EPOS Healthcare Solutions’s Pharma Market Access services provide the administrative support you need to help your pharma clients’ patients receive the therapy they need quickly and cost-effectively. We remove barriers that can cause patients to abandon treatment or switch to another medication. Our highly trained, global workforce acts as an extension of your core group of stateside case managers to handle benefit verifications, patient enrollments, payer follow-up, and prior authorization support on behalf of your pharma clients.
Managing prior authorizations can be a resource-intensive, time-consuming process. Yet, it’s a process that is critical to the success of the case. EPOS Healthcare Solutions’s team of dedicated prior-authorization specialists can manage the entire process on your behalf. Our experts identify the authorization requirements for each patient case and then follow up with clinics, insurance companies, and manufacturers to get appropriate authorization in place so patients can begin their therapies. But we don’t stop there. When denials do happen, we can take care of the appeals process as well. We contact the payer to confirm the appeal documentation has been received and then continue following up until the appeal is approved or denied.
The popularity of high deductible health plans means patients now owe a larger portion of their healthcare costs. This financial strain can lead them to make difficult choices, especially for those needing expensive specialty medications—many of which have exceedingly high out-of-pocket co-pays. We believe cost alone shouldn’t be a barrier to receiving therapy or cause a patient to switch medications. Our Patient Co-pay Assistance service reviews the Explanation of Benefits (EOB) and submits a copy to the specialty pharmacy to reference and to determine the patient’s out-of-pocket costs. Using this information, we educate clinics and their key stakeholders on copay programs offered from pharma manufacturers. We act as a virtual sales force for manufacturers to liaise between clinic staff and the manufacturer to increase awareness of copay assistance programs available to patients.