Patient navigating online health care
Patient navigating online health care

Improving the Road Map to Patient Support Programs and Reimbursement

By Alan Birch, Associate Director of Provider Solutions at Sentrex and Founder of Drug Access Canada

As a former Oncology Drug Access Navigator (DAN), I understood that my patients needed treatment urgently for their cancer, and they didn’t have time to wait for it. Nonetheless, I am well aware of the fragmentation in the reimbursement space that causes this complex process to drag on.

Often, manufacturers will provide “bridging” drugs through their Patient Support Programs (PSPs) until patients have coverage from a long-term source, such as a provincial drug program or group benefit plan. Unfortunately, even after drug approval, patient copays of 20% or more can remain as an unaffordable option for an $8,000-$10,000 per month medication, and patients may continue to receive assistance from PSPs for copays indefinitely. As a result, the system has become very dependent on PSPs in Oncology as well for other services that they provide, like nursing support.

Over the years, this has led to a large number of Oncology PSPs, which can be seen in the BC Cancer PSP Index. There are now dozens of PSPs for cancer drugs, and DANs use them every day to help patients. Each PSP operates independently and does not communicate among each other, which requires coordination by DANs when patients are on a drug regimen with two or more medications – occurring often in Oncology. This can be time consuming and frustrating for DANs. In response, I created Drug Access Canada, a centralized resource center to help health care providers (HCPs) navigate drug access in Canada that simplifies the siloed and diverse world of drug reimbursement.

Currently, Drug Access Canada focuses on Oncology, but it also includes content for other disease areas like Multiple Sclerosis and Cystic Fibrosis, where PSPs are also essential for initial, and sometimes ongoing, access to medication. The website’s database is exclusively for the use of HCPs; however, anyone can find helpful content such as training modules on drug reimbursement, links to important websites and videos that discuss DANs and reimbursement. To further support HCPs and streamline the PSP enrollment process, Drug Access Canada also offers fully digital enrollments for a robust list of PSPs through a partnership with OkRx. HCPs can choose the PDF paper-based PSP enrollment form for a specific PSP or enroll their patient electronically through OkRx’s online platform. These two resources simplify the HCP experience and make enrolling in PSPs faster and easier, while still allowing paper-based forms to be used if preferred. To find the appropriate PSP, HCPs just type the name of the drug being prescribed and they will be able to see all available PSP information.

For HCPs who are submitting prior or special authorization forms through group plans with insurers, there are additional resources available through the OkRx platform. OkRx has developed several resources for HCP and PSPs including an online claim form library that is already substantial and growing, as well as a technology solution that improves the process for preparation and submission of prior authorization claims through electronic prior authorization. These solutions cut down on the time needed to access and fill out claim forms, collect signatures and attach relevant medication records prior to submitting to insurers for review. As a result, decision time is reduced leading to expedited access to therapy for patients.

Drug Access Canada now also works with Haven by Sentrex. This recently launched Cancer Support Program acts as a single hub providing access to services for drugs from multiple manufacturers, i.e., multiple PSPs in one. This means less enrollment forms and paperwork for HCPs when they use Haven. HCPs only need to deal with one program for multiple drugs, which simplifies and speeds up communication. By combining PSPs together, combination therapies can also be sent to patients together, including supportive medications for side effect management. It is a one-stop-shop. Patients can also self-enroll for access to Haven’s support services if an HCP hasn’t enrolled them.

My goal in creating the Drug Access Canada website is that the resources on the site will alleviate some of the complexity of drug reimbursement for HCPs so they can spend more time with their patients. HCPs and patients can get the support they need by having everything together in one place. Drug Access Canada, OkRx and Haven are exactly what all stakeholders need in today’s resource strained and complex healthcare environment.

In addition to his role with Sentrex and Drug Access Canada, Alan Birch is a contributing member of the Simplify Prior Authorization initiative.

Thank you to Gold sponsors of the SPA initiative Amgen and Gilead, plus Silver sponsors AstraZeneca and Cencora/Innomar Strategies.

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