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Evaluating the modern field reimbursement and access program: key considerations

By Amerisourcebergen

How do pharmaceutical manufacturers create a field reimbursement and access program that addresses the challenges patients and providers face today?

Today's field reimbursement and access programs provide support throughout the product lifecycle. For example, during the drug launch phase, a manufacturer needs to develop strategic product messaging, supported by access and reimbursement services that address both provider and patient access barriers. This need for field-level support to providers continues during the first few years after a launch when flexibility to adjust support levels and education activities is most critical.

Here's how to identify a field reimbursement and access program that's up to handling the challenges manufacturers face today.

Find a partner who understands the needs of manufacturers and providers

Manufacturers must educate providers and build awareness of new drugs while keeping them abreast of reimbursement and access requirements. Providers need to understand payer coverage requirements, how to access product and patient support information, how to navigate payer websites, and more.

A field services program can support these needs while building confidence and trust on the provider side. Ideally, look for a program that provides:

  • Close collaboration with case managers who staff reimbursement and access support hotlines
  • Field tools, such as billing and coding tip sheets, miscellaneous J-code instructions, and in-office educational sessions
  • Customized training options that suit your provider relationship needs
  • Experienced associates who can effectively build relationships with your providers and their staff as well as provide impactful education on your reimbursement and access support programs

Establish a compliance framework

For all the transparency the Physician Payments Sunshine Act (PPSA) and HIPAA provide, it's just the beginning.

A modern field reimbursement and access program will allow you to partner with policy and reimbursement experts to develop legally compliant education and programs that support providers, distinguish your brand, and align with other access initiatives.

Efforts should include user-friendly, compliant reimbursement and access education and/or tools that support providers and staff to navigate the evolving landscape of coding, coverage, and access.

Review PHI-handling practices

Providers know they must safeguard protected health information (PHI), and they want any manufacturer teams they work with to adhere to the same standards. While the sales relationship is typically firewalled from access to PHI, other types of field roles, such as field reimbursement and access specialists, often view PHI in the normal course of business as they support providers. Therefore, a robust set of engagement rules that guides the activities of the field team as well as the safeguarding of PHI is a critical element of a successful field team.

Manufacturers should work to ensure that any field reimbursement and access program prioritizes federal privacy regulations, such as HIPAA, when crafting the team's engagement rules. In addition, it's important to comply with state laws, such as the California Consumer Privacy Act (CCPA), and monitor emerging legislation at the federal and state level.

Look for post-pandemic strategy

The role of the field reimbursement and access specialist has changed as COVID-19 has progressed, and it's not just limited visits to doctors' offices. For example, patients are facing new challenges to medication access during the outbreak. Some populations face an increased risk of poor medication adherence and the subsequent impact on their health.

Manufacturers can play an essential role in ensuring access by focusing on the patient experience and potential barriers, as well as the needs of providers. This can include expanding patient assistance programs, setting up portals where patients can learn about and enroll in patient assistance programs, and streamlining benefits verification processes.

Learn more

Find out how to incorporate essential field services into your access 
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