ACTICS eAccess

Patient-first Access and Affordability Through Electronic Benefits Verification and Prior Authorization Submissions

In many cases only 60% of the electronic verification results are accurate and more than 70% of prior authorization submissions are rejected with little to no reporting on the patient’s status. ACTICS eAccess, EVERSANA’s new proprietary eBV and ePA platform, improves patient access and accelerates speed to therapy.

Elevating the Benefits Verification Process

Verifying a patient’s insurance eligibility should be a simple and straightforward process. Unfortunately, it is most often a painstaking process that consumes HCP staffs’ time, causes confusion and frustration due to inaccurate information, and most significantly, delays initiating treatment for patients in need.

EVERSANA’s eBV tool is elevating the benefits verification process beyond prior, traditional models. By leveraging electronic connectivity with over 1,500 payers rather than algorithms, highly accurate coverage for both pharmacy and major medical benefits can be confirmed in minutes rather than days – with as few as five simple data points.

eBV benefits

+90^%
Success rate in identifying coverage 85% Success rate returning NDC and J-code specific product coverage
1,500
Electronic Payer Connections
+90^%
Representation of lives covered
50^%
Reduction in time to complete annual and monthly reverification while avoiding traditional reverification staffing increases

Key features of EVERSANA’s eBV tool:

Integration of Pharmacy Benefit (PBM) and Major Medical: Enables verification of patient benefits with as few as five inputs (Name, Date of Birth, Gender, Zip Code and SSN or Member ID).
NDC and J Code Specific: Fully understand a patient’s specific profile and predict their OOP down to the dollar, ensuring price transparency and affordability.
Real-time Access: Provides HCPs and office staff access to coverage information via brand.com, client portal or existing CRM integrated platforms.
Automated Business Logic: Assess if patients are eligible for copay support and apply specific copay offerings. Assist with Patient Assistance Program (PAP) eligibility criteria by determining insurance coverage and access to products.
Built to Product Archetypes:
- Retail: Provides patients with real-time OOP cost removing need for a full hub.
- Specialty Pharmacy: Real-time benefit removes burden on HCP and Pharmacy and informs course of therapy.
- Buy and Bill: Real-time benefit removes burden of manual effort and associated costs on HCP and removes delay to therapy initiation.

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Unmatched Excellence in Benefits Verification

INDUSTRY-LEADING ACCURACY AND SUCCESS RATES

EVERSANA’s Proprietary Software and electronic connectivity to payers support benefit verification accuracy through patient identification, verification of coverage, and real-time, accurate patient out-of-pocket costs.

EFFICIENCY

EVERSANA’S best-in-class people, technology and data deliver real-world efficiency to patient hubs and Patient Assistance Programs (PAP):

- Reduction in time spent tracking down individual patient data and submitting verifications through patient hubs.
- Reliable PAP eligibility verification to reduce over-spending while ensuring financial support is provided to those patients who need it most.

SPEED

Identify patient coverage and NDC specific product coverage real-time through EVERSANA’s direct, digital connections to payers.

FLEXIBLE AND CUSTOMIZABLE

Exclusive system of product archetypes generate flexible, customizable deployment models that can be seamlessly integrated into client CRMs within weeks. Product configurations allow for additional products or services that support the growth of client programs.

ENABLES NEXT-BEST ACTION

More data and actionable insights available to field reimbursement managers (FRMs) to reduce patient wait times and delays in therapy initiation.

PATIENT-FIRST AFFORDABILITY

Supports greater price transparency through HCP access to an online, self-service platform.