Editor’s Note: As the broader healthcare environment evolves from a fee for service environment to one that’s value based, life sciences manufacturers should follow suit. While extracting rebates and pursuing “at-risk” contracts from vendors and partners is not novel for the life sciences manufacturers, far too often manufacturers end up bearing a disproportionate share of the risk and receive little in return in the form of outcomes. This is particularly true when it comes to hub services providers where manufacturers are on the hook for the significant investments required to stand up traditional human driven hub services programs that are often limited in their effectiveness
The prior authorization process (PA) presents a significant (and growing) roadblock for healthcare providers trying to get a patient started on a prescription therapy they deem best. In general, a PA requirement affects patients' experience with their healthcare. It represents a length of time – and the associated frustration – they must wait to receive their medication or go without the treatment they have been introduced to by their provider and may desperately need
Editor’s Note: While innovation in healthcare has delivered tremendous advances in treatment options, the system is complex and disjointed, often in ways that adversely impact patient outcomes. Healthcare leaders have often turned to technological innovations to solve pressing challenges, yet, these solutions often fail to move the needle on the outcomes that matter. Why
Editor’s Note: With the convergence of rising operational costs, complex utilization management (UM) requirements, and healthcare consumerization, life science manufacturers are flying blind if they are not tracking every prescription from when it’s written until it’s either dispensed or abandoned. If brands are not leveraging this information to drive patient access strategy, they are at a competitive disadvantage as failure to do so adversely impacts the patient experience and gross-to-net (GTN). While most manufacturers recognize the value of such data, it’s typically hard to come by and challenging to translate into actionable insights
The use of prior authorization (PA) to control the utilization of prescription drugs, especially specialty medications, is growing, with 79% of medical practices reporting that PA requirements increased between 2021 and 2022. By design, the PA process is a barrier to medication access – it can leave patients waiting for days, weeks, or even months for approval, and coverage denial may occur despite a therapy being appropriately prescribed. The negative consequences of delaying treatment are well documented, yet more than 8 out of 10 patients still experience delays accessing their medications for reasons such as cost and insurance challenges
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