Challenge

A specialty pharma brand in a highly-competitive market needed to differentiate its brand by reducing inefficiencies within the path from pharma to provider to patient. Its hub experience had to reflect the premium price and clinical efficacy of its products.

Because the brand was primarily reimbursed by physician buy and bill, it needed to pay close attention to the high cost of stocking the product and the uncertainty of being reimbursed; therefore, the brand focused on improving its ability to:

  • Streamline product ordering
  • Ensure product dispensed is billed by the practice
  • Give practice managers visibility to existing inventory
  • Help practice overcome reimbursement challenges with prior authorization forms and mandated specialty pharmacy fulfillment
  • Track patients target date-to-return to the practice to ensure the patient stays on therapy

Additionally, the brand needed to offer faster turnaround times for reimbursement support because providers were choosing product based on the speed of the hub service.

Solution

Careform designed, built and deployed an inventory management solution developed to the needs of busy healthcare practitioners.

After understanding common clinical workflows, a web-based application was built around the products’ unique clinical and inventory characteristics.

Four key modules were combined into a single interface; inventory management, patient scheduling, reimbursement support, and reporting.

Careform then developed a customized reimbursement program that offered the industry’s fastest service level agreement with 4-hour turnaround on benefit verification cases.

Finally, Careform added a white glove specialty pharmacy and prior authorization triage service which addressed the two most common reasons for unfilled brand prescriptions.

Results

Early adopters experienced an easy-to-use interface as part of a new all-digital experience tying together the product ordering; the dispensing to a patient; inventory tracking; benefit verification submission; and reporting

Practices using the program reported a 7% growth differential compared to practices that didn’t use the program.

The provider portal is utilized in 90% of benefit investigations versus the previous program, which was utilized just 30% of the time. This resulted in:

  • Reduction in cases submitted with missing or incorrect information
  • Faster turnaround time in processing prior authorizations
  • Secure messaging between providers and the reimbursement support team which lead to a significant reduction in support phone calls.
  • A 50% reduction in the average days necessary to fill specialty pharmacy orders

In its first year, the pharma brand team exceeded the targeted number of installations to more than 1000 clinics. To date, activations continue to grow exponentially.

The brand reports a 20% growth in reimbursement support services and almost no attrition to competing programs.

The sales force is focusing efforts on obtaining new business and uses the program as a wedge to gain a foothold in provider offices.

Key Initiatives

  • Easy-to-use inventory management system
  • Automated personalized workflows to aid in logistics
  • Consolidation fo software features into a single interface
  • New reimbursement program with industry’s fastest service level agreement
  • White glove prior authorization triage service