A manufacturer launched with no payor coverage policies in place, commercial or Medicaid. Without coverage, patients and providers had no clear path to treatment, and the company needed policies established quickly to keep its launch moving.
PRO launched a patient support program (PSP) that included an experienced payor case management team. The team engaged payors and state Medicaid programs persistently, with outreach shaped by each payor's specific considerations. Coverage came through inclusion in medical policy and, for some payors, through contracted specialty pharmacy networks.
CONCLUSION
Within four years of launch, 95% of commercial lives had received authorization and 84% of Medicaid states, 42 in total, were granting authorization. Persistent, payor-specific engagement helped turn a zero coverage launch into broad access for patients. Learn more about our Market Access and Patient Support services.