A Q&A with Dr. Andrew Mellin on Patient Access and the Power of a Direct Connection

How is patient access evolving? Our chief medical information officer, Dr. Andrew Mellin, explains why speeding patient access is a critical issue in healthcare today, and why it’s important to have a direct connection to the source of truth.

Our conversation has been edited for length and clarity.

Chris: When you hear the words “patient access,” what does that mean to you, especially when it comes to life-changing medications?

Andrew: Many of today’s medications are complex. It’s not always as simple as the doctor writing a prescription and the patient picking it up at the local drugstore. A lot needs to happen for the patient to get started. So, even though “patient access” is a broad term, I generally think of it as a holistic way of helping patients get started as fast as possible on therapies that can make a huge difference in their lives.

Chris: What’s a real-world example?

Andrew: Imagine a patient with severe asthma, which can be hard to control with standard therapies. Her flareups are unpredictable, and when they happen, she has a lot of trouble breathing. She often ends up in the ER. The good news is that a new medication can help keep her asthma under control, so she can live the life she wants to live. But is it covered by insurance? Can she afford it? Does she know how to use the medication and keep up with her treatment plan? These questions need answers.

Chris: How do we find those answers?

Andrew: It starts with the doctor and care team, but there are additional avenues of support. For example, navigating the insurance process can be complex, and patient access programs can often support the patient with this. The first step is understanding if the medication is covered under her insurance, and that’s where we at Surescripts can help, with our Electronic Benefit Verification solution.

Chris: What is benefit verification?

Andrew: It’s the first step in this process of getting a patient started on these therapies. We want to know her coverage for the prescribed medication specific to her benefit plan, so she can better understand affordability options. However, the problem is that patient access programs don’t have easy access to this information. There’s a lot of work just to see whether the medication is covered—phone calls and paperwork and educated guesses. Our approach, on the other hand, takes just seconds. No paperwork. No phone calls.

Chris: What’s different about Surescripts Electronic Benefit Verification?

Andrew: It goes back to connecting with the source of truth. Instead of spending hours or days hunting down the information, life sciences companies and patient access vendors can clearly see if the medication is covered, how much it costs, and whether it requires prior authorization. This cuts a lot of friction out of the process because we’re facilitating the sharing of information between pharmacy benefit managers (PBMs) and patient access programs. We make it easy. The patient doesn’t need to find their insurance cards because the patient access program just needs basic demographic data to check eligibility, and the information is real and actionable because it comes from the source of truth: direct connectivity to the patient’s PBM. It really improves the patient experience by starting the first step of the process with instant, accurate and complete information.

Chris: What’s next for our work on patient access?

Andrew: As I said, benefit verification is the first step to unlocking all the next steps needed to get patients started on therapies that can make a huge difference in their lives. Frequently, after that comes prior authorization. Our goal is to continue removing the friction associated with prior authorization, just as we’ve done with benefit verification, and our approach goes a long way toward lifting the administrative burden.

Back to our patient with severe asthma: Now we know how her insurance covers the medication, including her out-of-pocket costs. We know if prior authorization is required (and can often get a decision quickly). With that information, the patient access program can collaborate with her on the best way to get started on the medication affordably.

All this helps to fulfill the promise of speeding up patient access in healthcare.