Health Insurance Hacks: Overcoming Medication Coverage Hurdles (Recording)
This webinar was recorded on September 24, 2024
How can healthcare providers help patients overcome health insurance barriers to medication access and medical care? What do patients need to know to ensure they can obtain — and afford — their prescribed medication? This webinar provides tools and strategies for overcoming barriers to medical care. It also addresses how Medication Access Coordinators can help patients. We are joined by Melissa Paige, President of the nonprofit National Association for Medication Access and Patient Advocacy (NAMAPA), who will discuss NAMAPA’s new Medication Access Coordinator training program.
Speaker:
- Melissa Paige, CPhT
President NAMAPA
Melissa’s unwavering passion for the well-being of patients fuels her relentless pursuit of breaking down access barriers and advocating for the highest quality of care. Her life’s work revolves around making health care more accessible and compassionate for all, leaving an indelible mark on the industry she serves.
As a recognized expert in patient access programs and navigation, prolific public speaker and educator, Melissa applies her unique set of medical related knowledge, diverse pharmaceutical expertise, and leadership skills to oversee and coordinate process improvement projects that enhance business models and redesign workflows for improved efficiencies. Her passion for the patient drives her to break down access barriers and seek avenues for the highest quality care.
CE is not available for this webinar.
Special thanks to Amgen who has provided funding support to make this webinar possible.
Transcript: While this transcript is believed to be accurate, errors sometimes occur. It remains your responsibility to evaluate the accuracy and completeness of the information in this transcript. This transcript is not intended to substitute for professional medical advice.
Lynda Mitchell: Will go ahead started. Hello, thank you for joining us today. I am Lynda Mitchell, CEO of allergy and asthma network. Welcome to this afternoon’s webinar. We have Melissa Paige as today’s presenter. I have a few housekeeping items. Everyone is unmute today. We will continue to keep everyone on mute as we go through the webinar. We will record the webinar and post it on our website in a few days. You can find webinars on our website if you go to our homepage and scroll to the bottom of the page. You will see the most recent webinars and upcoming webinars there. This webinar will be one hour in length, including time for your questions. We will take those questions at the end of the webinar, but you can put them at any time in the queue and a box in the panel. Someone will be monitoring the check — monitoring the chat if you have questions or technical issues. We will get to as many questions as we can before we conclude the webinar. We will be offering continuing education credits but we do have a certificate of attendance for anyone who may need one. We will put it in the chat and we will follow-up with an email a few days after the webinar and include a link to the certificate if you need it. Let’s get started. Today’s topic is health insurance tax, overcoming medication coverage hurdles. How can health care providers help patients overcome health insurance barriers to medication access and medical care? What do patients need to know to make sure they can obtain and afford their prescribed medications? This webinar provides tools and strategies for overcoming barriers to medical care and addresses how many — medication access core knitters can help patients. We are joined by Melissa Paige, president of the nonprofit organization National Association for medication access and patient advocacy, known as NOMAPA> Melissa Paige’s unwavering passion for the well-being of patients fueled her pursuit of breaking down access barriers and advocating for the highest quality of care for each of them. Her life’s work revolves around making health care more accessible for all. You can find from knowing Melissa. As a recognized expert, prolific public speaker, Melissa provides her medical related knowledge, diverse pharmaceutical expertise, and leadership skills to oversee and coordinate process improvement products that enhance business models and redesign workflows for improved efficiencies. Her passion for the patient drives her to break down barriers and seek avenues from the highest quality of care. I want to thank Amgen who has provided funding support. Thank you for being here Melissa. I will turn it over to you now.
