2nd Quarter 2008

Benefit Reverification: Support Ongoing Access to Chronic Therapies through Annual Benefit and Coverage Confirmation

By Courtney Aubrey

As insurers continue to shift drug costs to patients, it is becoming increasingly important for patients who require chronic or long-term therapy with premium-priced drugs to confirm, at the beginning of a new benefit year, that they still have coverage and can afford their cost share. In addition to the potential for increased out-of-pocket costs, insurers also continually review and update their medical policies, which can mean changes in coverage or prior authorization requirements. Unfavorable changes in coverage or cost share could result in discontinuation of therapy or other negative consequences for patients. By offering a reverification support service for patients, manufacturers can help patients and providers navigate the changing landscape of insurance benefits and coverage policies to support continuation of therapy.

Features of a successful reverification support service include the following:

• thoughtful planning and communication about the service to providers and patients;
• sufficient time to prepare for the initiative, including adding research staff to an existing reimbursement support program, as necessary;
• a robust database and telephony infrastructure to handle the volume of research requests and related phone calls;
• detailed processes to manage workflow; and
• ready access to data regarding progress toward metrics.

Reverification services are complemented by the existence of robust reimbursement support programs for providers and patients. If an insurer changes its policy, the reimbursement support program can assist providers with prior authorization requirements, for example. If a patient experiences a change in cost share, program staff potentially can refer the patient to available cost-sharing programs [501(c)(3) foundations, rebate programs, etc.] or to alternative funding resources.

Covance has expertise in developing and providing reverification support that helps identify and overcome reimbursement barriers to continuation of therapy. In one recent example, Covance completed over 5,700 reverifications in 10 business days, meeting the objectives of the sponsoring manufacturer. If you have any questions about reverification, please contact us.