Use Pharmacy Benefits Verification

Drug manufacturers can use Pharmacy Benefits Verification to provide their patients financial aid and help them understand their coverage. With immediate access to the patient benefits coverage and alternative drug options, healthcare providers can make informed decisions on prescriptions and referrals to financial assistance programs. Pharmacists can deliver accurate medication, avoid delays, understand patient benefits coverage, and offer alternative drugs at the time of drug fulfillment. Ultimately, Pharmacy Benefits Verification enhances patient outcomes by refining medication availability and reinforcing adherence.

Additionally, representatives can use Patient Support Programs console app to centralize all the pharmacy-related tasks in one place. For example, representatives can create a dashboard to check how many patients’ pharmacy benefits are yet to be verified.

When representatives initiate benefits verification requests, they can add a member plan directly from a care program enrollee record page without going through to the member plan object.

Representatives can generate a benefits summary and a call script with a single click, by using Einstein Generative AI.

• Patient Support Programs Console App
  The Patient Support Programs console app in the Health and Life Sciences cloud acts as a single-stop for all patient services representatives to monitor different aspects of care programs and care program enrollees. Representatives can customize this app according to their needs and access all the functionalities of patient support programs through the app.
• Add Member Plan from Care Program Enrollee Record Page
  Create a member plan directly from a care program enrollee record page without going to the Member Plan object record page.
• Pharmacy Benefits Verification Request
  You can use a guided flow to initiate a manual or electronic benefits verification request, generate patients’ benefits packages, and furnish a concise summary of the benefits related to the medications prescribed within a care program.
• Initiate a Manual or Electronic Verification Request
  Initiate a manual or electronic pharmacy benefits verification request to generate patients’ benefits packages, and furnish a concise summary of the benefits related to the medications prescribed within a care program.
• Benefit Coverage Response
  The Benefits Summary section shows the pharmacy benefit coverage response received from payors or clearing houses. The benefit summary section includes the patient’s benefits details such as coverage status, co-pay, and co-insurance.
• Generate Call Script
  Reduce the time patient services reps spend on call with payors to determine the missing fields from the benefits summary. Pharmacy Benefits Verification uses Einstein Generative AI to help patient services reps generate a call script, which they can use to fetch missing coverage information from payors.
• Generate Pharmacy Benefits Summary
  Pharmacy Benefits Verification includes Einsten Generative AI to generate the pharmacy benefits summary for reps. You can share this benefit summary with patients, prescribers, and practitioners. The summary helps providers recommend appropriate assistance programs to patients, and helps reps make informed decisions, such as enrolling patients in appropriate assistance programs.
• Update the Status of a Manual Verification Request
  You can mark the status of a manual verification request as Pending, Completed, Error, or Partial, depending on the business use case.
• Use Pharmacy Benefits Reverification
  Pharmacy Benefits Reverification checks a patient's eligibility for pharmacy benefits, ensuring continuous and correct coverage for their medications. The process helps insurance providers save time and resources by streamlining the reconfirmation of pharmacy benefits for patients in care programs. Reverifying benefits controls costs for both providers and patients by confirming that coverage is necessary and used correctly.