Melissa Paige: Thank you. Thank you for inviting me. I know that the bio is pretty long, but I think if we were to sum it up, I don’t like hearing the word no for my patients. We had to create a lot of infrastructure, organizations, and teams to be able to not only help myself and my team that I was on, but everybody who is dealing with these access hurdles. It doesn’t matter which therapeutic area on here. It’s access is a problem and denial and prior authorizations and terms that may keep us up at night. I am excited to be here. My name is Melissa Paige. I am the president of the national Association of medication access and patient advocacy and by trade am a licensed pharmacy technician. A very passionate licensed pharmacy technician making sure that we take care of our patients and everyone who came through my door at the hospital and all of my different roles. A couple of disclosures. I mentioned about the nonprofit that we started and I’m the co-CEO of the health care advocate Summit. That organization is a one time a year of that for these medication access coordinators. We will go on to the different roles that can encompass. What do I do, how do we support, and what do our organization support? It is from the physician to the patient. Anything to do with access, coordination, barriers, getting that treatment. Can it be affordable? Can I get the re-up? All of these things when you are diagnoseed or you had to let your patient know about a treatment or dual therapies, solutions that they can start and stay on that treatment. So, the National Association of medication access and patient advocacy, our mission is empowering health care advocates by providing a collaborative community focused on resources to navigate medication access and support. So, as we go through we will start on base level information overall. Some tools and solutions. Also education and guidance that we have put together with a lot of help from other health-care care workers, advocates, sponsors, and support that our free resources and tools for you. Almost like your phone a friend. I didn’t have that when I was working in a basement in an office with no window trying to help patients. Overall, I will go over some education. You may know about these things. You have heard them unsure.
Just — you have heard them I’m sure. Just to go through. Prior authorizations. What is a prior authorization? Prior authorization is the process where the health care providers must obtain approval from a patient’s insurance company before prescribing a specific medication or treatment. What I didn’t realize is that there are so many terms of what this can be called. It may get confusing. Per payer or the form, but the process may be called prior organization — prior authorization, pre-service review, precertification, prior approval. It is the step that you need to take either for your patients or as a patient to make sure that the insurance is going to authorize the treatment that has been prescribed. I started on this because the prior authorization I dealt with, I worked in an infusion site and others, I prepared my patients that it would be denied. Something usually gets denied. If I’m already preparing for the denial and what are the next steps, if it got approved the first pass they were excited. But you got a denial. When we would get the denials, and at some point during the treatment the insurance might deny coverage for your patient’s medication or care. If this happens, you will get a denial letter explaining why and what steps to take next. You may be able to appeal the decision, ask for coverage that the doctor prescribed. There are different rules for appeals depending on the insurance type. Usually, you can appeal twice. Once through the insurance, an internal appeal, then through an outside organization, external appeal. The denial letter is the recipe for the next steps. It might be one page or eight pages. It may not have a lot of information, but you always have to make a phone call. The denial letter will explain this. Your patient will get this as well as the doctor’s office or whoever initiated that. I would have my patients if they had questions call the service line as well. When I got a denial, is this really a denial? Are you denying me? Really? I would read the information carefully.
Some of the common mistakes that we’ve seen on an initial request is the incorrect insurance or benefit. Incorrect provider or ordering service — or service rendering. Incorrect dates, incorrect units, incorrect diagnosis codes or missing therapies. Once you checked all of that and you read through the denial carefully — look at it. Is it a request for information? Records? If it is a denial, what are the next options? Does the patient need to sign a consent? How much time do I have? The timing portion is how I would triage the patients on that. How quick do I need to make sure that the information is sent in so that my patients can have that right? With new therapies that came out, I will add a tidbit, I knew things would get denied because there are no policies in place. I am filling out a blank prior authorization form where it says, put the drug here. If it was a competitor drug, trying to enter the same things that the other drug was asking for their authorization. Really, sometimes I will let you know on our end we knew that it would get denied. I just needed to speed up to the peer-to-peer. There are ways to expedite. Sometimes I would expedite the denial process because I needed someone to talk to the insurance, especially on new approvals or new therapies, or even new indications. On searching for medication assistance programs, there are a lot of programs out there. Our patients and your patients are probably searching for them, googling them. A lot of them are spam. A lot of them are services that charge patients money to fill out a form for them that you may already do in the office. We already advise our patients to call us, let us know.
