Case Study: Successful Program Transition for More Than 1,000 Challenging PAs on Day One

  • Post published:August 15, 2022
  • Post category:General
You are currently viewing Case Study: Successful Program Transition for More Than 1,000 Challenging PAs on Day One

How Premier Pharmacy Services was able to turn a potentially disruptive program transition into an opportunity to help 1,000 patients get and stay on therapy

Situation

  • A small pharmaceutical manufacturer with a medication that helps patients manage postherpetic neuralgia decided to terminate their program at an existing specialty pharmacy (SP) in their network and move the program to Premier Pharmacy Services
  • The terminated program included over 1,000 patients for whom the previous SP had been unsuccessful in securing prior authorizations
  • At the time of transition, only 40% of patients could use commercial insurance to cover the cost of their medication. The remaining patients were either on the manufacturer’s patient assistance (PAP) program or awaiting coverage determination.
  • The patients, seeking relief from chronic pain, were frustrated and desperate for help.

Transitioning our patients to Premier was our only chance for successfully helping them get access to their medication. I don’t know who else would have gone the extra mile to take on so many patients at once and provide such thorough care.

Pharmaceutical Manufacturer

The Premier Approach

  • Premier joined the manufacturer’s SP network in June of 2021 and immediately transitioned the other pharmacy’s 1,000 patients to their program.
  • Because of Premier’s unmatched scalability, they could seamlessly activate a transition team of Treatment Advocates that stepped in to answer inbound patient calls, make outreach to patients and prescribers, and start working on PAs on day one.
  • As a practice, Premier proactively prepares for a PA with each new prescription with a workflow that captures the holistic patient picture, medical history, and psychosocial factors that influence payer decisions
  • The Concierge Team moved quickly to reach out to the prescribing HCPs to build rapport, offer heightened communication, and secure future prescriptions.

Results

  • More than 60% of the transferred patients have now secured commercial coverage for their medication through an approved PA. (50% improvement.)
  • All patients were teamed with a single point-of-contact Treatment Advocate and had the option to participate in the text messaging communication program to stay current on refills, PA/Appeals statuses, shipment deliveries, etc.
  • In response to the program’s success, the manufacturer’s sales team has continually referred more and more prescriptions to Premier.
  • Patients managed by Premier refill this medication an average of 10 times.