A diagnosis of cancer or a complex disease can make anyone feel like their world has been turned upside down. Just as much as it affects patients physically and emotionally, it can also cause financial distress from medical bills and other unforeseen costs.
Fortunately, our Fairview Specialty Pharmacy is here to help patients avoid financial hardships and navigate the insurance challenges related to medicines that typical pharmacies don’t supply.
“Our No. 1 goal is to handle all the details related to our patients’ prescriptions, such as prior authorization, coordination of first fill, and financial assistance like grants and foundations,” said Christine Carmichael, Fairview Pharmacy Business Manager. “We try to do the heavy lifting, so they can focus on what’s most important — caring for themselves.”
This well-oiled machine includes Clinic Liaisons, Patient Financial Advocates, and our Therapy Management team. “We each play a different role,” Christine said, “but we all keep our patients at the forefront of everything we do.”
Doing the work for the patient
Soon after a provider prescribes a medication that requires use of our specialty pharmacy, the team hits the ground running.
“Our team of 17 Clinic Liaisons are first to interact with the patient,” Christine said. “Ultimately, we handle the process from when the prescription is written to when it’s in the patients’ hands.”
First, they determine if the medication is covered by insurance and will submit any required authorizations or appeals on behalf of the provider and patient, figure out where the specialty drugs must be filled, and — most importantly — help offset the out-of-pocket costs associated with their medications.
Clinic Liaisons look to manufacturer-sponsored programs, grants and foundations, voucher programs, and copay cards. If a program is available, a team member will apply the savings on behalf of the patient.
“Sometimes that savings isn’t enough,” Christine said. “I’ve had patients tell me they now can’t afford their mortgage, monthly rent, or utilities because of their increased medical expenses. It can be so heartbreaking.”
For those circumstances, the team will look to a database of financial assistance programs. “We will identify a program based on needs and complete the application for the patient,” Christine said. “My team has helped patients get emergency assistance to help pay for gas, groceries, or other expenses.”
It takes a village
"Patient Financial Advocates will then take the lead and serve as a second set of eyes to make sure nothing has been missed or if there is any other savings we can offer patients,” said Amanda Robinson, Manager of Financial Access Services. “We then contact the patient and inform them about their savings, and they are always so appreciative — and often surprised.”
After the patient receives their prescription and is stable on their medication, Therapy Management Liaisons within the specialty pharmacy help with any complexity or issues that may arise with refills.
“It’s common for a patient with complex care needs to have multiple prescriptions that are released month-to-month,” said Mallory Snyder, supervisor of the Therapy Management Liaisons. “We help resolve any issues that get in the way and make sure they have enough medications on hand.”
The Therapy Management team will help connect patients with a pharmacist, a member of their care team in the clinic, or back to a Patient Financial Advocate — all depending on the patients’ needs.
“Our entire team really tries to make everything as seamless as possible for the patient and provide a great experience,” Mallory said. “We’re all here to help in any way we can.”
For more information, go to the Fairview Specialty Pharmacy website or call 612-672-5260.