Flipping the Script to Disrupt, Redefine and Accelerate the Patient Care Journey

During the COVID-19 pandemic, patients and providers began to recognize the considerable benefits of telehealth services. Patient demand and notable increases in access to care for many have compelled the industry to adopt telehealth as a modern way to treat patients efficiently and effectively. 

This advancement ushered in more consciousness around the notion that the widespread acceptance that a patient’s treatment journey will likely be a lengthy, stressful and complicated one should no longer be the standard by which we all live. 

Waiting months to see a specialist, driving long distances to appointments, not knowing if treatments and prescriptions will be covered, and other endless frustrations have long plagued the healthcare process every step of the way; but it’s time for that to change. 

With the industry’s first and only patient-led virtual care model, EVERSANA meets the demand for more robust telehealth services head on and empowers patients to guide their own treatment journeys. By navigating a digital end-to-end platform where they can choose when and how they meet with a provider, verify benefits in real-time, request prescriptions delivered to their front door and more, patients are in the driver’s seat for their own care more than ever before.  

Through this virtual model, manufacturers are also provided with effective tools to implement direct-to-patient strategies, allowing them to target traditionally underserved populations, expand their brand reach through hyper-targeted HCP and patient-finding capabilities, and generate data to provide actionable insights and inform decision-making. 

• HHS can only negotiate prices for drugs that Medicare Parts B and D spend the most money on and have been on the market for years without any generic or other competitors and exclude:
  • Drugs that have a generic or biosimilar available
  • Drugs less than 9 years (for small-molecule drugs) or 13 years (for biological products) from their FDA-approval or licensure date
  • Certain “small biotech drugs” (from 2026 to 2028)
  • Drugs that account for Medicare spending of less than $200 million in 2021
  • Drugs with an orphan designation as the only FDA-approved indication
• Companies face financial penalties for not abiding by negotiated prices — $1 million fines for violating agreement terms, and $100 million fines for providing false information.
• Medicare plans must include drugs for which Medicare negotiates prices on their formularies

 

1. A Part D redesign imposes new pharmaceutical liabilities earlier in the benefit cycle and throughout each coverage level. Part D plans face a significant increase in catastrophic coverage responsibility, to 60% from the current 15%.