Supporting HCP Engagement of Field Reimbursement Managers

By: Amanda O’Hora, Rachel Besse, Charlotte Hanby

Field Reimbursement Managers (FRM) assist healthcare professionals (HCPs) in navigating payer requirements to expedite access for patients and streamline reimbursement for products administered in the office. The need for FRMs has grown in importance as pharmaceuticals and the reimbursement landscape have evolved, and provider practices—especially those in specialty areas like oncology—may be experiencing staffing shortages and decreasing revenues. This is compounded by insurance plans continuing the use of complex prior authorization and utilization management policies, further burdening HCP staff. Additionally, government healthcare policy has undergone significant changes in the past 20 years, shining a spotlight on the importance of understanding the requirements, opportunities, and limitations of these policies to ensure timely reimbursement for products and services. 

Key Considerations for FRM Engagement of HCPs

Important factors to consider when engaging HCPs include provider specialty area and practice situation (independent, hospital/system-owned), practice revenue streams, the national and local payer environment, payer mix of the practice’s patients, and recent changes in federal and state healthcare policies. Magnolia Market Access can help arm FRMs with needed tools to educate HCPs and staff in a variety of areas:

Navigating Prior Authorization Challenges

Payer Requirements, state laws, and regulations pertaining to prior authorization can have a significant impact on practices and patients. According to the Council for Affordable Quality Healthcare (CAQH), prior authorizations almost doubled between 2021 and 2023—from 143 million to 280 million. The same report indicates that the medical industry spent $1.3 billion on prior authorizations in 2023, including time spent by HCPs and their staff.1 MMA can create product-specific guidance to assist practices in successfully navigating prior authorizations for new and/or specialty products. In this way, FRMs can assist practices in decreasing the time and cost of the process for HCPs and decrease the time for patients to receive therapy.

Supporting HCPs with Patient Assistance Programs and Copay Card Guidance

Manufacturers choosing to offer patient assistance programs and/or copay cards rely on FRMs to educate HCPs and their staff on the benefits and limitations of these programs. Various factors, including state and federal laws, and regulations, may require modifications to these programs. The information presented to practices by FRMs should be clear specific, and compliant to ensure that HCPs can act expediently in the best interests of their patients. For example, new therapy with a new program may require provider and caregiver education about the types of assistance offered to patients.  A change in program income limits, or cessation of a program as a result of generic availability is another situation that requires a sensitive discussion between HCPs and FRMs. MMA can develop appropriate materials to ensure that necessary education is available to convey new program offerings or program changes to enhance HCP and patient understanding and minimize challenges

Providing HCPs with Educational Materials on Federal Laws and Regulations

Materials identifying and explaining pertinent aspects of federal laws and regulations can assist HCPs in understanding the impact of government policies on their practice and their patients. The Inflation Reduction Act (IRA) is an excellent example. Numerous provisions within the IRA will impact practices, including the establishment of maximum fair prices (MFPs). Additionally, changes to Part D patient benefits and responsibilities under the IRA provide an opportunity for practices to educate patients and caregivers, ensuring patients are receiving the most appropriate, timely, and cost-effective care.

Addressing Practice Operational Challenges

In addition to the work FRMs do, provider education can supplement and complement these efforts by helping practices address operational challenges such as product acquisition, payer contracting, and setting up in-office infusions and injections. By offering additional resources and guidance in these areas, provider education can help improve practice workflow efficiency, establish sustainable financial models for delivering specialty care, and enhance FRMs’ efforts in optimizing patient access.

Optimize HCP-FRM Engagement with Magnolia Market Access

Effective HCP-FRM interactions are essential for navigating provider needs, healthcare policies, and payer dynamics. Magnolia Market Access specializes in tailored market access strategies to help pharmaceutical and biotech companies streamline engagement, educate HCPs on regulatory changes, and enhance patient access.

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Reference

i.         https://www.caqh.org/insights/caqh-index-report