healthcare insights, floated right to your inbox.

There was an error submitting the form. Please refresh or try again later.
iPhone showcasing News and Insights Article