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Field Reimbursement Managers Are Your Frontline
Sep 13, 2021
Often, the “last mile” of the circuitous access and reimbursement journey is the most challenging to navigate, especially when it comes to expensive specialty therapies. Long after the evidence has been presented, the price negotiated, and the contract signed, providers and patients still need to be reimbursed by payers for the treatment. This final step is just as critical to a product’s success as earlier dealings with payer organizations as two out of three patients are unable to navigate controls.1 The answer to addressing these challenges is leveraging the support of a specialist: The field reimbursement manager (FRM).
The work of FRMs, which includes facilitating product fulfillment, addressing claim denials, coordinating appeals processes, and verifying the information on intake forms, is now harder – but more necessary – than ever. Payers continue to tighten their controls with the use of step-edits and labyrinthine prior authorization requirements. Meanwhile, high unemployment rates and the loss of, or changes in, health insurance coverage exacerbated by the COVID-19 pandemic, have made it difficult for many patients to afford their medications.
The reimbursement frontline
FRMs work every day on the frontlines assisting providers in resolving reimbursement challenges that can be barriers to patients receiving the full benefits of their treatment plan. FRMs act as liaisons between providers, patients, payers, field sales, and the patient hub. Their intervention and expertise allow providers to spend more time providing quality patient care throughout the product lifecycle. This is particularly important during the launch period when proactive education can ensure the accuracy and completeness of intake forms and reimbursement information.
In time, assuming that payer policies and the competitive landscape are stable, this work moves to supporting office staff and practice managers remotely.
The impact of the COVID-19 pandemic
Providing proactive education and one-on-one support has been particularly challenging during the COVID-19 pandemic. Healthcare providers (HCPs) and office staff have been overwhelmed with the need to enact guidelines and practice safety protocols all while attempting to resume normal patient loads. These factors have added administrative time and burdens to overwhelmed offices who were already spending less time with patients.
COVID-19 has only solidified the need for FRMs to be advocates for providers and patients as they struggle along the reimbursement journey. FRMs help patients gain access to medically necessary treatments sooner and communicate with other stakeholders to secure financial assistance.
Support for support staff
FRMs perform their services best when they have the right information and tools at their disposal. By using a suite of data sources and applying dynamic insight generation, teams can segment HCPs based on personalized education and support needs. This requires teams to be armed with real-time policy information, secondary medical and prescription claims information, and appropriate HUB and patient support program data to enable proactive communication that meets provider-specific needs. Only then can they create and deliver effective education materials to support providers and patients.
1 IQVIA Launch Analyzer for Market Access, 2013-2020
Enable continuous access to treatment
Read more about Dynamic Deployment for Access and Reimbursement.