A look at the benefits of patient support programs for plan members, sponsors

With patient support programs providing a number of benefits for private plan stakeholders, ongoing digitization is likely to allow even greater connectivity and personalization for patients, physicians and payers in the near future.

During a panel exploring these initiatives at Benefits Canada‘s Face to Face Drug Plan Management Forum in Toronto on Dec. 5, Sandra Anderson, vice-president of consulting and business development at Innomar Strategies Inc., said patient support programs that are developed by pharmaceutical companies are designed to help individuals on a particular drug navigate through the system, filling in the gaps not covered by the health-care system.

Read: The pros and cons of patient support programs

This often begins with reimbursement — helping members understand their coverage — but also involves answering questions about drug injection, as well as how to schedule appointments and education. “Patient support programs are really there to help that patient through that journey, [to] monitor, support through a difficult time, to help them coordinate therapy and then follow them throughout their regime,” said Anderson.

In addition, she said, they also support the physician. “Physicians in specialty clinics have hundreds of patients, hundreds of files, hundreds of tests; there’s a lot of paperwork and so the patient program really facilitates that journey as well.”

Also speaking on the panel, Tania Gaetano, senior manager of program operations at AbbVie Inc., noted that while offerings such as reimbursement and navigation are standard among patient support programs, some have gone further to include value-added services. These include ensuring patients know how to take their therapy and also how to remain on their schedule, which helps them become more engaged with their therapy and understand the importance of adherence.

“Accessing medication is the first step, but learning to take it and stay engaged with it over time is how you get the clinical benefits,” she said.

Read: Panel explores solutions to boost adherence

Within the private payer industry, health case management services sponsored by insurers are also available to plan members. They offer some differences and similarities to patient support programs, which may cause confusion.

“Patient support programs support patients who are on the one drug,” said John Anacleto, director of payor relations at McKesson Canada. “As long as they are on that drug, they’ll support the patient, regardless of who their payer is in that situation. Case management, sponsored by insurance companies, supports the patient that [has] a specific disease.

“Case management has come in to fill in some of the gaps to manage a patient throughout their journey, as long as they remain with the same insurer and plan sponsor,” he added.

While Anderson noted the programs are complementary and each has the goal of ensuring adherence to therapy, she said communication with patients and physicians is key in order to avoid confusion.

For private plan stakeholders, the benefits of a patient support program vary, from reassurance to encouraging adherence to collaboration and information management.

“For the patient and the plan member, I see the benefit around having peace of mind, less anxiety, less stress, support in being able to navigate the logistics of needing these complex therapies, and peace of mind to be able to focus on the other things that are important in life,” said Gaetano.

Read: The costs, benefits of pharmacy services on private drug plans

It can also be cumbersome for patients to navigate policy changes related to reimbursement, and patient support programs are integral in helping them through the process, said Anacleto.

For plan sponsors, patient support programs can help ensure a drug is being delivered to a patient, that they’re taking it correctly and that they aren’t wasting it, noted Anderson.

In terms of trends to watch, while patient support programs were previously more focused on adherence, they’ve evolved in recent years, added Anderson, noting services are now increasingly centred on digital technology, providing physicians and patients with different ways to engage.

“With the evolution of digital, that connectivity of the patient with the family physician is really going to be a trend that we’re going to be evolving towards to make the physician circle of care more simple, but also for the patient and their family to be able to interact with their case manager virtually,” she said.

Ultimately, by using technology and focusing on health literacy, patient support programs are increasingly tailoring and personalizing the journey for patients, said Gaetano. “Patient support programs have begun focusing more on patient engagement, not just the communication touch points, but equipping the patient fully and holistically to be able to manage their therapy.”

Read more stories from the Face to Face Drug Plan Management Forum