OCTOBER 20239TECH OUTLOOKplans are sold primarily to self-funded employer groups as a cost saving measure. The plans are designed to exclude some or all specialty drugs from their formulary so the patients are considered uninsured or underinsured so that the alternate funding vendor can help the patients apply for needs-based charities or assistance. Whether these funds are provided by charitable donations or direct manufacturer-sponsored assistance, resources are finite, and the unintended outcome is that these plans may divert assistance from patients who do not have other resources available. Biopharmaceutical manufacturers should monitor the combination of payer coverage outcomes for their products and PAP application volume to assess impact to their brands.Reimbursement support, especially for new product launches, to verify insurance coverage, prior authorization and/or formulary exception processes continue to be essential services in the oncology therapeutic area. Oncology offices leverage reimbursement support to work through challenging cases, including prior authorization denials and claim appeals. Oncology has been a key area hit by the massive healthcare turnover in recent years, resulting in some oncology practices relying more on patient service programs for core services, like benefit verification and prior authorization assistance, in addition to the typical challenging cases that they have historically submitted.The staffing issues that oncology providers are experiencing also affect their ability to support patients and provide education. Biopharmaceutical manufacturers are being looked at to provide more educational support to help patients understand their therapy and disease state and provide resources and referrals to other patient support organizations. This has become an even more essential safety net as an increasing number of patients may not receive educational support directly from their oncology providers.Patient services and the required support from biopharmaceutical manufacturers continue to evolve to meet the needs of novel therapies, such as CAR-T treatments. This requires a broad approach to patient services, requiring a patient service team with a combination of oncology, insurance, healthcare provider office management, specialty pharmacy, and patient service experience to support oncology providers and patients as they navigate these innovations and disruptions. Supporting patients with financial hardship continues to be the primary service that oncology offices depend on biopharmaceutical manufacturers to provide, for both uninsured and underinsured patients
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