- Provide patient support to get payer access to the prescribed drug.
- Patient support in enrolling for pharmaceutical company-sponsored patient care programs until the payer authorizes the prescription. These include exception, appeal, and prior authorization processes that help the patient access prescribed therapies effectively.
- Educate their customers and HCP regarding the issue of insurance.
The Pharma company-sponsored patient assistance programs connect eligible patients to numerous financial assistance programs. They offer insurance support, co-pay help, and reduced cost medication during the patient's wait time for accessing preferred programs that offer coverage for commercial insurance. Such interim support programs make the expensive drugs more accessible for the patients by using free trial offers and savings cards that reduce or eliminate barriers to costs in the coverage criteria of their insurance plan.
Reimbursement specialists are involved in solving patient-level reimbursement issues. They will directly deal with customer accounts, be a payer expert of the respective territories and accounts, a call center extension, and live one-on-one coverage support.
In a nutshell, the field specialists' work is actually to help patients in getting into support programs. Therefore, the field specialists do work in the direction of helping patients-thus, they ensure more and more patients get enrolled into the therapy that are prescribed. Measuring patient outcome contributes significantly to measuring performance of the field specialists.
Assessing patient results by looking at the fulfillment rate
This will be estimated, according to the US Food & Drug Administration, that at least 20 to 30 percent of new prescriptions are not filled at any pharmacy. Thus, prescription fulfillment rate can be measured to estimate health outcomes.
For example, let's begin with NTB fill rate. NTB fill rate is the rate that quantifies the percentage of patients being successfully onboarded for the commercial program of a treatment against the number of patients who receive the same drug prescription.
Here is an example:
Step 1: Determine the number of successfully converted patients from the overall NTB patients at an account per month level for several months. Here, a successfully converted patient is someone who was initiated on a commercial program or subsequently migrated to one after being placed on some other program.
Step 2: Determine the percentage of patients who were effectively covered.
As a result, 60.8% of the NTB patients in this example signed up for the commercial program for the recommended treatment.
Assessing the performance of subject-matter experts
Determination of the effectiveness of the field specialist is highly based on the answer to the following question: "Is there a field specialist who is working to improve patient outcomes with NTB fulfillment rate or otherwise?"
In particular, this measure will be critical in trying to determine the following;
- How has the activity of the field specialist contributed to overall NTB fulfillment rate?
- What is the potential for this field specialist's activity to increase the rate of fulfillment?
To calculate the perfect fulfillment rate at a customer account level, it is important to predict the percentage of converted patients to the total number of patients, who were prescribed a treatment. Some of the common hurdles are:
- the "definition of therapy."
- thus, the correct calculation and account of "fulfillment.
Formulations of treatments that require a single dosage regimen are easy, while those requiring multiple dosages need to be well defined to ensure accurate accounting.
For instance, a therapy may comprise of several combinations of intravenous (IV) and subcutaneous (SC) injections. Several combinations are usually benchmarked against the standard dosages in this scenario. The average drug adherence and persistence should be taken into account considering the most frequently used patient journey to cover most of these scenarios. Also, specific business rules must be developed for every patient who begins the therapy so that the best possible treatment plans may be generated.
After pre-identifying the prescription objectives, contributions of field specialists toward the achievement of the latter become very important. Some of the standard drivers of fulfillment rates include market access (through formulary tiers), class of trade for account, formulary access to drug, socio-economic factors, and field force activity. It should be noted that formulary access levels along with the class of trade are critical to measuring field specialists' activity sensitivity. All these factors have a "synergistic" effect on patient outcomes.
Finally, appropriate advanced analytics and AI/ML models could be developed to regress NTB fulfillment rates as a function of the independent variables listed above, including those drivers to measure field activity. Since the target is a percentage variable, appropriately selecting the modeling algorithm will be important in order to robustly predict the target.
It will be important to assess the amount and accuracy of field specialists' contribution to patient care and health outcomes. It will make a robust measurement of their performance possible. As mentioned above, this is possible only when we successfully benchmark the definition of therapy and we can measure fulfillment accurately. Other possible measurement methods may exist as well, such as determining whether:
- The field specialists could effectively bring success in the speed of fulfillment.
- The field specialist intervention and support improved drug adherence and persistence.