What biopharma companies need to know about annual reverification
The right partner will guide efficient and accurate execution
Every year, patients face potential interruptions in medication access when the benefit coverage year changes. This annual reverification (AR) period is a time when minimizing disruptions in therapy is important. Disruptions on a larger scale have the potential to create havoc for the patients.
A combination of high-tech and optimal-touch efforts will guide biopharma companies, like yours, through this complex process.
Minimize therapy disruptions
Ask yourself: Does your AR partner offer comprehensive and flexible services that leverage technologies to deliver the information patients and providers need at the moment they need it–whether that's a full explanation of benefits, the details of a patient's health plan, or the cost-share for a specific medication? AR helps to enable adherence by making sure that the transition from one plan year to the next is seamless.
Admittedly, the AR operation is complex, often requiring millions of touchpoints with payers and providers over just a few weeks. But for life-altering or life-saving products, avoiding a lapse in coverage can make all the difference. Advances in technology enable automation for many of those touchpoints.
Therefore, finding a partner with the right mix of technology and talent is essential. The right AR partner will offer relevant and consistent communications. Skilled team members who continually monitor progress and can pivot when necessary, reporting outcomes on a regular basis.
While expanded use of artificial intelligence and machine learning has automated many tasks, it's still critical to have team-member expertise that can step in when needed. A partner with expertise in both automation and the human element can complete even the most complex benefits verifications. If systems can talk to each other easily, frictions will be reduced. This drives the ultimate goal—getting patients on their therapies faster.
AR success relies on strategic planning
A common misconception is that AR takes place one month out of the year — January comes and everyone reverifies. The reality is that, for an industry leader like Lash Group, it's a year-long process. "Organizationally, we invest a lot in the planning stages of annual reverification to get us to a point that we can flawlessly execute," says Brooke McClain, Senior Director of Operations, Client Delivery, Biopharma Patient Services at AmerisourceBergen, who oversees one of the largest programs. "As soon as one AR season ends, the planning work begins for the next. And we're continuously applying lessons learned in order to improve year over year."
Agility is essential when reviewing AR partners to ensure they can flex with the needs of the business whether planned or unplanned. For example, can they shift to a fully remote environment as was required for the pandemic? "By going to a fully remote environment, we could also recruit nationally, which expanded the talent pool and minimized the chance of disruption if the central location were to be impacted by a natural disaster," says McClain.
Comprehensive and flexible services leverage technologies that make it possible to get the information you need at the moment you need it–whether that's a full explanation of benefits, the details of a patient's health plan, or the cost-share for a specific medication
People and technology working together for successful AR
The annual reverification process has evolved to include so much more than benefit verification. It's about improving access to therapy and preventing treatment disruption through a number of services and solutions, including patient education and patient assistance program renewals. Leading partners like AmerisourceBergen also provide outreach to patients ahead of the new year to talk to them about coverage options and make sure they understand the actions they need to take to ensure continued access to their medications.
AR also means more than headcount. Historically, this effort has meant hiring thousands of temporary employees to meet benefit verification needs. But as technology evolves, those on the leading edge have looked to what they can automate, leveraging solutions like digital assistants, artificial intelligence, and automated calling technology to complete AR programs more efficiently. In particular, digital assistants are changing what's possible for patient support programs by combining artificial intelligence, natural language recognition, and speech synthesis technology to place automated calls to payers — freeing up more time for patient counselors to manage complex cases.
When evaluating potential partners, remember it's not just about the technology or even the associates on the phone. It's the entirety of the experienced team, who know how to address large volumes and anticipate changing dynamics. Their knowledge is how we ensure patient access is being prioritized by which cases are handled first.
The secret sauce, says McClain, is flexibility. "We can do AR in a way that isn't so labor-intensive or costly. Automation allows us to introduce efficiencies and some cost-effective options for clients. But where we also shine is our ability to be flexible and adaptable. We meet the needs of the program in terms of mixing technology with talent to manage the increase in patient volumes."
The right approach
Look for an AR partner that offers advanced technologies, team expertise, and a willingness to flex and problem-solve for clients and patients.
Do they leverage everything they offer — from people, processes, and infrastructure to technology and experience — to deliver a right-sized solution to offer far more than business as usual?