A trough Benefits Verification for all coverages is completed for the pharmacy and patient. All outcomes from the benefit verification is then communicated to the pharmacy and patient. If patient coverage is limited and/or patients cannot afford the out of pocket, the verification specialist will assist in enrolling the patient in Patient Assistance Program.
We don’t just assist with the Prior Authorization, we manage it. P5 Connect will ensure and follow the prior authorization process from start to finish and proactively manage the renewal process to ensure that there are no interruptions in patient therapy. A full database of coverage and criteria for each medication for each insurance is maintained to effectively collect the pertinent information from the physician that will result in higher approvals and quicker turnaround time.
Billing & Coding Support
We support the billing process for the dispensing pharmacy. Our proprietary “How To Bill Document” which contains all of the pertinent information necessary to create the invoice is sent to the pharmacy for all medical billing dispenses.
We support pharmacies in all appeals. These appeals can occur for either billing issues or prior authorizations. All correspondence with the insurance companies and Prior Authorization process are documented within the P5 Connect system to assist in the appeal process.
All payer benefit coverage criteria for the medication and therapy is documented in the P5 Connect system. This information is utilized to obtain all necessary data elements prior to requesting benefit coverage resulting in quicker approval time frames for coverage and prior authorizations. We also share the coverage criteria and partner with the Pharmacy to help manage their payer network. When a pharmacy is not in a payer network, P5 Connect will assist the pharmacy in the process of attempting to enroll in the network
Patient Assistance Programs
P5 Connect team members are well informed of all programs that will provide patient assistance either through co-pay cards, co-pay assistance programs, free product, samples and/or free trials. Throughout the Benefit Verification process, we identify what the patient out of pocket will be per fill as well as the estimated amount out of pocket cost for the benefit year. This provides the patient with the financial information needed to determine if any patient assistance program will be needed throughout the course of the therapy and allows P5 Connect team members to be proactive in finding the patient the financial assistance they need to complete the therapy.
Adherence & Clinical Services
P5 Connect develops customized adherence programs that center around the patient needs. Through our risk assessment programs we identify the care plan and patient outreach program that will work best for the individual patient.Our Clinical programs are designed to manage clinical pathways, therapy management and patient outcomes. All data is reportable and utilized in the communication to the physician and health care team.
P5 Connect team will provide Disease and Therapy educational materials for the patient, family and caregivers. Our clinical staff of pharmacist and nurses provide assistance throughout the course of therapy and become an extension of the patient health care team.
Web / Mobile Application
P5 Connect offers its clients an opportunity to gain the competitive edge through the use of a fully customizable mobile application that allows uniform direct access and secure information sharing among the pharmacy team, the provider, and the patient. The application provides the tools necessary to engage patients and improve outcomes through increased medication adherence monitoring, side-effect tracking, appointment and refill reminders, as well as education and training.
The application allows uninterrupted quality of care via real-time and immediate access to shared Clinical Care Plans, Medication Therapy Management, Progress Notes, Interventions, and Recommendations. Integration with tablets and smartphones for field fork forces like nurse educators and sales representatives enables real time access and interaction on the go.