Part of this is how medication access core Nader’s can help patients. These are pretty high level buckets of tools and resources out there. I advise from medication assistance programs that you have different stakeholders coming in from har — from pharmaceutical companies and you have pharmacy contacts. A pharmaceutical company I would say come you got your key account manager or sales. The ones coming in educating your physicians. Clinically you may have on label off label discussions or if you need to get additional studies there is the clinical person. There is also a person I call my phone a friend I have on speed dial. I make sure who can speak HIPPA to me. Who can speak about my specific patient if I fill out the application of who can help me assist with the authorization. What are they qualified for. Those roles go by a lot of different terms. They are called field reimbursement management. I have heard area reimbursement managers, field reimbursement access directors. Every pharmaceutical company has a different name. Everyone is coming in. I joke, you all look the same. Everyone is dressed to the nine’s, really nice suits. I don’t know who can help me in my role. My physician has clinically made that decision on what they want our patient to be on. Now, I need to carry the ball across the line. The quickest way for me to find if I had new therapies or new indications come in, my offices were close to the sales people because they need to have additional information. I would ask, who can speak HIPAA to me? From your organization with the appropriate authorization, who can help me? The resources have been great. They understand the payer policies. They can do things of helping us with education. We are doing all of the work at the office, not the ones filling out the forms for you. Now, why patients may not seek financial assistance. They may not understand their health care benefits, including
all of these words: deductibles, co-pays, out-of-pocket maximums. All of these terms that we see, acronyms on the bottom of our insurance cards. Patients may have information overload trying to remember all of these aspects of care. Being diagnosed or hearing these drug names or hearing I need to be on an injection, inhaler, infusion. What came to our patient’s minds is, how much is this going to cost? Is there a generic? A lot of medications may not be available as generic. We always let the patients talk with our physicians. Get the diagnosis. If they may not be ready to talk about that information, at least introduce yourself and say over the next few days I will be talking and we have a lot of great resources to help see what you can qualify for, what your out-of-pocket will be. We are here to guide you. They are here to hear they have an advocate in the office or someone in the family that will help have these discussions. You will pulse check that patient, their caregiver support as well. Patients may not be aware that medication assistance programs exist. A lot of offices don’t know what kind of assistance exists. Or if you have that type what else can you get?
Patients most likely to need financial assistance. Financial assistance can mean a lot of things like free medication, co-pay assistance, things to make sure that they can afford the cost of this treatment. The buckets that I put this into is you have uninsured, no insurance at all or no coverage that covers prescriptions. We have a lot of plans out there that are employer-based that are carving out these medication saying that they don’t have prescription coverage. Yet, there are ways to navigate that as well. Underinsured for infusions and injections. High out-of-pocket costs after insurance pays. Meeting hi deductibles. A lot of patients sign up for insurances based off of the cost of the monthly premiums. Sometimes lower monthly costs means a higher deductible. Hoping they may not need to use it. Depending on how the patient got that insurance or why they selected that, you are dealt the cards you have at that time as you get diagnosed. As you go into new enrollment or additional opportunities or change a job, there are opportunities to refine that. The patient needs to get on a medication. What insurance do they or do they not have. What resources are available. Underinsured for medication you take home, specialty medications. You may pick this up at a pharmacy.
You may get your specialty pharmacy your insurance is contracted with to ship to you. That is a lot of navigation. Someone tells you the cost. Sometimes with the pharmacies the way that I would educate my patients is always ask what assistance is available. Sometimes teams are trained that they have to hear some distress or a patient has to breathe a certain way or bring up something about cost before they can go into the other services. I tell them, let them know if they screen for assistance regardless if they have commercial insurance or not. A lot of patients don’t know. I make good money, I have commercial insurance, there are still programs for them. With patients who are in this underinsured for medication that you take home for specialty meds, the coverage may — these patients may need to pay for prescriptions at 100% to a certain point. Sometimes that’s a lot, especially on therapies that cost a lot. You have the patients currently employed and may not be able to work anymore or lose insurance coverage. You are on a drug, medication, treatment regimen, how will they have that quality of life to stay on their treatment? So, searching for available medication assistance programs. Every pharmaceutical company should have a website. Yes, sometimes they are hard to navigate. They usually start on the clinical page. There is some button that says access or patient access programs, patient support programs, reimbursement, affordability, patient foundation. Usually I advise the pharmaceutical companies to make sure that these resources are available to you, me, to everybody in three clicks or less. They are hard to navigate. Patients are going to the websites, too. They might have a patient-facing website that’s easier to understand at their health literacy rate and as well for yourself. As a medication access coordinator make sure that you look at both websites, because there might be resources or tools or other organizations or nonprofits that have these resources and tools to educate patients.
