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Imagine a patient with a rare autoimmune disease is prescribed a specialty medication that has the potential to transform their quality of life. Yet, weeks pass before they’re able to start the medication as they wait for prior authorization (PA) approval from their insurance company, lost in a cycle of paperwork, phone calls, and follow-ups.
This delay isn’t just inconvenient; it’s a barrier to critical treatment. Specialty therapies often have stringent insurance requirements, making PA processes like this a regular hurdle for patients, healthcare providers (HCPs), and the teams that support them.
The good news is that technology is available to streamline these core processes. Purpose-built patient customer relationship management (CRM) solutions transform how biopharma teams manage the patient journey, automating complex workflows like prior authorization, benefit investigation, ongoing patient support, and adherence.
Courier Health’s leading patient CRM integrates disparate data and streamlines communication across stakeholders. It enables functions like field reimbursement managers (FRMs) to focus on what matters most—providing strategic engagement and support that helps patients with rare and chronic diseases access life-changing treatments faster.
Whether a biopharma company is looking to more effectively navigate patient support challenges or wants to enhance its workflow efficiency, this blog will dive into how Courier Health’s patient CRM streamlines the PA process.
Prior authorization requests remain a routine requirement in healthcare, especially for high-cost specialty medicines. Though hardly favored by everyone, the purpose of PAs is to ensure that prescribed treatments meet insurance coverage criteria, which often includes verifying medical necessity or exploring alternative options.
While this process is meant to help control ever-escalating healthcare costs, it can become a labyrinthine ordeal for patients, HCPs, and office staff.
The PA process typically involves the following steps:
This cycle can repeat for specialty medicines every 90 days, often necessitating follow-up lab work or doctor’s appointments.
Unfortunately, the PA process is rife with difficulties such as incomplete documentation, slow communication between the various parties, or administrative errors. These inefficiencies can leave patients and their loved ones, who are already stressed about their health, in limbo for weeks, unable to access the medications they so desperately need.
And this experience is more common than you might imagine. Per the American Medical Association, as many as 7.4% of all PAs in 2022 ended up fully or partially denied—an increase over 2019-2021’s 6%. While that may seem like a small percentage, when you account for 46 million PAs in 2022, that will result in nearly 3.5 million denials.
For patients with rare diseases, the stakes are even higher. Already under immense emotional and physical strain, they and their loved ones face added stress trying to understand and manage all the paperwork and appeals.
The main takeaway is that it often disrupts medication adherence, worsening health outcomes and compounding the turmoil during an already difficult journey.
In the biopharma field, there are CRMs, and then there is Courier Health’s patient CRM. Unlike more generic platforms, Courier Health’s CRM is purpose-built for field access and patient services, providing functionality to alleviate the administrative burden of the PA process and ultimately improve patient care.
These functionalities can be categorized as follows.
Courier Health’s patient CRM centralizes patient, provider, and HCO contact management, offering teams real-time access to all the critical information they need in one place, including patient medical histories, prescription information, and health insurance details.
Having a central command center for the patient journey information that health insurance companies typically request (including clinical data), biopharma teams can more proactively manage the PA request workflow, which includes coordination across various stakeholders. With relevant data and upcoming deadlines at their fingertips, they can proactively stay on top of PA requests as they arise, avoiding a pile-up of requests or a patient falling through the cracks of a delayed PA workflow.
With real-time data access, the process becomes significantly more efficient. This allows for faster approvals and reduces the back-and-forth communication typically involved in obtaining prior authorization. This not only speeds up the process but also improves accuracy.
Courier Health’s patient CRM for life sciences includes automation capabilities developed specifically for dynamic patient journeys and biopharma workflows. Instead of siloed SOPs or more manual task-based approaches, Courier Health integrates workflows across internal teams, HUBs, SPs, and more, automating repetitive tasks and flagging recommended action items that need more strategic intervention.
This streamlines the PA process, including flagging upcoming renewals and sending reminders to schedule necessary appointments or lab work. This frees up the team’s time to work on more strategic initiatives or dedicate more time to complex cases, helping them keep each patient’s health plan on track and moving toward the next milestone.
Communication tools are embedded in the Courier Health CRM, including phone, SMS, secure messaging, fax, and eSign to meet diverse prior authorization rules and processes.
This streamlines communication, making it easier for internal teams, providers and office staff, insurers, and pharmacies to interact. This integrated approach not only saves your team time jumping between systems (and you the time and headache of managing multiple vendor contracts!), but it paves the way for smoother coordination and faster approvals when medications require prior authorization.
Last but definitely not least, the Courier Health patient CRM uncovers patterns related to PA denials and delays. By identifying macro and micro trends, commercial leadership and their teams can more quickly address issues and provide targeted education and support.
For instance, identifying a low first-time PA approval rate or patterns of incomplete submissions from specific HCPs might prompt the team to strategically engage providers or their staff, offering guidance on proper PA processes to boost success rates. This data-driven approach improves collaboration and outcomes and ensures patients can start and stay on their specialty medications.
The Courier Health patient CRM has a proven track record of making prior authorization processes more efficient, leading to better patient outcomes and operational success for biopharma teams.
One rare disease biotech CEO reported on an earnings call that with Courier Health’s CRM, they completed more PAs in January 2024 than in the entire first quarter of 2023. This dramatic improvement highlights how investing in patient services and adopting innovative technologies can streamline workflows and boost productivity.
This example demonstrates how proactive investment in cutting-edge solutions like Courier Health can transform core workflows, saving time and reducing patient and provider stress.
As the unsung heroes of market access in pharma, field reimbursement managers (FRMs) spend their days navigating the complex pathways required to ensure patients can access specialty medications. Given the need for prior authorization for these treatments, FRMs can benefit tremendously from purpose-built technology that unlocks end-to-end visibility, streamlines processes and helps them improve the overall patient experience.
When companies choose a CRM, they should look for solutions designed specifically for biopharma that offer these essential features:
In addition, they should ask vendors thoughtful questions before selecting a CRM, such as:
Selecting the right vendor means finding one with a deep understanding of market access in pharma and the challenges FRMs face. The CRM should help FRMs transition from reactive problem-solving to interacting strategically and proactively with various stakeholders.
Courier Health’s patient CRM embodies these principles, equipping FRMs and their teams with the tools to simplify the prior authorization process, boost their productivity, and help more patients receive the required specialty therapies without delays.
Field reimbursement managers and their teams have a lot on their plates. Balancing the needs of healthcare providers, internal teams, payers, and patients to get specialty treatments to those needing them isn’t easy—especially given the manual workflows and fragmented data sources common in the biopharma industry. Streamlining key processes like prior authorizations is particularly challenging without the right tools.
Courier Health’s patient CRM stands above the rest, giving biopharma commercial teams the tools they need to be more efficient, collaborative, and proactive. Centralizing data, automating workflows, and integrating communications help FRMs manage all the complexities accompanying prior authorizations. This results in smoother access to specialty medications requiring prior authorization, improving overall patient health outcomes.
For teams who want to know how to speed up prior authorization for medication and optimize access and reimbursement pathways, get in touch.
True patient-centricity. Everyone says it, but few deliver. Upgrade your patient experience with Courier Health.
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