Advanced Benefit Verification

Learn about the AssistRx Advanced Benefit Verification (ABV) Solution

Real-time access to patient coverage and out-of-pocket cost drives adherence

The Advanced Benefit Verification tool leverages our Surescripts partnership along with multiple data sources and proprietary algorithms to improve overall patient coverage results and includes monitoring and reporting.

In addition to Real-time Pharmacy Benefits information, this advanced solution provides additional data insights on costs and prescription benefit to drive even greater accuracy and automated return responses to further enhance the patient journey and overall experience.

Leveraging our proprietary network that connects to all the major payers and PBMs, our Advanced Benefit Verification solution provides immediate and comprehensive patient coverage results for all pharmacy benefit therapies in less than 30 seconds.

Advanced Benefit Verification goes above and beyond other real-time pharmacy benefit solutions in the market to provide real-time, immediate access and further enhanced return results on:

– Patient coverage
– Patient out-of-pocket cost
– Drug access restrictions (e.g., prior authorization required)
– Coverage alerts (e.g., age limit, days or supply exceeded)
– Fill options for all therapies
– Unique data such as formulary status and employer
– Plan- and patient-level prior authorizations

Advanced Benefit Verification is able to return cost whether or not a prior authorization is in the way of a fill. The solution also includes monitoring and reporting to improve price transparency and informed decision making on an ongoing basis.

Use Case: Product Launch and Prescription Drug Coverage

Advanced Benefit Verification supports patients and healthcare providers throughout the patient journey and is particularly useful during a product’s launch phase. Advanced Benefit Verification can support patients as coverage for a therapy becomes more available.

Upon enrollment, a patient is immediately run through the Advanced Benefit Verification tool to determine if coverage exists at that point in time.
If the therapy is covered, the patient is taken through a standard process that leads them toward the most affordable and best option to drive adherence.
If the therapy is not currently covered by the patient’s plan, the patient can be provided with options to access therapy, such as a patient assistance program.
Patient’s coverage is regularly auto-audited to convert the patient once a formulary decision is made by the plan or the patient obtains coverage for the product.

The goal of the Advanced Benefit Verification solution is to take as much work dealing with payers off the hands of humans, so they can focus more on patients—delivering empathy and making brands more patient-friendly. We complement our technology solutions with human expertise should payer outreach be necessary.

Advanced Benefit Verification can be accessed through iAssist, provider engagement sites, the brand website and Patient Solutions CRMs.

iAssist is the only streamlined solution that includes real-time automation for e-prescribing, e-prior authorization, e-consent and more.

Learn more about iAssist