These are terms that I put on: patient foundation or keywords across the websites. For manufacturer patient assistance programs, you will hear words such as Quickstart, bridge, patient assistance program. There are other terms I will go into, but I thought that I would break down these three buckets as well. The Quickstart programs are for patients to access the medication immediately. Thank click start — think quick start without having to wait for an insurance authorization. It allows the patient to see if the medication is right for them. Usually it is a one-time supply medication. Every organization is different. You can really read that. These can be for medications picked up at the pharmacy that may be available in a voucher or a form. I’ve seen specialty meds that use of and ship it to the patient. Each program varies on the requirements and quantity provided. The Quickstart, what I advise offices is if you have certain medications in your practice, the common ones, see what programs they have two initiate or start that patient on therapy . There are a lot of ways that these programs, sometimes they come in vouchers that pharmaceutical sales had to give me or a website that maybe I can do it on behalf of the patient with their permission or with them in the office, or maybe I need to send a link or a text message for the patient to sign up. Maybe I need to send them a coupon. Good Rx is one.
You can initiate these things there. Once they do the quick start medication, it needs to go to the pharmacy or whoever is providing that medication, because there will be important information. The ID number, the vin number, the group number, anything that they need to run that in the pharmacy. It should show zero dollars or really look at the benefits on the quick start programs. Sometimes I see that it’s up to a certain value or dollar amount. The pharmacy it says start up to zero dollars. Sometimes it may only cover a certain amount, so there is actually still a cost to the patient. When you hear patients calling back, really see what the cost was of the medication at the pharmacy they were in. Also look at the benefit of that card. I never promise my patients that it is going to be zero dollars even if it says zero dollars because you could run into these things based off of the pharmacy, how much they are purchasing the meds for, things we don’t have control over. That is quick start. I love quick starts, easy enrollment, I can get the information, and I don’t have to wait for an approval process. So, the next term that we hear is bridge programs. This is meant to help prevent interruption in therapy. A patient has started on a medication. Something happened, an unexpected gap, loss of insurance, change of insurance, maybe the reauthorization didn’t come through or they are missing paperwork. There are two scenarios I’ve seen with the bridge programs and therapeutic areas. I touched everything in the infusion site, all the medications, including allergy and immunology. What I see is if you started on a certain treatment, let’s say treatment A, and then there is a gap of some sort. Treatment A will bridge you on their program. Sometimes it is one month fill up to three times a year. Because you can have gaps. Or three times in the lifetime of this product. Then I see bridge programs where it is, I started on a medication in this same class and it is not getting approved. I’m showing this was denied. Sometimes I need to show I’m trying for this new therapy in the same class that my physician wants to transition the patient for.
That medication, I’ve seen with bridge programs, say show me one denial or the last document down , when you submitted the auth, there are rules behind it. Is it more than seven to 14 days? Are you trying to go for an appeal? These programs are all different and all meant to support the patient’s. That is why I say from the field reimbursement manager, you don’t have to memorize everything or even really read the fine print if you don’t want to at first. Just make sure that you have contact with the field reimbursement manager to make sure that what you are reading and understanding, what is the intention of the program? Or, there’s always some telephone number that goes to a case manager. They call it hub, but every pharmaceutical company — sometimes through chat or software — you can call them to ask information about the programs. Just so you know, on the hub site, when you call they have 100 to 200 questions, frequently asked questions that they have talking scripts ready to go to make sure what they tell you is what the program is. As you are verifying these things, I’ve noticed depending on which hub it is — sometimes I call once, twice, or three times to make sure I get the right information before I tell my patient. The last bucket within this area is the patient assistance programs, also known as PAP. Pharmaceutical companies have programs that might be able to provide free medications to patients who cannot afford it. The eligibility is usually limited to uninsured or underinsured, medication denials .
