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How to Elevate Access and Reimbursement Support for Customers

  • Writer: SAKS Access Team
    SAKS Access Team
  • 5 days ago
  • 3 min read
Four hands are putting together four puzzle pieces, representing the blog post How to Elevate Access and Reimbursement Support for Customers

When a pharmaceutical company’s account management team gains favorable market access for a given product, the work is done, right? Not so fast. The product may have secured coverage and reimbursement, but are customers truly able to access the product with ease? Any friction that patients and providers encounter will act as a brake on uptake, even for products with favorable coverage and formulary position. This is why it’s crucial that brand leaders build a strong access and reimbursement program into their launch planning.


For this discussion, we will think of an access and reimbursement program as a program focused on supporting providers of buy-and-bill drugs covered under the medical benefit. This is a situation very different from a patient support program, where for a pharmacy benefit drug the priority is the patient experience. At SAKS Health, we offer capability in both these areas as part of a continuum of market access services that augment our clients’ path to success, including:


  • Access and reimbursement strategy & communications 

  • Patient support planning & execution 

  • Market research and insight generation

  • Market access/channel strategy & planning

  • Preapproval disease state & PIE communications

  • Value messages & development


It’s important to recognize that the strategy, narrative, and voice needed for a payer value proposition is entirely different from that needed for access and reimbursement communications. 


Yet it all falls under the heading of market access, so be sure your agency partner has the multidimensional capability you really need. Providing our clients with expertise and experience in all aspects of market access helps us partner with them to provide Better Healthcare Tomorrow™.


The focus of an access and reimbursement support program is on the provider who will be seeking reimbursement in a buy and bill scenario. Buy and bill is a highly complex dance filled with potential missteps and pitfalls. It’s essential that the program provide clear, helpful guidance for billing professionals and other staff to help them avoid claim denials or delays. 


A detailed coding and billing guide is a core resource for meeting this need. Sponsors can develop guides that list applicable ICD-10 diagnoses, HCPCS, CPT codes, and common modifiers. In addition, billing resources can explain how to bill under various payers—commercial plans, Medicare Part B or D, Medicaid, and specialty pharmacy arrangements. 


The basic coding and billing guide can expand to a full-on access and reimbursement resource. This is a comprehensive roadmap that covers the entire process, with information on ordering, enrolling patients in a support program, benefits verification, prior authorization and appeal, coding and submitting claims, and appealing denials. A well-designed resource will include examples of correctly completed claim forms, templates for letters of medical necessity and letters of appeal, and common pitfalls to avoid. Critically, it must be designed with an understanding of what the user will be looking for and empower them to make it easy to find. 


Providers want digital resources that are available for download from the brand or company website over printed materials. Make sure they can access critical information with ease. Field reimbursement managers should be equipped to email resources directly to their customers.


Manufacturers that invest in comprehensive access and reimbursement support not only facilitate patient access to therapies but also build stronger, more collaborative relationships with providers. Through well-crafted guides, educational tools, strategic pull-through efforts, and dedicated field support, manufacturers can help ensure that clinical innovation translates into real-world patient benefit.

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