Readers Write: Surviving the Blizzard: How Technology Can Ease Specialty Medication Re-Enrollment Season

Surviving the Blizzard: How Technology Can Ease Specialty Medication Re-Enrollment Season
By Julia Regan

Julia Regan, MBA is founder and CEO of RxLightning of New Albany, IN.

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, which is 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 challenges in medication access. Most common adjustments include updates to a coverage policy and a new prior authorization requirement, reset deductibles, the end of co-pay 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 immediate 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 is a necessity.

To accelerate the benefits verification process and reduce the resources and costs required, providers should understand which plans, manufacturers, FRMs, and hubs they may be working with, and proactively collect as much information about coverage changes and patient health changes so that re-submitting paperwork can be more nearly seamless. Additionally, teams should communicate with patients early to understand who may be changing plans, alert them of potential upcoming requests such as signatures required and plan details, and support them through this confusing time.

While many programs transition on January 1, enrollment or PAP forms are often available 1-2 months ahead of time, enabling teams to 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.

There will always be a need for real people to manage some of the more complex patient 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 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 form with no missing information, greatly reducing the risk of a downstream issue in the application.

Another important step that can be streamlined with technology is (re)confirming the patient’s insurance and completing an eligibility and benefits check. Instead of manually scrolling through documents on a plan’s website or calling a representative to confirm coverage, real-time connectivity can accurately display a patient’s plan details while providing insight into cost and restrictions required, reducing time spent confirming details and allowing 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 by the desk to collect a signature. Instead, consent can be collected remotely in a matter of seconds.

As mentioned, with deductibles, co-pay, and PAP all resetting, it is essential for technology to surface affordability options that can support patients, whether through long-term PAP enrollment, 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. Using this technology can greatly fast-track certain patient cases over others.

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, personalized, and error-free than ever before.

With a thoughtful plan, innovative technologies, a robust ecosystem, and proficient staff, Blizzard Season can require less resources and time, enabling what matters most, consistent care with no lapse in medication access.