There are a lot of pathways. Usually the patient has to make under a certain FPL, federal poverty level, to qualify for these programs. Each drug company has its own rules and applications and forms. What I have found with the patient assistance programs is that they really don’t publicize a lot of the information. If you meet the criteria, here is some black-and-white. If the patient makes a little over the federal poverty level I wouldn’t rule them out. I would exhaust every option that you have. I’ve been successfully, in our practice and others, make a phone call and say, yes, they are over the federal poverty level, but this is their yearly out-of-pocket medical spend for family. This is their income based off of — sometimes I have given a list of where the patient’s expenses are going to. I list the mortgage, really listed it down. I would even categorize these as some higher income patients. Just because you have a higher income doesn’t mean you have extra funding that you can pay for expensive therapies. As you or the office, there are programs available and you want to make sure that your patients have every option before you have to switch a treatment or maybe not go on that treatment because they cannot afford it, and that is not what we want. The other area that I see that’s easy to find a lot of the times is the co-pay assistance. When I hear co-pay assistance, ring it with co-pay assistance goes with commercial insurance. Don’t count your Medicare patients in here. On the co-pay assistance, it is private or commercially insured patients only. You will usually see on the fine print, not from Medicaid, Medicare, TRICARE. It is usually offered for brand-name medications. Without a generic equivalent available most of the times. Most of the time the co-pay assistance programs say, past low as $5. This could be for pharmacy benefit medications. They are picking that up and getting them shipped into them and self injection at home. The co-pay assistance is available for in-office treatments like infusions, injection therapies as well. The dollar amount, zero dollars up to this amount of money, I always throw in the caveat that we have to do a full benefit investigation to figure out how this co-pay assistance will help the patient. The last thing that you want to do is set them up for unrealistic expectations or the patient gets treated and they don’t have an option. I thought that you said this was zero dollars. They only get one month of treatment because they won’t go on it again. I try to let them know, overall, we are here with you and we will help you as we navigate through this. What you read in print, every pair is one — every payer is one and one program is one program. They all run differently. Charitable patient assistance programs.
These are foundation assistance through disease state funds. They are most frequently utilized to cover Medicare coinsurance is that are not eligible to be paid with manufacturer co-pay assistance. Read these foundation assista nts. I’ve seen a lot for travel assistance. There are other organizations that have a certain grant amount for the disease state, but you don’t have to use it on your medication. You can use your funds the way that you would like. AB towards your — may torture co-pays at your doctors office or balance. — maybe towards co-pays at your doctor’s office or balance. I will send after this so resources out there. There are probably nine top ones, but in this disease state that you guys are supporting there are a couple of them. On the foundation’s end, their goal is to spend all of the funding they get. They are always trying to get more funding for these certain therapeutic areas. They are saying we have a lot of patients who need help. They are trying to get donations into programs to help out your patients. So, medication access coordinators. This term can go by a lot of different titles. I’ve seen about 20. I only put a couple on here. I feel in this space that your teams are working on the term that I hearing a lot is Biologics coordinators. A medication access coordinator helps you get your medications, especially if there are challenges like high costs, insurance issues, their jobs may include working with insurance, they help get approvals, solve problems if insurance denies coverage, they help find financial help, they connect you with programs that may lower the cost of your medications, they coordinate with the doctors and pharmacies and make sure everyone is on the same page to make sure patients can get medications quickly, and provide support. They explain the process and help manage costs and paperwork and extra education. The other terms are patient assistance coordinators, financial navigators, financial coordinators, patient Access team members, patient advocates, financial assistance staff members. Overall, whoever is doing this role, and it may be the reception person or the person doing benefit investigations, this role is super valuable for you and your practice. If you are not investing in this because of funding and other things,t here our tools and resources that can help as long as you dedicate some time or a portion of a role to do this it will come back tenfold. Patients can come to your practice, you are getting paid, they come back the next time.
