Anytime we engage in a public debate about the source of rising U.S. healthcare prices, the conversation always seems to end up on the cost of prescription medications. And it’s no wonder. Last year, the median annual price for new FDA-approved drugs exceeded $200,000. Who could be expected to afford these prices, especially with inflation still burdening many households?
Many Americans tend to believe that pharmaceutical companies are largely responsible for rising drug prices. A 2022 survey by the consulting firm ZS found that 75% of patients think that “drugmakers are at fault for high prescription prices,” far outstripping all other healthcare entities including insurance companies. But is the story really so simple?
Unsurprisingly, the forces behind high patient out-of-pocket costs for prescription drugs are much more complex than they might initially appear. The price that any one patient pays at the pharmacy is a result of an opaque system that can be influenced by insurance companies, government policy, distributors, pharmacies, and yes, pharmaceutical companies. To make a real difference, we need to look for serious solutions that bring together all stakeholders in a meaningful way.
How TailorMed Approaches the Problem
At TailorMed, we see the challenge of patient affordability as a complex problem demanding a multi-pronged solution. High costs of care place a significant burden not only on patients, but on the entire healthcare system. Providers are struggling with uncompensated care and bad debt, with unpaid healthcare bills amounting to $140 billion in 2020. And pharmacies are dealing with the loss of revenue that comes from prescription abandonment.
By harnessing the power of technology, TailorMed seeks to address the patient cost burden by removing financial barriers for patients and healthcare organizations. Our platform uses predictive analytics to proactively flag patients who are at risk of distress and automate the process of securing financial resources.
Our Evolution to Date
In the beginning, TailorMed focused primarily on partnering with provider organizations like hospitals and health systems. We knew that doctors, as well as financial navigators and counselors, were on the frontlines with patients facing cost-related barriers to care. We wanted to meet them there, so that our technology could empower them to help more patients in need.
We later recognized the important role that pharmacies play in helping patients afford their medications. So, we developed our Pharmacy solution, which streamlines enrollment and tracking for free and replacement drug programs. We expanded our reach to include not only hospital-based pharmacies but national partners such as AllianceRx Walgreens Pharmacy.
We’re not stopping there. As TailorMed has grown, we’ve realized that the problem of financial toxicity requires a comprehensive, coordinated solution. That’s why we’re now building the largest network in our market of providers, pharmacies, life science companies, foundations, and other partners. Our vision? To create a single hub through which all patients are connected to the financial resources they need to afford their care.
The Next Phase: Life Sciences
Innovative life science companies are acutely aware of the financial burden patients face with all types of chronic medication, particularly higher-cost specialty medicines. And with those same life science companies already funding the vast majority of financial resources available to patients — such as copay programs and patient assistance programs — they are natural partners in the holistic solution that TailorMed is working to build.
As a co-founder of Vivor, a financial navigation platform that is now part of the TailorMed family, I have already seen first-hand the strong interest that many drugmakers have in working to innovate with technology companies like TailorMed. At Vivor, we developed the Express Enroll solution, which seamlessly connects the financial navigation experience to the copay programs and patient assistance programs offered by pharmaceutical companies. Those programs can often require extensive forms and the collection of signatures, which Express Enroll simplifies through automatic data mapping, real-time API connections, and embedded e-signature workflows.
We connected Express Enroll to four manufacturers and over 30 brands, resulting in thousands of patients successfully – and seamlessly – securing financial resources for treatment. The feedback from financial navigators, pharmacists, and other healthcare professionals has been even more impressive, with many of them lobbying their pharmaceutical company reps to expand Express Enroll across more brands.
Partnering with Pfizer
We’re excited to bring even more life science companies into the TailorMed network. Today, we launched a new Express Enroll capability in partnership with Pfizer Oncology Together, a support program for patients prescribed Pfizer Oncology medications. Now, TailorMed users will be able to complete the enrollment process for the Pfizer Oncology Together Patient Assistance Program directly within our platform. Later this year, we’ll expand Express Enroll to Pfizer Oncology’s Copay Savings Program.
This interface will help more patients access lifesaving Pfizer Oncology drugs, thereby improving patient experience and outcomes. At the same time, it will create a faster, simpler enrollment process, easing the administrative burden for providers and pharmacies in our network.
Looking ahead, we’ll be rapidly expanding our partnerships through the end of this year and beyond. Along the way, we’re working hard to be a force for positive change, reducing the friction that too often prevents patients from accessing the assistance they need. After all, why can’t patients secure financial assistance with the same “one-click” experience everyone has come to expect when shopping online?
To learn more about the new Express Enroll interface with Pfizer Oncology Together, visit us here. We encourage current TailorMed clients to contact their Customer Success Manager.
New to TailorMed and interested in learning how we can help your organization optimize patient financial assistance? Get in touch with us here.