50% of patients struggle to adhere to prescribed treatments. This is particularly concerning for patients who take specialty medications required to treat complex chronic conditions such as cancer, multiple sclerosis, and rheumatoid arthritis—as they are often expensive and require specialized handling and administration.
This is why annual reverification (AR) is essential for pharmaceutical manufacturers. It helps them support patients in continuing to use these life-impacting medications. A successful AR season enables you to enhance patient satisfaction and improve retention rates. There are proven best practices to identify and select a reliable AR partner who can streamline the process while ensuring compliance and patient satisfaction. Read on to better understand what an excellent partner brings to the table, the dangers of poor partner selection, and a case study highlighting results of the ConnectiveRx team’s work with a top five biotech client.
What is Annual Reverification?
Annual Reverification is the systematic process of confirming patients' insurance coverage for prescribed medications as plans and policies change yearly. AR season typically runs between January and March. It involves verifying benefits, identifying plan changes, and ensuring that providers and patients are informed about their current coverage status. For HCPs and patients, AR can mean the difference between continuing the prescribed treatment plan or facing poor health outcomes due to financial barriers put in place by payers.
Benefits of a Good AR Partner
Choosing the right annual reverification partner comes with a lot of advantages that can greatly benefit your brand(s). These include:
- Improved Patient Retention and brand drug loyalty: A reliable annual reverification partner ensures that patients' coverage is up-to-date and reduces the likelihood of treatment disruptions due to benefit changes.
- Enhanced Patient and Provider Satisfaction: With a streamlined AR process, patients, and their providers, are informed early about their insurance status, reducing any potential stress or uncertainty.
- Increased Efficiency: Working with an experienced AR partner who uses optimal technology and smart processes can help reduce administrative burdens and ensure due dates are met.
- Improved Data Accuracy: A good AR partner will have a robust system in place to verify benefits and detect any discrepancies or errors, ensuring accurate data for future reference.
- Reduction in Denied Claims: AR helps prevent claim denials due to coverage lapses, policy changes, or expired prior authorizations (PAs). This not only facilitates timely payments but also reduces unnecessary paperwork.
- Cost Savings: By avoiding denials or delays, your brand can save money by preventing wasted medications and resources.
What to look for in an Annual Reverification Partner?
Source: ConnectiveRx performance report. Comparison of client's prior vendor, primarily fax, vs. ConnectiveRx submission via BrandHub portal.
Having the right partner can help you cut through the AR "red tape" faster so that there is little interruption in a patient's therapy. Therefore, selection is critical. Here are the top qualities you should look for to help make your decision.
Strategic Planning
Successful AR requires meticulous planning. For example, at ConnectiveRx we begin our preparation in the first quarter of the year. Getting started early lets us better strategize when it comes to unique drug circumstances with payers, staffing, resource allocation, and collaboration with key stakeholders to develop scalable frameworks to handle all types of project volumes.
Process Improvement
A good partner will continuously seek ways to optimize the AR process, identifying bottlenecks and implementing solutions to enhance overall performance. For instance, once we've identified a payer who has long hold times, we'll start ‘stacking’ those cases and attempt to complete as many benefit verifications (BVs) on one call.
Technology Enhancements
Partners who utilize advanced technology like electronic verification services will significantly enhance the speed and accuracy of the annual reverification process. By eliminating the need for faxes or phone calls to enroll patients, you can now automate what once was a very manual process.
Hiring and Training
Ensuring that staff are well-trained for the AR season is essential. This entails seeking an AR partner that has an experienced Talent Acquisition team capable of recruiting volumes of highly-skilled Teammates. Additionally, AR leadership should provide comprehensive training to manage the influx of cases and foster the empathy and emotional intelligence necessary to navigate the challenges of AR season.
Experience in the Process
There is no real substitute for experience. Working with an AR partner that understands the nuances of myriad payer policies and is up to date on regulatory changes, ensures that processes align with the compliance requirements.
Client Case Study: A Strategic Approach to Drive Efficiency While Retaining Quality
For a top five biotech company with a vast portfolio of autoimmune disease brands, an inefficient AR process with another solution provider led to low provider utilization, creating delays in patient access to therapy. In order to avoid these delays, increase utilization, and complete reverifications by the company’s goal of mid-February, ConnectiveRx undertook a strategic approach.
Collaborating with the client team, ConnectiveRx AR and hub leaders set parameters around which patients qualified for annual reverification and, starting well in advance of the new year, messaged patients to opt-in for reverification while also providing clinics with a list of patients who qualified for AR. They also expanded beyond traditional AR to include Medicare Part D patients in Patient Assistance Programs (PAPs).
By evaluating patient data and leveraging an active field team that was working with patients, they could reduce the volume of patients to process (focusing on only those that were eligible for AR during this season) which was beneficial for their providers because it reduced the mountain of patient information they had to process as well.
The new AR process incorporated automation to make the process more efficient. System-generated messages for patient opt-in helped ensure patients were active in their overall journey, and an AI-guided voice response system to expedite benefits verification and navigate payer wait times – with a ConnectiveRx expert Teammate behind the scenes evaluating results and able to get on the phone in real-time if needed to ensure positive results.
Through this strategic AR approach, all patients who were eligible were reverified well in advance of the client’s deadline – having both their benefits verified and updates to prior authorization requirements. Less than 1% of all reverifications resulted in escalations and most importantly, patients experienced no interruptions to their therapy, despite increased utilization management (UM) requirements.
What are the Dangers of Poor Annual Reverification?
As you can see from above, inadequate reverification presents substantial risks that can affect both patient care and the operations of your drug and brand. Working with an inexperienced AR partner can expose you to several dangers such as:
- Medication Nonadherence: Ineffective reverification can result in treatment interruptions, leading to nonadherence to the medication, which may worsen health conditions and negatively impact the return on investment.
- Reputation Damage: Issues related to medication access significantly impact patient satisfaction, potentially leading to a loss of trust in your brand. A tarnished reputation can have long-lasting effects on customer loyalty and market perception.
- Diminished Revenue: As mentioned earlier, delays in the reverification process can create a ripple effect, resulting in postponed payments and cash flow challenges. This financial strain can hinder investment in research and development, ultimately affecting the company's growth.
- Compliance Issues: Non-compliance with evolving regulations and industry standards can expose pharmaceutical companies to substantial penalties and legal repercussions. Maintaining the highest standards is crucial not only for avoiding fines but also for ensuring patient safety.
ConnectiveRx: Your Winning Partner for AR Success
As the landscape of specialty medication continues to evolve, mastering Annual Reverification is paramount for a manufacturer’s continued success. By selecting the right AR partner and leveraging technology and expertise, you can ensure patients' uninterrupted access to life-saving medications. At ConnectiveRx, we work with our clients through every step of the process and provide the innovative solutions needed to stay ahead during AR season. Connect to one of our experts now to learn more.