Compassionate Patient Care Simplified Sampling Single-Source Patient Access

Single-Source Sample Management Fast, Efficient Sample Fulfillment Strategic Reimbursement Services

Compassionate Patient Care

The Problem

A young child was diagnosed with a rare disease. After a series of tests and surgery, practitioners determined that the only effective treatment was an expensive medication, which cost $24,000 per dose. The family's insurer, however, denied payment. The patient required one injection a day, with each vial of medication lasting one week. Therapy was to continue over a six-week period.

The Solution

The child's physician contacted HealthBridge, which immediately began to investigate options. The HealthBridge Internal Verification group determined that the patient was denied service coverage because of plan restrictions and formulary limitations. HealthBridge, however, worked with the insurance plan administrator to override the plan limitations and cap benefit amounts, leaving the family with only a $25 co-pay per fill and refill.

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Simplified Sampling

The Problem

A sample operations manager at a pharmaceutical manufacturer with a field sales force of 500 determined that the company's representative carry-sampling program could be more effective. The traditional sampling program demanded unique operational requirements for each brand and required representatives to spend significant time reconciling, waiting and organizing samples. The representative carry-sampling program also increased the need for internal staff to handle sample reconciliation and manage operational processes. The client wanted a solution that would reduce expenditures needed to meet regulatory requirements while minimizing risk. In doing so, the client was looking for ways to increase the efficiency of the sales force.

The Solution

The client decided to implement a direct-to-practitioner sampling program to simplify their sales and supply chain processes. HealthBridge designed a customized approach to meet the unique business requirements of each brand. HealthBridge provided detailed client operating specifications to implement the programs while meeting regulatory requirements and eliminating the administrative burden of managing samples from the representatives. Upon implementation, the client simplified its sampling programs and achieved its goals:

• Saved more than over 65% in total costs compared to representative carry sampling program
• Increased sales force effectiveness and efficiency
• Obtained the same representative access to practitioners
• Minimized regulatory risks

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Single-Source Patient Access

The Problem

A pharmaceutical company manager spent endless hours trying to successfully manage several patient assistance programs with multiple vendors, including a separate pharmacy vendor. Each program had unique operational requirements, different delivery dates, particular eligibility qualifications and access parameters, unique reporting styles, various billing routines, and other specific requirements for each vendor. Without a central focus for the management of the programs, business rules were not consistently followed. This resulted in wasted resources, operational inefficiencies, redundancies and increased costs.

The Solution

The client decided to consolidate these programs through a single source – HealthBridge patient access solutions. We mapped out a strategic, customized approach for merging the programs and streamlining the requirements. By combining both the front-end and back-end processing, patients and practitioners could call a single number to access the reimbursement hotline, insurance verification, alternate funding, co-pay assistance, patient assistance application processing and product fulfillment.

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Single-Source Sample Management

The Problem

A pharmaceutical client anticipated significant challenges as it prepared to launch a controlled substance particularly since its 500-member sales force would be using the sample-carry method. This approach greatly elevated the company's compliance risk due to the nature of product. With only six weeks until product introduction, the client sought a way to proactively manage its samples, as well as to monitor representative activities.

The Solution

HealthBridge provided a single-source solution for sample management, shipping samples directly to representatives and initiating sample accountability measures. The client was able to monitor all activities through the HealthBridge sample operations portal, an online tool for ordering, tracking and managing sample inventory. In addition, HealthBridge streamlined and managed all vendors whose services supported the launch, including printers and paper suppliers.

As a result, the client was able to launch the sampling program three weeks ahead of schedule. The timely and efficient implementation strategy saved the client more than 40% in development costs. In addition, the client was able to identify non-compliant representatives by analyzing program data found in the sample operations portal.

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Fast, Efficient Sample Fulfillment

The Problem

A pharmaceutical manufacture developed a new product which had the potential for "blockbuster" success in the highly competitive market. To capitalize on this window of opportunity, the manufacturer needed to get samples of the therapy into the offices of more than 70,000 primary care physicians quickly. Along with the samples, the manufacturer wanted to deliver a targeted clinical message to practitioners and their patients.

The Solution

HealthBridge designed a multi-dimensional sampling approach to help increase market share for the manufacturer. The program featured both "sample-carry" and "sample-send" methodology. HealthBridge likewise helped to generate prescriptions by enabling the physicians to re-order samples through easy online order forms. The program targeted high prescribers for representative-carry sampling, and provided education materials to ensure patient retention and adherence.

Relying on this aggressive approach, HealthBridge responded with speed and efficiency, shipping more than 350,000 units over a three-day period. As a result, product samples were in the hands of the most important physicians first, helping to capture critical market share quickly.

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Strategic Reimbursement Services

The Problem

A manufacturer of an orphan pharmaceutical injected product that had been on the market for 50 years with more than 50 indications (most off-label) decided to change distribution from retail to specialty pharmacy. Since patients would no longer be able to get the product at a local pharmacy, the manufacturer needed a program to protect their market share while the patients transitioned to the specialty pharmacy process.

Along with the change in distribution, the manufacturer significantly increased the price of the product. The manufacturer anticipated delays in getting patients on therapy and the product reimbursed while payers loaded the new pricing information and began requiring prior authorization for the product.

The client's objective was to re-launch program services, recognizing that outreach was needed to ensure patients, practitioners and payers were aware of the new program model. At the same time, the client wanted to maintain continuity of care, anticipating hospital discharge delays because of payer concerns about the price increase. The company was also concerned about the impact of positioning the product under the pharmacy benefit instead of major medical within such a short window of time.

The Solution

HealthBridge identified a five-pronged strategy to assist the manufacturer:

• Build a HUB model that would ensure cases were turned around in a timely manner and that relationships were built with key opinion leaders in the marketplace. Install a multi-tier and regional team approach to the HUB so that payer, practitioner and pharmacy work happened concurrently, which allowed the cases to be moved along expeditiously.
• Give high-prescriber offices access to dedicated HUB personnel at admission providing more time to process payer and pharmacy reimbursement-based tasks.
• Work strategically with payers to educate them on the price increase and shift to pharmacy benefits; confirm that payers have the manufacturer's product on their urgent drug list in order to turn approvals around in a timely manner.
• Coordinate conference calls with stakeholders to explain the HUB model and customize casework based their discharge process.
• Recruit expert reimbursement specialists and deploy them into teams and regions. These individuals are selected because they display the ability to troubleshoot on the spot and move cases ahead while requiring limited oversight.

The innovative HealthBridge approach reduced benefit investigation and prior authorization turn-around times by 50%. The client was also able to sustain market share within a disease state they forecasted would not be profitable for them, based on the service offerings of the HUB. In addition, the manufacturer was able to maintain referral levels despite the price increase and significant changes to the distribution program.

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