This is where I sat for 10 plus years in a large health system, eight in fusion sides and hundreds of thousands of patients doing this role. You get to know all of these different programs and you get to meet the field reimbursement managers to help educate you on those solutions. What can medication access coordinator’s help patients with? Medication access coordinators, they no specific costs covered, specific costs that can be covered, assist coordinate refills, answer questions, and they help assist on looking into other long-term solutions. When I had to have a patient get started — first, let’s get you started, but what is the long-term solution? Do we need to do a patient assistance program? Do I need to obtain free medication while your payer is getting this on formulary? Free drug is not the solution for all. It should be a last resource, because overall I want to make sure that my patients can use their insurance benefits and make sure that they can afford it and meet their deductibles. When you get free medication it takes you longer to hit the deductible, because nothing is going towards that from assistance, co-pay assistance. Sometimes helping enroll patients into insurance programs. Do you have a dedicated medicare benefits specialist? Are you helping to educate? They may assist with prior authorizations and other treatments. So, patient authorizations and coverage. These are additional roles. As a medication access coordinator, finding the correct application. There might be an application to start, usually called start forms, but if they go to a certain point and they find out the patient doesn’t have insurance, and now they have to qualify for a free medication program, that might be another application. Maybe the pharmaceutical company has an all-in-one 500-page application. If you get those forms, I ask, what can this form get me? If I invest my time how far can I bring this patient on their journey of finding solutions or will I need another form? Can I be proactive and get some of this information? You might need income information or additional things are these applications. Also, filling out the applications correctly. There are a lot of questions. Even I get confused sometimes. There is a patient portion of the application, a prescriber portion. We help guide. There is basic demographic information that normally with authorization, if you can help fill out that portion, and then the patients can sign. Also, the prescriber’s portion. There are so many different checked boxes and who gives permission for what, really, if we printed it off we would highlight it or docusign. The physician just wants to know where their section is. They are super busy. This is two signatures and this is what it will get us. Finding the correct documents, faxing the paperwork, uploading it to portal, and following up on the programs. I felt most of my day was follow-up. On the phone with the payers, with the pharmaceutical companies. If I could not get through, this is where I will bring in specialty pharmacy. I am also following up on refills. There are a lot of dashboards out there. I think they are meant to be good, but every dashboard is different. I feel like a lot of dashboards are missing key portions of information I still need to call someone on. That is the benefits of really becoming friends and having that relationship with your key account managers at specialty pharmacies. A lot of offices you buy and bill and want to service it there, but sometimes they make the patient fill it at a pharmacy. If you have to use that route, let’s make it as easy for the patient and yourself to make sure the medication shows it up on time. That is how I found those relationship industry partnerships are valuable. Or I ask if they heard something with the payer or any offices around me that are having the same problem that maybe they can connect me.
I want to make more friends doing my role that I don’t know. For the infusion medications, coordinating the shipment, free drug which pharmacy, sometimes replacement products. Also, ensuring that the medication assistance is provided correctly to their hospital or clinic and they receive credit. Accountant receivable, who is doing that? I came from a big health system practice, but it’s easy to credit the wrong account, the wrong data service. So, some of the things that we would do for our patients at the end of the year preparation, which this is a toolkit that you can download and hang up in your office, but the end of the year preparation, right. I asked my patients, is your insurance changing? Do you think it might change? Have you received information from your employer that they are switching? Are they changing their Medicare plan during open enrollment? Starting October -ish we would ask, any insurance change, and say we need that so you can continue your medication January 1. Letting the patient know where they fit in their journey and where they can help you keep the ball rolling. If the answer is yes, we verify the changes, we work on the new authorization. So, this is the background information, high level. I like to give a lot of tips. Tools and education. You don’t need to memorize all of this. It’s a lot of work, especially dealing with these therapies. Maybe you are not prescribing this in your office except for certain patients. There is a whole community we have created. We have put tools and education for whoever is doing this role. We have two portions. You have education and the NAMAPA community. The NAMAPA community is a free resource. Think of it as your LinkedIn, Facebook, or Instagram. It is behind a wall. You have community forums and member maps. Who else is doing this role that you can connect with? Education and resources, events, workshops, webinars, or questions. Sometimes I have a question on a diagnosis code or code in my CMS-15 whatever I’m filling out. We have gotten a lot of support to get this going. Selfishly, the reason I always wanted something like this, and I knew that I wasn’t the only one, is I covered a large health system and I didn’t know who did rare disease, neurology, therapeutic areas, or allergy and immunology. I was heavily based in oncology, but when you take on a patient you help with their other therapies too, or you step in when Sally is on maternity leave. This is the goal of trying to find who knows this role. In your office, even your day to day, some of the terms and things we are doing we don’t have a lot of contacts out of our office or know who does this role or how to write a job description for this role. The free resource is great. We launched in January, so it is completely free. When you go in there, and this is to explain some of the therapeutic areas, what does your journey look like on this app or desktop? You get to select what communities you want to be part of. For me, I covered dermatology, oncology, some allergy immunology. I may bounce in and out of home infusion. If I had a question I could go to these certain communities. Think of it as your own Facebook group. It is its own community of all people who also have interest that you can ping questions off of. Of course, we don’t share patient information. It is all HIPAA compliant. A payer is a payer with a drug access problem and we can help each other a lot. What I find here is a lot of people are trying to find their field reimbursement managers or trying to understand if there is a co-pay program with this new drug. What have you heard? What is your experience?
