Getting the Most Value from Manufacturer-Sponsored Reimbursement Support
One of the most vital roles of the oncology practice manager and financial assistance staff is managing patient affordability issues for oncologic therapies. Preventing patient sticker shock is essential to avoiding any disruption of therapy and the imposition of additional emotional burden on the patient and family. Unfortunately, studies show that acute sticker shock—manifesting as prescription abandonment or failure to fulfill a prescription—is increasingly common among patients who are prescribed expensive oral oncolytics, where copays can amount to hundreds or even thousands of dollars per prescription.1 Prescription abandonment rates are particularly high among Medicare patients, who comprise approximately 50% of all patients being treated for cancer and whose out-of-pocket burden for medication costs are up to 3 times higher than those of commercially insured patients.2 For practice managers on the front line with patients worried about the affordability of their therapy, this aspect of the practice management role is becoming increasingly burdensome and difficult.
In July 2012, Reimbursement Intelligence (RI) surveyed a national sample of oncology practice managers working in medium-to-large oncology practices. The goal of the survey was to identify the impact of patient financial issues in the selection of therapy, and the specific resources that may be needed by practice managers to assist them in managing these patient affordability issues that are encountered on a day-to-day basis. Almost 70% of the practice managers surveyed agreed that a patient’s financial burden can impact the choice of therapy (Figure). More than half of the practice managers (52%) said that they have experienced physicians writing 2 or more different prescriptions for a patient, with the final treatment selection made after insurance coverage and out-of-pocket costs have been determined. These findings suggest that practice managers and office financial staff are an essential touch-point for pharmaceutical representatives to provide information about programs and services that are available from the manufacturers to support access to and affordability of their products.
Manufacturer Reimbursement Services: No “Easy” Button for Practice Managers
Although virtually all manufacturers offer and promote the availability of extensive reimbursement support services for oncology practice staff, the RI study showed that practice managers had widely varying experiences with the quality, timeliness, and value of these services. Practice managers, most of whom reported they typically spend 30% to 50% of their time on activities related to obtaining patient reimbursement, place the highest value on services that can save them time and actually streamline the process, such as information or assistance with all aspects of precertification or information about the breadth of a company’s offerings for copayment assistance.
In actuality, a majority of practice managers reported that manufacturer reimbursement support hotlines or online portals often fall short of expectations. Wrote one practice manager, “Either you can get the forms for the right plans, or they’re not in the format I need to be able to file them online.” Company sales representatives who call on practice managers and financial assistance staff were described as “well-intentioned” but were not able to provide detailed or accurate information about key reimbursement support services, such as copayment assistance programs for underinsured patients.
Practice managers were sometimes frustrated by their interactions with company support services, and more than half of the practice managers surveyed reported that they had shared negative experiences with a manufacturer’s patient assistance program with a physician or other practice staff.
Manufacturers Striving to Better Support Oncology Office Staff
Oncology product manufacturers are becoming increasingly aware of the importance of expedient and effective reimbursement support as a key component of their overall customer service offerings to patients and practices. As a result, manufacturers are investing in research and training to enhance the support capabilities of their field sales representatives as well as the representatives that staff their toll-free assistance hotlines for practice staff. Practice managers can support the manufacturers’ efforts by providing regular feedback to company representatives about their reimbursement support needs and wants, as well as share their personal experience with the manufacturers’ support services. When difficult reimbursement situations are encountered, practice managers should ask for support from a manufacturer’s reimbursement specialist, who is specifically trained in resolving problems and expediting support. By becoming vocal self-advocates for their professional needs—and for the needs of patients—practice managers can better access optimal support from pharmaceutical manufacturers.
About the Author
Rhonda Greenapple is the founder and CEO of Reimbursement Intelligence, a research and consulting firm based in Madison, New Jersey.
1. Streeter SB, Schwartzberg L, Husain N, Johnsrud M. Patient and plan characteristics affecting abandonment of oral oncolytic prescriptions. Am J Manag Care. 2011;17(Suppl 5):38-44.
2. Clinical Oncology News. http://www.clinicalon cology.com/ViewArticle.aspx?d=Solid+Tumors&d_id=148&i=April+2011&i_id=720&a_id=16928. Accessed July 10, 2013.