From Pain to Progress: Faster Benefit Verification for Specialty Medications

Healthcare professionals are generally driven by the same purpose: to help patients get the life-changing care and medications they need, as smoothly as possible. But for all the incredible advancements in medicine, going from prescription to therapy—from pain to progress—often feels like we’re stuck on pause. This is especially true for the complex, specialty medications that can make a profound difference in patients' lives.

The Manual Maze: Why We're Stuck on Pause

For life sciences companies, patient support programs are a vital lifeline, connecting patients to the help they need to navigate complex treatment plans and get access to medications. However, the care managers who help run these programs frequently encounter a significant challenge: manual benefit verification. 

Imagine a patient with a severe, chronic condition, eagerly awaiting a new medication that promises relief. Now, imagine their access to that medication being stalled by the following benefit verification pain points, almost as if someone hit the pause button:

• Endless Phone Tag: Care managers spend hours on the phone, trying to reach health plans or pharmacy benefit managers (PBMs). It's like a broken record, stuck in a loop.
• Missing Information: Critical information about coverage and out-of-pocket costs is unclear, buried in paperwork, or simply unavailable. The information flow just stops.
• Frustrating Delays: Days, even weeks, go by while patients wait for answers. They wait but nothing moves forward. When asked how long it should take to get a patient started on a new therapy, 95% of prescribers said it should take no more than six days. In practice, however, 18% reported that it typically takes a week or more.

These aren't just minor inconveniences. The manual benefit verification process represents a significant operational and human toll with additional work for prescribers and frustration for patients. Ultimately, manual verification can undermine the very purpose of patient support programs that are meant to get patients started on their medications.
 
As specialty medications become more sophisticated (and expensive), these inefficiencies are tangible barriers to care that impact health outcomes and erode patient trust.

We're all paused, stuck in a loop, and it's simply not good enough.

Time to Push Play: The Power of a Direct Connection

What if benefit verification could happen instantly, without phone calls or paperwork? At Surescripts, we believe it's time to push play and get things moving with a direct connection to the source of truth.

Our Electronic Benefit Verification solution is designed to eliminate these common friction points, transforming patient support into a streamlined, patient-first experience that benefits everyone in the healthcare ecosystem.

Here’s what Electronic Benefit Verification can do for patients, prescribers and life science companies:

• Accelerate Time to Therapy: We help patients start their prescribed therapy sooner by making it easier for care managers to verify their pharmacy benefit coverage and out-of-pocket costs without faxes, phone calls or analyzing past claims.
• Empower Patient Support Programs: With accurate benefit information seamlessly arriving from health plans and PBMs, patient support programs are equipped with real, actionable data indicating whether a medication is covered and how much it will cost a patient. Because information is arriving directly, no extra information is needed from prescribers.
• Seamless Integration and Security: We connect care managers at patient support programs to pharmacy benefit information directly within their existing workflows. This ensures data stays secure from end to end, minimizing disruption and maximizing efficiency. No hitting rewind because of lost information or repeating steps.

We’re moving beyond the pause button, pushing play on efficient processes and fast forwarding to a healthcare system where patients can access the care they need, when they need it, with the support they deserve.

This is the future of patient care and it's within our reach.