![]() If a patient’s co-pay expenses are prevented from chipping in to the deductible, paying it off becomes an uphill battle. Co-pay programs are often the only thing getting patients through their out-of-pocket expenses until their coverage kicks in. High-deductible healthcare plans have become a fixture in our system, and the use of accumulators in HDHPs to prohibit co-pay programs from applying to patients’ deductibles only exacerbates difficulties for patients. To date, RxCrossroads has successfully overturned 42% of PA denials and secured more than $3.5 billion in co-pay assistance for patients. ![]() If the PA denial is upheld, RxCrossroads can help the patient identify other avenues to secure funding. If the PA denial is overturned, RxCrossroads will notify the pharmacy to reverse and rerun payment under the patient’s primary coverage, lowering the brand’s expense. Meanwhile, the co-pay claim data triggers a notification to a PA support specialist who attempts to resolve the PA issue. If a prior authorization is rejected, patients can enroll in the LoyaltyScript® program and submit co-pay claims, so they aren’t stuck without the treatment they need while they go through the appeals process. Through an exclusive integration between RxCrossroads’ LoyaltyScript® co-pay program and CoverMyMeds’ PA Reach℠ prior authorization technology, patients have a closed-loop solution to address the prior authorization cost barrier. Supporting patients with coverage alternatives is key to addressing this. This places additional burden on patients as prior authorization creates delays to starting therapy or results in denials. Addressing Prior Authorization Cost ImplicationsĪs the number of available medications to treat chronic diseases grows, an increase in the volume of prior authorizations (PA) is an inevitable response payers are using to control spending. Through machine learning that leverages proprietary data, RxCrossroads by McKesson has identified four principal affordability barriers and is tackling them with highly intelligent and targeted affordability program strategies. So, what can we do about it? Four things. Yet many biopharmaceutical companies are struggling to fund them, as external threats such as accumulator models and the ever-increasing cost of high-deductible health plans (HDHPs) make them less viable. ![]() The costs for chronic and specialty medications are often cost-prohibitive for patients, making co-pay and affordability programs more important than ever. Large patient populations are cycling in and out of hospitals as they start and stop treatment plans they can’t always afford, adding pressure to an already-strained healthcare ecosystem. population living with chronic diseases,¹ our system is being put to the test. Unless patients can afford the medications they need, we don’t have a healthcare system that works - and with more than half the U.S. Data intelligence unlocks doors for patients who can’t afford their medications. ![]()
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