The reimbursement process for specialty chronic care medicines is particularly complex. Each insurance company has its own process for prior authorizations, benefits investigations, benefits appeals, etc., which adds an additional layer of difficulty once a patient has been prescribed a therapy. Physician practices and their staff aren’t always able to help patients with this process – in a survey of oncologists conducted by Cardinal Health in 2020, 81% said their staff were constrained in their ability to help patients with social needs, such as financial support. The result is that medication approvals can take longer than optimal, and patients end up waiting longer than usual to get started on necessary therapy.
One way that some pharmaceutical companies have addressed these challenges is with a Field Reimbursement Manager (FRM) program. At Cardinal Health Sonexus™ Access & Patient Support, Field Reimbursement Managers, also known as Access and Reimbursement Managers (ARMs), work as an extension of a manufacturer’s team and help to facilitate a smoother path to therapy for patients by educating administrative staff at physician practices about reimbursement processes. When evaluating the merits of an FRM program and determining whether to insource or outsource the capabilities, pharma companies should consider the following: