The Medication Access Specialist is a patient-facing position focused on seeking grants, disease-specific foundation and/or pharmaceutical sponsored copay assistance or free medication programs to offset patient financial toxicity from oral and injectable therapies including chemotherapy/biotherapy and support medications. Additionally, will coordinate with insurer directed prior authorization for Specialty Pharmacy fulfillment, the patient and the clinical team.
Responsibilities:
Supports ProHealth Care Mission and Value statements, including compliance with USP 797 and 800 guidelines, TJC standards, Federal and State Laws and Regulations.
Demonstrates exceptional interpersonal and customer service skills in all interactions with patients as well as internal and external healthcare team members.
Ensures all demographic, insurance, and eligibility information is obtained and up-to-date
Perform insurance verification in a timely manner for initial and subsequent pre-authorizations with all third-party payers for oral chemotherapy and other therapies to minimize disruption to care
Interacts with prescribers (or team) to obtain appropriate clinical documentation to ensure accurate indications from EMR prior to completion of third party prior authorizations.
Maintaining up-to-date knowledge of requirements for enrolling patients in: manufacturer, state, and local medication assistance programs; disease-specific assistance grants from non-profit organizations (foundations).
Document in electronic medical record all prior authorization of medications that ensures accuracy and within the date range and quantity of medication received.
Working collaboratively with the healthcare team (nurses, physicians, pharmacists, others) to obtain clinical and financial information for timely copay and medication assistance program enrollment for oral and injectable therapies including chemotherapy/biotherapy and support medications
Working with patients and their family/caregivers to apply to the programs for which they qualify.
Assisting with applications for patient assistance and co-pay programs to ensure demographic, insurance, and eligibility information is current.
Obtaining patient financial records (as needed/required for eligibility)
Liaising between the patient, the clinical program (i.e. Cancer, etc.), and the patient assistance program(s).
Utilize tools to manage and track all financial assistance obtained, metrics, and patient interactions with governmental and non-governmental payer(s), as well as patient assistance, drug replacement, and grant or foundation programs
Willingness to train new hires/existing employees on process and procedure
Collaborate on pharmacy SOP, Policy and Procedure development (Retail and Hospital)
Communicate and collaborate with PHC Specialty/Retail Pharmacies for dispensing of oral and self-injected medications
Organizes procurement of medications and supplies for the pharmacy
Requirements:
PTCB Pharmacy Technician Certification preferred upon hire or within 2 years of hire.
2 years of pharmacy technician experience preferred.
Basic competency using Microsoft Excel and Word.
Prior experience obtaining prescription prior authorizations preferred.
Completes organizational, departmental and job specific competencies, as assigned
