5 Takeaways: The ‘New’ Electronic Benefit Verification

The electronic verification of prescription benefits isn’t “new,” exactly, but Surescripts Electronic Benefit Verification brings unique value to patient access programs. Here are five takeaways.

Electronic Benefit Verification was designed specifically to meet the needs of patient access programs led by life sciences companies as well as patient access vendors. These programs aim to speed patient access, optimize patient outcomes and address affordability.

But first, you’ve got to make it through the benefits verification process. Verifying patient benefits is typically the first step to getting patients started on the critical services that patient access programs provide.

Electronic benefits verification has been around for some time now, but most services don’t live up to the “electronic” in the name because they still depend on robocalls and faxes. Too often, case managers at patient access programs must pick up the phone to get the information they need to verify and enroll the patient.

The First Truly Digital Benefits Verification Solution

Case managers undertake benefits verification before enrolling patients and helping them get needed medications to treat serious conditions like cancer. The process involves checking a patient’s coverage and benefits with an insurance company or pharmacy benefit manager (PBM) before treatment to ensure reimbursement. Understandably, patients need to get started on therapy as soon as possible, but this process can stand in the way.

Until now, that is.

Electronic Benefit Verification replaces the fax and phone with one electronic solution built on the foundation of Surescripts’ interoperable network. We’ve dusted off the old and made it new.

1. Master Patient Index: Virtually all insured Americans are represented in our Master Patient Index, which means that case managers can get the patient-specific information they need.
2. Patient-specific information: Pharmacy benefit information is pulled directly from PBMs, with no need for past claims analysis, AI-generated estimates or the patient’s Social Security number.
3. Faster speed to therapy: It takes just seconds to receive patient-specific pharmacy benefit information. Paperwork is automatically populated and digitally processed. No faxing, no phone calls.
4. Better medication adherence: Research in the peer-reviewed journal Patient Preference and Adherence suggests that patient access programs have a positive impact on medication adherence. Electronic Benefit Verification bolsters this impact.
5. Reduced administrative costs: Streamlined intake and enrollment cuts administrative costs for life sciences companies.

As we partner and collaborate with life sciences companies and patient access vendors on Electronic Benefit Verification, we’ll scrub the friction of the fax, phone and paperwork to get patients started on treatment faster.