One of the most challenging times of the year for providers, medication access staff, biologics coordinators, and other team members who support specialty medication onboarding is re-verification and re-enrollment season – aptly known as Blizzard Season.
While insurance selections are finalized and patients are counting down the days until the New Year, coverage modifications on the back-end can cause significant delays in medication access. Most common adjustments include: updates to a coverage policy and a new prior authorization requirement, reset deductibles, the end of copay assistance and patient assistance programs (PAP), or the selection of an entirely new insurance provider. Some of these changes can wholly prevent the continuation of medication fulfillment, while others – like deductible and financial assistance resets – may surprise patients enough to forego the ‘unexpected’ costs and adherence to their meds.
Manufacturers, hubs, and patient support groups often hire small armies of workers to meet the influx of benefits verification demands, but this model is inefficient and expensive. While much of the work cannot be started until updated forms and insurance details are finalized, a robust Blizzard Season plan and digital technology are necessary to alleviate undue burden during this frenzied time.
Preparing for the Blizzard
In order to accelerate the benefits verification process and reduce the resources (and costs) required, teams must prepare well before Blizzard Season begins.
Stakeholders should understand which providers, plans, manufacturers, FRMs, and hubs they may be working with, and proactively collect as much information as possible about patient coverage and health changes – so that re-submitting paperwork can be more seamless. Additionally, teams should communicate with patients early to understand who may be changing plans, alert them of potential upcoming requests (signatures required, plan details, etc.), and support them through this confusing time.
While many programs officially transition on January 1st, enrollment or PAP forms are often available 1-2 months ahead of time, enabling teams to understand what information is required and get a head-start on the re-enrollment process. With the right plan of attack, as well as the right technology, Blizzard Season can be more efficient and straightforward.
How Technology Can Help
There will always be a need for real people to manage some of the more complex patient onboarding cases wherein new coverage restrictions, financial assistance, or prior authorization is required to continue a patient’s care regimen. However, a significant portion of re-enrollments and re-verifications can be streamlined by using various types of technology.
In many cases, the first step for re-enrollment is finding the appropriate medication or PAP paperwork, and completing the paper form correctly. While this may seem simple, completing thousands of paper forms is a tedious and error-prone task. With new digital enrollment technologies providers and care teams can be assured that they are completing the most up-to-date forms, with no missing information – greatly reducing the risk of a downstream issue in the application process.
Another important step of the process that can be streamlined with technology is (re)confirming the patient’s insurance plan and completing an eligibility and benefits check. Instead of manually scrolling through thousands of pages of documents on a plan’s website or calling a representative to confirm coverage, real-time connectivity to insurance databases can accurately display patient plan details while providing insight into cost and restrictions required. This automated process considerably reduces time spent confirming information, and allows stakeholders to move on to more complex steps of the process.
Next, collecting consent. While patient and provider signatures are necessary to re-enroll for a specialty medication or PAP, with the click of a button, email and SMS notifications can be sent to appropriate stakeholders to securely sign documents from wherever they might be. No waiting until the next ‘in-person visit’ or ‘stop-at-the-desk’ moment to collect a signature – instead, consent can be collected remotely in a matter of seconds.
As mentioned, with deductibles, copays, and PAP all resetting, it is essential for technology to surface affordability options that can support patients – whether that is long-term PAP enrollment, ad hoc foundation or grant support, or short-term low-cost options that a patient can receive in the interim (while their specialty medication enrollment is being finalized). With an interconnected network of coupon and discount providers, care teams can easily identify and communicate with patients about affordable options that are available to them.
One of the most time-consuming tasks of the re-enrollment process is filtering which patients are qualified for PAP or financial assistance programs. Major credit check companies now allow technology vendors to connect into their systems to provide real-time insight into income and credit score – enabling an initial verification of assistance eligibility. Combined with pre-seed questions, stakeholders using technology can immediately filter eligible patients and fast-track certain patient cases over others.
Clearly there are many areas where technology can support stakeholders through the Blizzard Season slog. Luckily, RxLightning’s robust solution suite can support each and every stage of this journey, from completing digital enrollment paperwork to selecting patient affordability options. By leveraging innovative technologies, interconnected systems, and automation to alert and support teams through re-enrollment steps, Blizzard Season can be a more personalized, successful, and error-free experience.
The Future of Medication Access
The unfortunate truth is that manufacturers, hubs, patients, and providers all have work to do to complete a specialty medication re-enrollment successfully. However, from digitized forms to automated eligibility checks, and digital consent collection to real-time notifications, the process to re-enroll a patient is more streamlined than ever before.
With a thoughtful plan, innovative technologies, robust ecosystem, and proficient staff, Blizzard Season can require less resources and less time – enabling what matters most, consistent care with no lapse in medication access.
To learn more about how RxLightning can support your team through Blizzard Season, reach out today.
As seen on HIStalk