Preparing Patients for Open Enrollment


Improving access and ensuring adherence with coverage transition assistance.

Open enrollment for the health insurance exchange marketplace is here. For pharmaceutical manufacturers, it's an opportunity to access new patients and ensure existing patients are equipped with Empowered Care Sidebarcoverage to continue their therapies. But three years into healthcare reform, millions of patients remain uninsured and confusion continues around eligibility, affordability and benefits. These issues may be preventing these individuals from attaining the health insurance, and thereby the therapies, they need.

While patient assistance programs (PAPs) are essential tools for helping patients access and adhere to critical therapies, empowering patients to be informed healthcare consumers is an important aspect of the manufacturer's role in the therapeutic journey. Manufacturers can help patients navigate their coverage options in a way that complements and extends PAP offerings by focusing on outreach, education and assistance.

Understanding Patient Needs During Open Enrollment

Even years after its implementation, many patients are still unfamiliar with the Affordable Care Act and struggle to understand their coverage options and benefits. They may be concerned about their ability to afford coverage, or they may not be aware of their eligibility at all. Of the 10.5 million uninsured but eligible Americans, many are young adults who may be struggling financially or who may be unfamiliar with basic healthcare terms.1 A lack of understanding could lead to slowed enrollment, or even risk a patient's ability to use and retain their benefits,2 causing a breakdown in adherence and therapy. Patients' questions during this important time may include:

  • What are my coverage options?
  • Am I eligible for Medicaid?
  • Will my treatment lapse during the transition?
  • How do I apply for coverage?

Education and Outreach
Effective outreach is the first step toward educating and empowering patients to overcome challenges surrounding open enrollment. PAPs may be able to provide vital data to help manufacturers determine eligibility, such as patient demographics and financial information. Many patients are still unfamiliar with the ACA and struggle to understand their coverage options and benefits. And progressive manufacturers are feeding this data into mapping applications to identify areas where outreach to uninsured patients makes the most sense.3

Manufacturers should leverage their resources to help provide answers and fill in the gaps for patients. One solution is to form an open enrollment center of excellence, staffed with trained experts who can answer patient questions and help them understand their coverage options. Alternatively, manufacturers could produce educational materials that answer these questions at a high level and provide resources where patients can find further information.

Manufacturers should also consider investing in an outreach team. By developing a team of coverage and enrollment experts, manufacturers will be better able to reach, engage, empower and, ultimately, enroll patients. This team can also help determine the most effective outreach method in their area, whether it is an inbound or outbound hotline, door-to-door soliciting, brochures and posters strategically placed in health centers or coverage and financial aid information mailed directly to patients' homes.

After identifying their targeted patient population and clearly identifying coverage awareness, pain points and questions, manufacturers can begin to craft an assistance solution that actively helps patients understand coverage opportunities, overcome challenges and navigate open enrollment. The most effective assistance programs are a blend of high-tech and high-touch. They balance providing information and self-service programs with personalized support.

This year's enrollment period may be the toughest yet, as outreach and enrollment campaigns strive to appeal to patients who have avoided or been unable to enroll in health insurance for the past two years.4 Although Health and Human Services Secretary Sylvia Burwell set a modest enrollment goal of just 10 million paying premiums by the end of next year,5 federal officials have vowed to pursue the uninsured with a vigorous outreach campaign.6 And manufacturers should follow suit. Accessing new patients is far more than a good business decision that improves brand perception and loyalty. It is an opportunity to expand coverage for additional drugs and office visits, helping patients to access and stay adherent to critical therapies, avoid treatment lapses and experience improved outcomes.

Learn more about adding coverage transition assistance to patient support programs.

1Administration Has Modest 2016 Obamacare Goals. (2015, October 15). Retrieved from
2Sun, L. H. (2014, July 16). New challenge for Obamacare: Enrollees who don't understand their insurance plans. Retrieved from
3Kendall, J., & Sullivan, J. (2012, September). Best Practices in Outreach and Enrollment for Health Centers. Retrieved from
4Carey, M. A. (2015, September 22). HHS Vows Push To Enroll More Uninsured In Obamacare This Fall. Retrieved from
5Ibid 1.
6Ibid 4.

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