Case Studies

Reimbursement Call Center and Patient Assistance Program Design - Multiple Product Classes

Insight

A specialty pharmaceutical company addressing unmet patient needs in oncology and other disease states enlisted The Aequitas Group to maintain their competitive advantage by providing superior customer service through precise reimbursement hotline support. The Aequitas Group guided the client through the process of defining its value and access strategies to meet the growing needs of current and potential customers.

Strategy

The Aequitas Group worked with the client and its multiple patient assistance program (PAP) and reimbursement hotline vendors to review standard operating procedures (SOPs) and identify areas for improvement including benchmarking and process development for communicating and training staff on policy information. The Aequitas Group also provided project management support for the client’s request for proposal (RFP) process for new PAP and reimbursement hotlines. In addition, The Aequitas Group developed a comprehensive reimbursement training program that clearly and effectively described key reimbursement concepts to field sales and reimbursement management teams. This information was presented in a way to allow the audiences to understand how coding, coverage and payment under Medicare, Medicaid and commercial payors relate to real-world experiences encountered in the field.

Execution

After evaluating the client’s workflows, The Aequitas Group identified gaps in knowledge as well as best-in-class practices and service offerings for the clients PAPs and reimbursement support hotlines. The Aequitas Group updated the SOPs and business rules to be best-in-class and provided oversight for the move of seven products from one third party hotline vendor to another. The Aequitas Group remains the clients’ third-party auditor for all U.S-based patient assistance programs.