Patient Affordability, Backed by Payment Technology
Copay, patient assistance, bridge, and travel programs, configured to your business rules and designed to protect gross-to-net.
Automated Payments, Built Around
Your Benefit Type
We configure claims and payment processing around your therapy’s benefit type and program rules.
- Pharmacy benefit: Claims adjudicate in real time, resolving the patient’s cost at the point of sale.
- Medical benefit: Processing follows the provider’s workflow, beginning after the service is rendered and the payer responds. Targeted communications keep the physician office informed.
- Dual benefit: A hybrid design uses internal accumulators to apply and report copay assistance against one annual program maximum across both coverage types.
Connected Data. Flexible Rules. Gross-to-Net Protection.
Dispensing and hub services can operate within one program, connecting redemption, formulary, and claims data. That visibility and flexible business rules help us:
- Tailor assistance by patient group and coverage status.
- Adjust support to each fill’s cost and quantity.
- Identify maximizers in real time at first fill to help protect gross-to-net.
Beyond Copay: Support that Helps Patients Start and Stay on Therapy
We support programs that address financial and logistical barriers:
- Patient assistance: Free product for patients who meet your program’s eligibility criteria.
- Bridge support: Assistance during gaps before coverage begins.
- Cash pay: A pathway for patients without coverage or on high-deductible plans.
- Supplemental care: Travel, lodging, and meals to help patients access treatment.
Patients can enroll and attest through web and mobile microsites, portals, text, email, or QR codes, with connected access across programs.
Patient Access, Built Around Every Patient and Every Case
What's different about copay assistance for a medical or dual benefit product?
Each benefit type has its own dynamics. Pharmacy benefit claims adjudicate in real time at the point of sale, in a way that is similar to traditional insurance. Medical benefit support begins after the provider renders a service and the payer issues the EOB, and it is designed in line with the provider’s workflow, with rules-based claim review before payment, so the process and the timeline both look different.
How fast do providers get paid?
Once we confirm coverage and program enrollment, VDC and EFT payments generally take two to three business days. Programs are designed around each buy and bill office’s or institution’s preferred payment method (VDC, check, or EFT), and targeted communications to the physician office keep providers informed along the way. Checks go out on the 15th or the last business day of the month, depending on the calendar.
Can PRO-spectus support just the medical or dual benefit part of our portfolio?
Yes. Configurable program design means we scale to your portfolio, supporting the medical or dual benefit piece on its own or all benefit types together, and working alongside any programs you already have in place.
What's the difference between copay assistance and patient assistance programs (PAP) or bridge?
Copay assistance adjudicates a claim for eligible patients and submits a payment request, either at the point of sale or through post-service claim review. PAP and bridge provide free product directly to eligible patients through a compliant handoff, without claim adjudication or provider payment.
What should manufacturers look for in a copay partner across pharmacy, medical, and dual benefit products?
Look for flexible business rule configuration; fast, reliable provider payment options (VDC, check, or EFT); an established operational cadence between hub, dispensing, and copay teams; hands-on experience with medical benefit claims, which require post-service adjudication and EOB review that differs from how pharmacy claims are handled; and tools to identify maximizers and accumulators so gross-to-net stays protected.
How does an integrated dispensing partner help protect gross-to-net?
Dispensing can sit inside the same program as the hub, so redemption, formulary, and claims data come from one connected source. Combined with configurable business rules, that gives ongoing visibility into how copay dollars are being used by plan type, so gross-to-net protection is built into how the program runs.
