EnvoyHealth is a comprehensive market-access solution. Our staff blends expertise across disciplines to enable the most effective treatment journey. We work as a seamless extension of our clients’ operations, tailoring services to their unique needs.
EnvoyHealth’s patient care coordinators complete benefit investigations and verifications under both the medical and pharmacy benefits. They regularly work with payers to complete prior authorizations and appeals. Our patient care coordinators provide expert triage support to ensure prescriptions reach network pharmacies and patients receive timely care from their providers.
Where possible, we leverage electronic benefits verification technology to obtain real-time automated responses from pharmacy benefit managers, and our electronic prior authorization capabilities allow us to start prior authorizations and receive details from payers. Both systems are integrated into our workflow management solution.
EnvoyHealth carries out annual reverification efforts, including those within disease states with high-volume prior authorizations, to support patients on chronic therapies and manage expectations on changing out-of-pocket expenses for your brand. We also offer separate reporting for reverification programs and have the ability to track payer service success rates inside and outside reverification efforts to provide a holistic market access reporting structure.
Prior Authorization Support
EnvoyHealth initiates and completes prior authorizations and precertifications using our streamlined, industry-leading technology. Our experienced patient care coordinators use the clinical information on the enrollment form and/or obtain the appropriate authorization form and material from the provider to prove medical necessity. Our patient care coordinators will follow up on the status of the prior authorization regularly to ensure an efficient resolution.
If the prior authorization is denied, EnvoyHealth’s patient care coordinators will collect appeals requirements and offer appeals assistance to the office and patient. This process results in faster approvals and quicker access to therapy.
EnvoyHealth helps providers with appeals for therapies initially denied coverage by payers. We identify the reason for prior authorization denial, coverage denial, or claim rejection; obtain the appeals requirements and provider’s signature; and submit the final appeal on behalf of the patient or provider. The patient care coordinator will follow up on the status of the appeal regularly to ensure an efficient resolution.
Specialty Pharmacy Triage & Tracking
As part of our reimbursement service offerings, we identify the appropriate distribution channels for our clients’ patients and ensure their prescription reaches those channels. Prescription triage and follow-up expedites the fulfillment process and makes pickup more convenient for the patient. The easier we make therapy for patients, the more likely they are to stay adherent.
EnvoyHealth has pharmacy network resources available to identify appropriate retail pharmacies within patients’ immediate area. We can verify a patient’s preferred pharmacy is in-network and expedite the script to that pharmacy.
For contracted pharmacies within your open- or closed-distribution network, we provide linking of reimbursement data to distribution data to better target market-access strategies.
Copay Assistance Eligibility Determinations
EnvoyHealth leverages our experience with manufacturer copay programs to carry out copay assistance eligibility screenings and benefit coordination.
We can accommodate clients’ preferred method to offer copay assistance, whether by debit card, by check, electronically, or through other means. We also offer file transfers to the copay service vendors selected by our client partners. This allows those vendors to provide copay assistance and report service activation and program usage data to EnvoyHealth.
The data is reportable by account, payer, patient demographic, program usage, and other data elements as desired. Real-time financial criteria checks allow EnvoyHealth to provide instant approvals over the phone with customers who meet the criteria. Our system has a built-in audit trail for compliance.
Patient Assistance Determinations
We leverage industry-leading technologies and automated income verification checks to provide patient assistance determination via phone, with verification within 24 hours. EnvoyHealth has an effective, built-in audit process that ensures accurate verification of patient assistance criteria. This allows for instant confirmation and decisions with patients to reduce turnaround times and get them on product faster.
Alternate Coverage Research
EnvoyHealth works with many alternative funding sources to ensure patients can afford their medications. We proactively contact key alternative funding programs, including 501(c)(3) organizations, to stay up to date on program availability. In addition to identifying potential funding sources, EnvoyHealth will also assist patients and providers through the application process until a determination is received.
Adherence & Persistency
EnvoyHealth can provide patients with customized adherence and education programs, with a 24/7 clinical help line and home healthcare coordination available. Our nurses and pharmacists provide medication-specific expertise to patients, and our field nurses can provide on-site training and support for injection and infusion patients. We’re adept at providing disease education and medical information to patients and providers through automated and live calls, always according to manufacturer guidelines. We can also provide these services remotely through our Virtual Office & Field service line.
Reminder & Refill Communication
EnvoyHealth works with healthcare organizations to implement patient adherence and persistency programs. Depending on the requirements of the therapy, these programs can include:
- A welcome call and assessment
- An initial welcome kit sent to the patient’s home
- A check-in call after week one of therapy (on or near day seven) based on therapeutic requirements
- Refill and appointment reminder calls
- Therapy restoration calls
- Therapy restoration follow-up calls
- Multi-channel communication according to patient preference
EnvoyHealth has more than 20 years’ experience monitoring and reporting adverse events and product quality complaints. Combined, we have handled more than 300,000 for our clients. We can provide customized reporting on adverse events.