We are all trying to do things a little better. I cover every therapeutic area, but it is really neat. You can jump in groups or out if you want. Also, I am all about everyone coming to the table. Any therapeutic area, organizations, nonprofits, everyone is doing a good job. We would like to help support from a centralized place of letting people know in a certain therapeutic area, what other things are out there? Maybe you want to search something else? What events or organizations? When I moved to rheumatology, I didn’t know anything about it. Who do I call? What events? What tools, resources, or nonprofits? The second portion is the medication access coordinator training. The training that we have is a 10-part module series. Think of it as 101. You are bringing on someone new or you need a refresher. This is a very intense but slow to pace to understanding these things. The introduction to medication access for Nader terminology, fundamentals of health insurance, overview of commercial insurance, introduction to Medicare including when you can enroll in all of the situations that patients can switch their plan in the middle of the year. We went through all of these modules on here, and it has been a great foundation piece. We were able to get this sponsored by two wonderful pharmaceutical companies to support this on their advocacy lens. Overall, the national Association for medication access and patient advocacy, we were excited to launch this medication access coordinator training. It went live this year. This is a new education aiming to empower health care professionals by equipping them with critical skills and knowledge to overcome challenge in medication access. It includes 10 modules covering everything from health insurance fundamentals to medication assistance programs. That was taken from our press release. What I am seeing is — leaders, what I encourage you is, if you have people doing this in your office or if you are in this office doing these types of roles, try to use this as justification of crafting your skills. We successfully have seen other organizations and large health systems that people are either being compensated or having a discussion for maybe a salary raise or bonus. If you have core competencies that one they will do their job better, understand, and you have this phone a friend background, for myself being in this role, and a lot of you out there, people ask, how do you know what you know? By experience. We are super excited to launch this. The other two things that I will quickly bring up before going to Q&A’s we have, between these two guides, preparing for the blizzard.
They use the term blizzard, the insurance re-verification season starts in about October. The blizzard kit is what you need to do to start preparing going month by month of certain checklists. Patient letters to proactively reach out to avoid delays that they may have by not letting you know about their insurance. Making sure that you are well equipped and how to prepare for the next year or two. Then you go on to the starting of the new year and all of the things about authorization types. There are nuances between medical and pharmacy benefit, continuation of care, drugs with classified and unclassified codes. When you calling for an authorization, you could say, is there an authorization? No. There are 10 or more questions asked to drill down to make sure what you’re asking and how to prep yourself, and even when you call back what you need. These are also free resources available. With that, this concludes my portion of the presentation. Going through, you can tell I’m super passionate about this, but I will turn it over to the group to see if there are any questions and answers.
Lynda: thank you, Melissa. This is such an off topic for our usual webinars that this is new information for a lot of us. It is great to have someone like you who is so experienced in this who can pull it all together. I really appreciate that. One thing, as Melissa said, they have a wonderful training program that’s free because of sponsorship from Amgen and AstraZeneca. In addition, Melissa Co. organizes this annual conference just for medication access coordinators. You had that a few weeks ago or so. That also now you can listen to all of the recordings from that because of sponsorship. Do I have that correct?
Melissa: That is correct. After this I will provide everything. I will provide you the code to put on to the email. We got a sponsor that we have access — or anyone can have access to about 80 plus sessions. There is continuing education for five different licenses. Even if it is not for your license, I have seen you be able to get continuing education. Great resources on inflation, the IRA coming up, setting up programs in your office, advocacy. We encourage — it is a pretty low rate to attend. It is in Las Vegas every year. We had it the first of September and it was a great success. Every year it continues to grow.
