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Streamline the path from benefits investigation to approval
PATIENT ACCESS & PRESCRIBER REIMBURSEMENT
 

Streamline the path from benefits investigation to approval

Payer approval is one of the first steps in the specialty patient journey. Our expert guidance helps manufacturers and providers move forward with assurance.

NAVIGATING COVERAGE
 

Work with experts on prior authorization, appeals and more

Complex patient journeys go hand in hand with complex payer requirements for access and reimbursement. The knowledgeable team at PharmacyElite™, our hub solution, provides prior authorization support and related guidance on behalf of your brand, walking providers through the predictable steps and unknown variables that must come together to help patients gain approval for their specialty journey. We draw upon decades of experience in complex oncology and rare disease access pathways to:

  • Conduct benefits investigation (BI)
  • Provide compliant prior authorization support
  • Provide prescriber reimbursement assistance
  • Coordinate appeals support for claim denials

PharmacyElite supports patient access by:

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Managing complex, nonlinear access pathways

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Supporting diagnostic confirmation and site readiness

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Coordinating time-bound therapy initiation

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Serving as a single source of truth for manufacturers navigating small patient populations

Due diligence before the journey begins

Gaining reimbursement for specialty therapies is complex and requires experienced support for both patients and providers throughout the reimbursement journey. In addition to insurance benefits, PharmacyElite can help patients connect with financial assistance or advocacy programs they may be eligible for. We can also channel our targeted knowledge in various disease states to help inform prior authorization submissions, advising prescribers regarding the documents and details required to pursue approvals.

Communication, reimbursement and compliance-first appeals support

PharmacyElite™ provides our biopharma partners with real-time communication loops, supported by transparent tracking and reporting, to help you understand bottlenecks and barriers that affect time to therapy. Additionally, our specialty expertise positions us to provide insightful guidance on coding and billing, as these typically differ from nonspecialty pathways.

PharmacyElite takes compliance seriously, providing specialized appeals support for claim denials. Our programs are designed from the ground up with regulatory alignment in mind. For example, we can work proactively with biopharma manufacturers to develop templated resources to help providers make their own case for coverage. As always, our team is available to answer questions and provide key product insights as requested.

Collaboration with field reimbursement teams

The hub collaborates closely with manufacturer field reimbursement teams through defined communication and escalation workflows to support providers with access and reimbursement challenges. While the hub manages patient-specific operational activities, field reimbursement managers focus on provider education and field-based support. This coordinated approach ensures a consistent provider experience, avoids duplication of effort and operates within approved compliance guardrails.
 

Value for biopharma partners

  • Experienced teams familiar with complex oncology and rare disease access pathways
  • Customized workflows tailored to each therapy and payer landscape
  • Consistent, clinically aligned communication with provider teams

Designed for complex patient journeys

Purpose-built hub programs supporting oncology, rare disease and cell & gene therapy.

Biologics Hub Services

Addressing financial barriers

Program‑level affordability support designed to help biopharma partners address financial barriers and support access across patient populations.

Affordability Support

Supporting non-commercial therapy models

Hub support for patient assistance programs and free or reduced‑price drug initiatives.

Non-Commercial Dispensing