Providing timely access to reproductive health therapy

Ryan Humschild, PharmD, MBA, MS: According to the Affordable Care Act, we must be sure that we have a process of exceptions. The exception process must be clear and cannot create undue stress for the provider or patient. We worked hard to make sure we had something that was easily acceptable. If there is an exception process, we will look for the FDA indication. We will look at the patient’s medical information and also make sure that people know how to provide this information, and then we will create a very timely review. There are exception processes. They are appropriate and we did it in a way that is quite trouble-free for the supplier, as long as the correct information is provided. Clarifications have been issued because some groups of payers are not being created [exceptions] as easy as the program envisioned, so this is something we get feedback from some of our first users and lives covered. “Do you have problems completing this exception process?” Is there anything we can do to improve it? ”We are constantly focused on that.

We create different queues when we review because [in the case of] the timeliness of contraception or treatment of uterine fibroids or any kind of health of other women, adherence to the patient is related. If someone goes to a pharmacy or sends a prescription and has a long time to complete it and sometimes you will find that the patient does not follow this prescription or does not adhere to it. We have a separate queue where they will go and be redirected. According to the ACA [Affordable Care Act], they want to make sure that this is a timely examination according to the indication. While we do our due diligence, we have a separate queue that will not reduce any kind of motivation for the patient to take therapy and will reduce frustration on behalf of the provider.

Endometriosis and uterine fibroids are extremely important because they cause a lot of pain for patients and affect the quality of life. We have created better access to the therapies that are most appropriate for these patients, and we have created an easy process of exceptions so that patients can receive the appropriate therapy approved according to the needs of their prescriber, as well as programs that address their share. of the days covered. We know that adhering to these therapies usually leads to better results – and quite quickly when we work on suppressing some of the hormonal [issues] with uterine fibroids. When we create timely access and better adherence and then monitor these patients, these are the types of comprehensive programs that allow them to be most successful.

There were many new players in women’s health and this is exciting for patients. This is more complicated for payers because you want to make sure you always provide the right therapy to the right patient, but what would trigger a review is, if we see a new mechanism of action, all the new clinical efficacy data we think that they have an improved standard of care or an improved safety profile. What not many people think about, but payers do, is patient adherence. We want to make sure that clinical trial data becomes real evidence. The better the drug from the adherence profile – it can be taken once a day or taken orally to reduce any of the barriers to adherence -[the more] we will focus on [it]. The mechanism of action, the safety, the clinical profile and the way the medicine is taken all play the role of a class review and we do it often to make sure we are up to standard of care.

This transcript has been edited for clarity.

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