Feedback: What are some of your biggest challenges? #Advocates
After multiple phone calls, outreach's to healthcare facilities personally inviting them, and conversations with those wanting to participate in the Summit, validates this type of gathering was long overdue.
Once we connect with the person/team who is doing this work at the facilities (Navigating Access & Reimbursement), it has taken about 20 seconds to hear that relief on the other end of the phone that someone else can relate, and understands their language. We have received multiple responses and emails of the excitement for an event to finally come together.
Some of the feedback we have received from Advocates attending the Summit who are currently Navigating Access & Reimbursement.
What are some of your biggest challenges?
Having a conference to address the needs!
One of my biggest hurdles is knowing who my industry contacts are. Many in industry do not focus on the pharmacy and navigator team. They have a singular focus of getting the provider to write for their product and forgetting that if you don't have an ally in pharmacy, your product may not make it to the patient.
The manualness of the job, and the lack of communication between different departments
On a day to day basis, my biggest challenges include working with the insurances to the PA approvals/override, working with other specialty pharmacies, navigating where prescriptions need to be filled, and enrolling patent for copay cards.
Some of the biggest challenges are financially justifying the coordinator role and getting the support from healthcare leadership to obtain all of the tools needed to effectively manage a medication assistance program.
Navigating medical benefit vs. pharmacy benefit Navigating payer requirements and their own unique pathways Obtaining complete and accurate information from the payers
As a manager I would say my biggest challenge is staffing. The need for medication assistance is great, and it is a challenge to get positions approved for this team. I feel that we are just scratching the surface in each product line that we are involved in. Sometimes the biggest hurdle is getting the support from senior leadership to invest in additional manpower. Another challenge, is the level of awareness within our own organization of the existence of our program and the available resources that are out there that can meet the medication needs of our patients.
Some of our biggest challenges is finding ways to help patients cover the cost of their deductible, copay, and coinsurance. These seem to be getting higher each year and we see more and more patients struggling to make their medical bill payments.
A big challenge for me is the office staff and providers not understanding the process, and how to effectively support patients and get them started on therapy. Another challenge is the ongoing issue with insurance companies, of step therapy!
Having patient's meet the OOP to get free medications. Grants being closed on a regular basis for a specific disease state.
Payers don't always cover medications the patients need. HUBs / Hotlines: Usually a third party and often have a "one size fits all" Standard Operating Procedure (SOP). Case Managers often are not well trained and / or not allowed to think "outside the box", often delaying pull-thru on the medication. They don't always understand the coverage caveats of the meds if it's something they haven't worked on before. Specialty Pharmacies: There is often a disconnect between the SP, the hotline and the office to contact the patient for final shipment of the medication. At times, the shipment will fall thru because of this disconnect.
What do you hope to get out of the Healthcare Advocate Summit?
Finding out who all of my point of contacts are for the Manufacturers and Specialty Pharmacies. The phone is glued to my ear, and I know there has to be an easier way.
I am hoping to learn about what other pharmacies and health care advocates do to help their patients.
I hope to learn how other facilities help their patients with financial assistance. I feel like I’m alone out here with my team.
I and really hoping to network and meet new people from different areas of the healthcare industry. I want to give and get advice and be a part of a community that is making a difference
I don’t know where to start. I feel inadequate knowing there are all these resources out there and no process to implement them.
I hope to see advocates come together to network across the industry. Together, advocates can encourage pharma to increase look-backs, reduce the minimum copay, increase income limits, and make the enrollment process easier and faster for all. I'd like to hear how other institutions are coordinating their programs and what tools they are using.
What is your role?
Advocate, Medication Assistance, Manager Infusion Medication Access, Financial Coord, Pharmacy Director, Social Worker, Care Coordinator, Nurse Coordinator, Biologics Coordinator, Discharge Team, Infusion Pre-Cert Team, Revenue Cycle, CFO.
Medications you work with?
Orals, Injectables, Infusion (across therapeutic areas)
Manufacturers you work with?
At this time, we do not work with drug manufactures. It’s unfortunate but the patients are advocating for themselves. We know we need to take this on.
Amgen, AstraZeneca, Bayer, BMS, Celgene, Clovis, Dexcom, Genentech, Gilead, GSK, Horizon, Janssen, Lilly, Merck, Novartis, Osiris, Pfizer, Puma, Sanofi-Genzyme, Sun Pharmaceuticals, Takeda, UCB and more.