Lynda: I was living vicariously on LinkedIn every day you were there. Definitely something to think about for next year. You can access the recordings and check it out yourself now. We have been working, the Allergy and Asthma Network, working on patient-facing information. This was the coordinators and office staff to learn more about the process of insurance reimbursement and getting access to medication. We launched, with the help of Melissa and her team at NAMAPA, a patient facing set of resources on our website. I put the link in the chat and we will include it in the follow-up email to you so that you can access. This is written to be readable and understandable by patients and family so that they can understand better the basics of insurance coverage and where to get help with their medication has been denied. We definitely brought this complex information down to a reading level that we hope is understandable to the majority of people. There is more. I feel like a TV commercial for this. We also have a Biologics podcast that just went live last week. Dr. William Anderson did a wonderful job talking about the office -based doctor-based perspective of trying to get patients access to Biologics they need. We know that they are so expensive. We do a podcast series in conjunction with a group called the — podcast. They did a wonderful interview with Dr. Anderson that just went live. I will put the link in the chat as well. In early October we will have two more podcasts where Melissa and her team are going to be interviewed. Once will be — one will be about the same topic regarding medication access coordinator training, podcast format. We are also going to do what to do if a patient is denied access to their medication. It is more patient-focused. We have additional resources. I don’t want to keep going on and on. We will include them in the follow-up email. We will do videos on our social media regarding key topics related to insurance access, so people who utilize those channels will be able to get tip s and strategies for trying to navigate this themselves. I want you to count on us. We are working well and closely with Melissa and her team at NAMAPA to try to get as much information out about this important topic. It is a major advocacy issue for us. We feel like if we can handle it through our missionaries of outreach, advocacy, resource, we are doing a service to help everyone. That is why we are committed to this important topic. With that, I will see if there are any questions. I kind of went on and on. What assistance is there for Medicare patients for things like macular degeneration? I know that this is a little off topic.
Melissa: As far as the assistance for certain ones, I think that the best tool that I’ve seen out there is called pan fund finder. They do an aggregate of other foundations. You can drill down exactly for that. If you cannot see something on that, feel free to email us and we can look as far as other resources. We are tapped into and friends with the different foundations that help support our conference. The specific resources, that would be a great question for the chat or community group. Pan fund finder is one that you can login and see all of the diseases. It will tell you which is open and which organization does that.
Lynda: Thank you. Again, is there a cost to the medication access coordinator training modules?
Melissa: No, there is not. We have been patiently waiting for the right partners to come to the table to provide this information for free. It is available for free.
Lynda: One last question. How do assistance programs affect Medicare part D?
Melissa: Medicare assistance programs, like, depending on that medication assistance program. If the patient is getting a free medication they aren’t using the insurance at all. If they get assistance through a foundation grant, because grants can help out Medicaid patients, that will help with their out-of-pocket. When you usually get approved for certain disease state or things that can be 2000, 5000, $10,000. With the changes in Medicare that are happening, which we will be doing two webinars coming up on the new changes in enrollment, how will they help patients from next year and what that looks like. As far as foundation assistance, funding will help with that patient’s out-of-pocket. Whatever the patient responsibility is, that is the portion that they can help out with. If it is free medication, they were denied or were not able to get funding, if they were to get approved through patient assistance program which, patient assistance programs, sometimes they deny you based on you do have insurance, regardless of if it is what type of insurance. Make sure that you ask. What are the steps? Are there appeals processes? They don’t put this publicly. I hope that helped out a little bit.
Lynda: It is 12: 59. We did a great job ending on time. This has been so informative. For everyone who is on the line, we have two webinars coming up in October. First, we will welcome Dr. Bill Berger to discuss chronic hives and how to meet the needs of patients. That will be October 16th. October 31, we will welcome a doctor from California to discuss biologic medicines, what they are, how they work, and who might benefit. You will receive any mail from Zoom in a few days with the links to the recording, valuation, and supplemental resources that we told you we would share today. Thank you from all of us here at Allergy and Asthma Network. Join us as we work every day to improve the lives of people with allergies, asthma, and related additions. Thank you, again, Melissa.
Melissa: Take care.
