Healthcare affordability has been a topic of conversation for many years. But recently, the number of patients who delay or abandon care because of cost has skyrocketed. Unfortunately, the pattern of high costs driving non-adherence is often cyclical, causing additional healthcare needs and worsening population health. For example, a diabetic patient who skips taking their insulin may end up in the hospital (or worse), faced with additional health issues and avoidable costs. The stories – like those featured in the New York Times – can be devastating.

Healthcare affordability challenges are well-documented, and increasing costs clearly have a negative impact on adherence – especially in the specialty medication space. That is why, as an industry, we must do everything possible to reduce the overall cost of care, provide transparency into costs, and support patients in finding affordable care options.

Unfortunately, the processes to understand a patient’s out-of-pocket cost for a medication and discover what options might be available to support that patient are incredibly complex. Through this blog, we will outline some of the ways RxLightning is supporting patients in finding and enrolling in affordability programs throughout their medication access journey.

Real-Time Benefit Check

One of the first ways that a provider, care team member, or patient can have insight into the cost of a medication is through a Real-Time Benefit Check (RTBC). RTBC tools are typically embedded into the EHR or prescribing workflow, and provide real-time information on the cost of the medication prescribed, any restrictions that may be present (prior authorization, step therapy requirements, etc.), or alternative medications that might be clinical equivalent and cost less.

Going one step further, some RTBC tools – including the one RxLightning offers – also display a variety of pharmacies that can supply the medication being ordered, and the cost associated with each. For example, the pharmacy down the road might have the medication for $55, but the pharmacy across town might have it for $25 – a worthwhile switch for many patients.

Real-Time Benefit Check tools are designed to provide transparency into the cost of medications. While they can support patient affordability by offering recommendations on lower-cost options, knowing the patient’s payment responsibility is the first step in understanding if they will be adherent or not. The ability to have a conversation around cost at the point-of-care eliminates abandoned medications down the road, and can help support patient adherence upstream.

Copay Assistance

In some cases, when a patient is prescribed a specialty medication, the manufacturer may offer a discount card, savings program, or coupon to reduce the out-of-pocket cost they are responsible for. While these assistance programs may not cover the entirety of the medication cost, any support provided to patients can enable greater adherence and health outcomes. Prescribers and patients are made aware of these programs through their own research or visiting the manufacturer’s website.

RxLightning works with directly with partner manufacturers to surface copay assistance programs within our portal. When a prescriber selects the patient and medication within RxLightning, the tool alerts them of available discount offerings. Additionally, RxLightning can automatically attach copay cards to applicable specialty medication enrollment forms, streamlining the submission process and ensuring the pharmacy dispenses the medication at the discounted rate. For example, a copay card can be attached to an enrollment, which can bring the cost of a drug to $10 a month, instead of $65.

Patient Assistance Programs

Patient Assistance Programs (PAPs) are another way for manufacturers to support patients and drive medication adherence. Similar to copay discounts, PAP programs help patients afford high-cost specialty medications. However, while copay programs are often available to anyone, PAPs are typically reserved for people who are uninsured or designated as low-income. Financial documentation, including tax forms or pay stubs, are typically required to confirm eligibility for a manufacturer PAP – which can bring the cost of the medication to zero.

One of RxLightning’s most common use cases is enabling the delivery of digital PAP forms to manufacturers. Instead of 2-4 weeks, care teams can find electronic versions of PAP forms within the RxLightning portal, complete the forms, collect patient and provider signatures, and submit to the manufacturer – all within a matter of minutes. RxLightning creates a streamlined, automated process to identify when PAP forms are available, pre-qualify patients who may be eligible, enroll patients in programs, and ensure paperwork is no longer a hurdle in the process.

Foundations, Grant Programs, and the MedAccess Queue

One additional method may be available for patients to reduce the cost of care. There are numerous non-profit foundations nationwide that provide grants to pay for high-cost medications. These charitable organizations often receive donations to support specific disease states. For example, there may be an open fund – a pool of money – that can be allocated to help patients pay for liver cancer, osteoporosis, sickle cell disease, or HIV care. The challenge is that these pools of money dry up quickly, and can be difficult to apply for.

RxLightning solves this challenge through our Affordability Module and MedAccess Queue, which scour the web for open foundation programs and alert end-users when new funds open for specific disease states. In this way, a patient can continue enrollment – with the support of a copay coupon or PAP – but enroll in grant programs when they are available. This real-time look into available funding prevents the administrative burden that was previously required to find open funds across dozens of foundations. RxLightning removes the hassle for care teams and enables enrollment into funds directly within our platform.

Bringing It All Together to Support Patients and Providers

In order to most effectively support patients through the medication access journey, providers and care teams must be aware of – and be able to enroll patients in – a variety of affordability options. RxLightning integrates RTBC, copay assistance, PAP enrollment, and foundations into our MedAccess Ecosystem, creating a one-stop-shop for patient affordability.

With these tools, patients can be educated about the cost of their care and work with their providers to find the best financial assistance program possible. Meanwhile, providers can leverage best-in-class technology to enroll patients and support medication access. To learn more about how RxLightning’s affordability offerings can support you or your team, reach out today.