Closing The Loop on Patient Engagement: Overcoming the PA Washout

By Dan Rubin, CEO

As pharmaceutical marketing has evolved from “selling pills” to assuring that medications actually get dispensed and taken by patients, many brands have layered patient engagement and support programs into the marketing mix to assist with a range of issues including patient education, therapeutic support, benefit verification, financial assistance, and adherence support. Many brands utilize a patient support program (sometimes referred to as a “patient hub”) as a single point of contact for patients to access these support services online or via 800 numbers. Beyond receiving general product/condition education prior to therapy initiation, patients frequently use these support programs to verify insurance coverage, understand whether prior authorization is required, obtain co-pay cards, or explore the potential availability of Medicare tier exceptions.

While patient support programs often claim to address patient access issues such as PA, they usually fail to result in high physician submission and approval rates. After performing a patient-specific benefit verification and determining that a PA is required, the typical action is to fax a PA form to the prescriber. Similarly, if the patient is covered by Medicare and might be eligible for a lower co-pay from a tier exception (TE), they typically fax the Medicare Coverage Determination form to the practice. In either case, practices frequently do not follow through on the PA or TE request due to the burdensome submission and follow up process required by the managed care (or Medicare) plan. As a result, the PA doesn’t get submitted and the patient gets switched to an alternative therapy or abandons treatment altogether.

One brand utilized an innovative program to drive more prescriptions by integrating a full-service PA support program based on the result of their benefit investigation. Prior to implementing this new program, the brand reported that physician PA submission rates were very low and when a PA was submitted, approval rates averaged around 50-60 percent.

Results. After implementing the new program, the brand saw significant increases in both PA submission and approval rates. Physicians submitted PAs more than 50 percent of the time after receiving a notification from the service provider. Over 42 weeks, physicians submitted a total of 952 PAs independently (without receiving any notifications). After receiving notifications, physicians submitted an incremental 4,967 PAs, with a 75 percent average approval rate.

Overall, the program resulted in nearly 4,000 incremental approved PAs, which translated into approximately 10,000+ incremental TRx’s. The brand’s return on investment in the program was sixteen to one, and more importantly, approximately 4,000 patients ended up receiving the medication their physician deemed best, instead of a substitute therapy or abandoning therapy altogether.

When left on their own, many practices will not deal with the cumbersome process of completing and submitting PAs. A service that makes this process more streamlined and less time consuming for physicians and their staff will lead to higher PA submission rates and more prescriptions dispensed.

Many pharma brands have already created patient support programs that address patient coverage issues.  Adding an effective PA service can be a small incremental step that yields large benefits from more patients on therapy, less physician frustration, and fewer prescriptions being substituted or abandoned.

The above is excerpted from an article by Dan Rubin, President and CEO, PARx Solutions, appearing on PharmExec.com. To read the complete article, please go to: http://www.pharmexec.com/closing-loop-patient-engagement-overcoming-pa-washout.