New Models Of Benefits Verification Solve For Complexity, Accelerate Speed To Therapy, And Deliver Price Transparency

By Maria Kirsch, President, Patient Services, EVERSANA

Navigating health care insurance coverage can be a supremely convoluted process for anyone, especially patients or caregivers recently faced with coping with a life-threatening disease. While the advancement of many new treatments and scientific innovations in the form of “specialty drugs” has been invaluable in treating complex diseases, these conditions often muddy the benefit verification process even further by requiring complicated dosing regimens, burdensome administration methods and monitoring, and visits to different specialists. Additionally, there may be a multi-payer coverage landscape depending on a variety of factors such as administration route, commercial or government plan and accompanying requirements for therapy (e.g., physician administrations, surgical procedures and infusion supplies).

Medical benefit verification and expertise has long been considered the most complex arena to navigate for patients and health care providers (HCPs). Determining benefits and out-of-pocket costs for all elements inclusive of physician administration, infusion supplies, surgical procedures, nursing support, transportation, and lodging can be a time-intensive process and can slow speed to treatment. Current electronic benefits verification (eBV) tools only demonstrate a 60% success rate in estimating a patient’s financial responsibility. New technologies and models that tackle the obstacles tied to eBV are gaining traction and hold promise to increase speed to market, enhance price transparency, and grant each stakeholder access to online tools and self-service platforms.