Digital Access Plus Expert Provider Support Enhances Specialty Brand Drug Access and Accurate Prescriptions

Providers who prescribe advanced therapies are having greater success by initiating the process through a prescription access platform that can streamline the patient’s start on therapy.

Yet, many providers are uncertain about the specific insurance details required for complex therapies, which can lead to delays due to incorrect submissions even if e-scribed through a digital access platform.

Insurance plans often have stringent criteria for covering high-cost branded medications, starting with the prescription details and extending to additional clinical data required for utilization management processes like prior authorizations or step therapy. Proper prescription intake is essential for a smooth experience for both healthcare providers and patients, and is crucial in achieving high adoption and coverage rates for brands in pharmacies.

A prescription qualifying for brand coverage should comprehensively include:

• Patient's full name and birth date, accurately spelled

• Exact medication name, strength, dosage, and administration route

• Instructions that are consistent with the drug's approved indication

• Prescribed quantity and refills adhering to the plan’s limits

• Clear indication for “dispense as written,” “brand name only,” or “no substitutions”

When submitting through a prescription access platform, the prescription often accompanies the insurance company's prior authorization request. This should include essential clinical details to determine coverage eligibility, typically comprising:

• Patient's full name and birth date, accurately spelled

• Exact medication name, strength, dosage, and administration route

• Instructions that are consistent with the drug's approved indication

• Prescribed quantity and refills adhering to the plan’s limits

• Clear indication for “dispense as written,” “brand name only,” or “no substitutions”

One of the services that Gifthealth offers in addition to its digital platform is a dedicated account management, and field team that can support prescribers and manufacturer’s existing team to enhance the quality of written scripts. With a combination of digital access and human prescriber support the following enhancements are being realized:

• Understanding insurance requirements for specialty brands is a significant challenge for physicians, so it is crucial to educate prescribers on the correct submission of prescriptions through digital access platforms, addressing queries about insurance coverage and PA requirements to ensure submission of high-quality prescriptions, and automating as much as possible for them.

• The integration of provider field teams with digital prescription access platforms is vital. These teams are knowledgeable about the details needed to ensure a script fill, the digital platform’s role in success, benefits of patient support programs, and details of copay programs.

• The digital access platform should streamline the PA process within the prescribers existing workflows, pre-fill required forms with available clinical information, and monitor the full patient prescription journey to ensure the inclusion of necessary information and patient support.

Improved Fill Rates: By eliminating inaccuracies and omissions that lead to denials and require resubmission or appeals, field representatives can ensure medications are dispensed without barriers, avoiding the need to switch to alternative treatments.

Quicker Therapy Access: Keeping prescribers informed about insurance coverage prerequisites eliminates frustrating delays in accessing patient medications, often caused by incorrect patient information.

Increased Prescription Coverage Rates: There is a direct correlation between the quality of prescriptions and the successful coverage of branded therapies.

Enhanced Experiences for Healthcare Providers and Patients: A negative prescribing experience can negatively impact brand loyalty and patient adherence. Streamlined prescription processes through Gifthealth's digital platforms significantly improve adherence rates.

With the right prescription access platform and human support, brands can gain insights into the prescription process. This allows for performance monitoring and optimization of script quality at a national level. Armed with appropriate data, brands can effectively address issues, whether they be incomplete PA forms or missing ICD-10 codes, leading to improved patient access and overall treatment success.