A High-Touch Approach to Improving Patient Access


Using field support to navigate reimbursement challenges

July 01, 2015

For the brand and reimbursement teams who must develop commercial strategies for the biopharmaceutical industry's most innovative specialty products, declining reimbursements and increased payer management are not new challenges. Stakeholders across the healthcare continuum are continuously tasked with finding ways to combat shrinking reimbursements. And when it comes to billing for drugs that are dispensed in a practice setting, healthcare providers are facing very specific obstacles to overcoming coding errors and receiving the appropriate reimbursement from payers. 

The Reimbursement Landscape: Provider Challenges, Product Opportunities

The ramifications of the Affordable Care Act, from Electronic Health Records requirements to increased focus on how providers bill for their services, mean the threshold for billing and coding errors is now lower than ever. Complicating the reimbursement landscape even further is the fact that providers have a limited understanding of the programs available to assist them with managing errors. Navigating support programs, plus managing patient cost-share issues, ultimately takes the focus away from patient care by increasing the administrative burden on the practice.

Considering the complexities associated with reimbursement, it's no surprise that provider expectations for reimbursement support and education are also higher than ever. The need for education on how products work - particularly drugs such as biologics and oncolytics - is now accompanied by and expectation of live support from highly qualified reimbursement professionals. And as the complexity of administering these products, escalates, so does the need for high-touch support services. Although practices may manage some tasks internally and rely on external resources for odd payers or difficult cases, there is no denying the need for dedicated, specialized reimbursement support.

So What Does This Mean for Pharmaceutical Manufacturers?

Reimbursement challenges present both risk and opportunity. Manufacturers must ensure providers understand what procedures to follow in order to receive appropriate reimbursements for the manufacturers' products. Often it's this lack of understanding that is behind coding errors. Then, when it comes to new products, physicians will react with caution as new product launches offer special reimbursement challenges, understandably valuing time with patients over time confronting coding challenges. This presents additional risk for manufacturers: less time for patients on therapies and getting them on those therapies. As such, manufacturers increasingly need to differentiate their products from the competition, not only in terms of efficacy, but also when considering the design of support programs. And this means factoring in how high-touch services can uniquely improve practice efficiency, speed to therapy and duration of therapy.

It's those high-touch aspects of support programs that present the greatest opportunity for manufacturers if designed properly. Pre-launch, manufacturers must look at the process for everything from labeling for administration to the buy and bill model and its impact on providers and access. Post-launch, monitoring reimbursement trends and having robust tools and support available will be critical. Hands-on reimbursement expertise allows manufacturers to supplement their support programs and add value while differentiating their product and easing providers' administrative woes.

Optimizing Program and Product Performance through Coordinated Support

To learn about best practices for a coordinated plan that incorporates high touch field resources with high tech patient support to ensure providers and patients have the right support at the right time, read our complete white paper.


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