Anytime we engage in a public debate about the source of rising U.S. healthcare prices – especially during an election year – the conversation always seems to end up on the cost of prescription medications. And it’s no wonder. The average annual cost for one specialty drug reached $136,401 in 2020, which is double the median U.S. household income of $65,712. Who could be expected to afford these prices, especially with the cost of everything else going up?
Many Americans tend to believe that pharmaceutical companies are largely responsible for rising drug prices. A recent 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 last year. 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 financial navigation 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 Prime.
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 co-pay 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 co-pay 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 thirty brands, resulting in thousands of patients successfully – and seamlessly – securing financial resources for treatment. The feedback from financial navigators and pharmacists has been even more impressive, with many of them lobbying their pharmaceutical company reps to expand Express Enroll across more brands.
Looking ahead, we’re excited to bring even more life science companies into the TailorMed network. We’ll be rapidly expanding our partnerships through the end of this year and into 2023. 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?