Driving greater efficiency in free drug and assistance programs

February 2020

You likely wear more than one hat in your role, with responsibilities ranging from supply chain, payer and trade relations, to oversight of free drug and patient assistance programs. An innovative new platform developed by our colleagues at Cardinal Health Sonexus™ Access & Patient Support is helping to streamline patient access and has been recognized by industry watchers for its strategic and efficient approach to benefits processing.

In recent years, electronic benefits investigation (eBV) and electronic prior authorization (ePA) technology have been introduced to expedite the processing of insurance benefits and accelerate the delivery of care. Yet, while some eBV/ePA systems have effectively automated manual processes and reduced turnaround times, manufacturers using these platforms have continued to express frustrations. Cardinal Health Sonexus™ Access and Patient Support set out to build a better platform. The result is Benefit Source.

The Cardinal Health team leveraged their deep expertise in benefits and insurance requirements to write algorithms that help to expedite approvals. For example, a certain medicine may only be covered for a certain dose or a specific days’ supply, such as 90 days. By building those conditions into Benefit Source, Sonexus™ ensures that initial requests meet the requirements and are less likely to be unnecessarily rejected.

And, because Benefit Source connects directly to payers, the data provided back to manufacturers reflects real-time benefits coverage that it is accurate on all fronts—prescription data, insurance plan specifics, and treatment details. This contrasts with other eBV systems that use analytical tools and historic data to predict what a payer will cover, but don’t consider patient-specific factors, such as whether patients have already met their deductible.

Another advantage of Benefit Source is its scalability—the ability to perform benefits verification in large batches in very short periods of time. For manufacturers that perform annual reverifications on patients, this process can often decrease the reverification timeline by weeks, while significantly reducing labor costs. When applied to patient assistance program eligibility checks, the efficiencies are so significant that manufacturers are able to move to quarterly—or even monthly—reverifications without increasing their costs.

“Many of our hub services clients perform annual benefits verifications for patients who participate in their assistance programs,” said Tara Herington, Vice President of Sonexus™ Access and Patient Support. “By applying our Benefit Source technology, we can often decrease the reverification timeline by weeks, while significantly reducing labor costs. In addition, the quality of data delivered by our platform is typically higher because it connects directly to payer systems, rather than relying on historical data or manual entry.”

PM360, a leading trade magazine for decision makers in the biopharmaceutical industry, has named Benefit Source, the electronic benefits verification / electronic prior authorization (eBV/ePA) platform from Cardinal Health Sonexus™ Access and Patient Support, as one of the most innovative services of 2019.

To learn more about Benefit Source or the services of Cardinal Health Sonexus™ Access & Patient Support you can ask your CRM or visit cardinalhealth.com/sonexus