In a recent survey, 82% of patients prescribed a specialty medication reported spending an hour or more on the phone trying to coordinate access to their therapy.1
Individuals living with a chronic health condition often experience challenges that can delay access to prescribed therapy. Here we discuss how specialty pharmacies like BioMatrix help patients obtain timely access to treatment.
Patients benefit from accessing prescribed therapy quickly. According to a survey of health industry professionals, 70% felt there is room for improvement in speed-to-therapy initiation.2 Specialty pharmacies help patients receive their medication in a timely manner by promptly securing necessary insurance authorizations, identifying resources, reducing out-of-pocket costs, and providing access to specialty medications.
Prompt Therapy Authorization
Specialty pharmacies can help cut through the red tape of coverage issues. We employ staff who are very well versed in specific health conditions. They use their knowledge to promptly obtain authorization for therapy and resolve coverage issues. We ensure patients understand their specialty medication insurance coverage, conduct comprehensive benefit investigations, help with prior authorizations and appeals, and coordinate care to help patients quickly begin therapy and maintain access to their specialty medication.
Regina Valenzuela is an Intake Manager with BioMatrix. She shares, “Navigating healthcare coverage can be difficult. I help patients understand their coverage while working with insurance plans to obtain timely authorization for prescribed therapy. My contribution is to listen, provide clarity, and facilitate prompt access to therapy.”
Reducing Out-of-Pocket Cost
Living with a chronic condition is costly. When patients have to pay high out-of-pocket (OOP) costs for their treatment, they’re more likely to skip optional care and delay critical care. This leads to both poorer treatment outcomes and overall health.
BioMatrix is committed to helping patients identify and obtain financial support so treatment can begin without delay. We help identify co-pay assistance programs and connect patients with the right resources for enrollment. From manufacturer co-pay programs to charity-based financial assistance, we provide resources and support to reduce financial barriers and help patients access specialized healthcare.
Out-of-pocket costs are covered for 93% of BioMatrix patients by either manufacturer copay or 501c3 foundation support, and 44% of BioMatrix patients have achieved $0 OOP associated with their prescribed therapy.
Diviesh Patel is the Pharmacist-in-Charge at our Totowa, New Jersey location. He notes, “Patients with chronic or complex conditions often need additional assistance managing the equally complex social and financial issues that can stand in the way of better health. My number one goal as a pharmacist is to advocate and help remove those barriers wherever I can."
Many specialty drugs are not found at local walk-in retail pharmacies. Due to the complexity of these medications and the unique situations faced by the patients prescribed them for treatment, specialty drugs require more resources and support at the point of dispensation than the medication found at your neighborhood pharmacy. This includes specialized shipping and handling, advanced packaging, unique patient education, home-nursing support, and specialized monitoring. Research shows specialty pharmacies are successful in helping patients adhere to therapy, identify utilization or dosing mistakes, and avoid unnecessary hospitalizations.3
Joseph Hensley is the Pharmacist-in-Charge for our Charleston, West Virginia location. He asserts, “Communication is the key to helping people effectively manage their health. People with chronic health conditions are going through a lot. My role as a pharmacist is to communicate empathetically and help patients understand how to manage their therapy so they can live a healthier life.”
Specialty pharmacies help minimize medication access barriers. From gaining timely insurance authorizations, to reducing out-of-pocket costs, our job is to help patients safely obtain and maintain access to prescribed specialty therapy.
BioMatrix Specialty Pharmacy is proud to make a difference in the communities we serve, one patient at a time.
Our clinicians and support staff offer a tailored approach to every therapeutic category, improving quality of life for patients and producing positive outcomes along the healthcare continuum.
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References
Cover My Meds. (2021). 2021 medication access report. https://insights.covermymeds.com/medication-access-report
Duey M. (2013). Speed-to-Therapy Insights in Specialty Pharmacy. Pharmacy Times. https://www.pharmacytimes.com/news/speed-to-therapy-insights-in-specialty-pharmacy
Joo EH, Rha SY, Ahn JB, Kang HY. Economic and patient-reported outcomes of outpatient home- based versus inpatient hospital-based chemotherapy for patients with colorectal cancer. Support Care Cancer. 2010;19(7):971-978. doi:10.1007/s00520-010-0917-7
