Pharma Market Access Services

We help you deliver more services—and more value—to your pharma clients.

Omega Healthcare’s Pharma Market Access services provide the administrative support you need to help your pharma clients’ patients receive the therapy they need quickly and cost-effectively. We remove barriers that can cause patients to abandon treatment or switch to another medication. Our highly trained, global workforce acts as an extension of your core group of stateside case managers to handle benefit verifications, patient enrollments, payer follow-up, and prior authorization support on behalf of your pharma clients.

Member Enrollment

Getting members enrolled in a timely manner is essential to help them receive the therapy they need without delay. We streamline the entire process. Our Member Enrollment team works with each client to establish a dedicated eFax queue to which they can send their intake/patient enrollment forms. We review each fax received, after which a patient case is created in our client portal. Once all elements are complete, the cases are queued up to begin the eligibility verification process. If information is missing, our team follows up directly with the client until all information needed has been captured.

Benefit Verification

Omega Healthcare’s team of insurance experts is 100% focused on eligibility and benefits verification. We leverage multiple processes to gather accurate information, including phone, payer portals, email, fax and more. This includes the identification of secondary and tertiary coverage. We contact payers and PBMs to verify both medical and pharmacy benefits for the specific therapy, then enter that information into the client portal. If authorization isn’t needed, the information is sent to the manufacturer. If authorization is needed, we take care of that too. 

 Omega Healthcare Benefits Verification

• Patient eligibility verifications completed within 4 hours for priority cases
• Verification for large inventories takes just minutes
• Omega Healthcare deploys API, BOT, or other technology to automate status checks within your systems and workflow.

Prior Authorizations

Managing prior authorizations can be a resource-intensive, time-consuming process. Yet, it’s a process that is critical to the success of the case. Omega Healthcare’s team of dedicated prior-authorization specialists can manage the entire process on your behalf.

Our experts identify the authorization requirements for each patient case and then follow up with clinics, insurance companies, and manufacturers to get appropriate authorization in place so patients can begin their therapies. But we don’t stop there. When denials do happen, we can take care of the appeals process as well. We contact the payer to confirm the appeal documentation has been received and then continue following up until the appeal is approved or denied.

Patient Co-pay Assistance Service

The popularity of high deductible health plans means patients now owe a larger portion of their healthcare costs. This financial strain can lead them to make difficult choices, especially for those needing expensive specialty medications—many of which have exceedingly high out-of-pocket co-pays. We believe cost alone shouldn’t be a barrier to receiving therapy or cause a patient to switch medications.

Our Patient Co-pay Assistance service reviews the Explanation of Benefits (EOB) and submits a copy to the specialty pharmacy to reference and to determine the patient’s out-of-pocket costs. Using this information, we educate clinics and their key stakeholders on copay programs offered from pharma manufacturers. We act as a virtual sales force for manufacturers to liaise between clinic staff and the manufacturer to increase awareness of copay assistance programs available to patients.

Care Coordination Solutions

Care doesn’t end when a patient leaves the hospital, provider practice, or other healthcare settings. Our Care Coordination Solutions help organizations extend timely, effective care and data analytics  throughout the entire continuum. The result is improved outcomes, lower costs, and greater patient satisfaction. Care Coordination solutions include:

• Remote Patient Monitoring

  Empower patients with the support they need to manage their health needs from the comfort of their homes. Omega Healthcare provides proactive remote monitoring of your patients to improve adherence to medication and care plans and to visits to the ER. Our Remote Patient Monitoring Services are provided by a team of highly skilled clinicians, most of whom are registered nurses. Our team includes both native English and Spanish speakers to deliver more effective communication and better patient comprehension.

• Healthcare Contact Center

  Answering patient inquiries in a timely manner can be challenging, especially for organizations struggling with staffing shortages. Omega Healthcare can alleviate these challenges by fielding calls on your behalf, managing patients and representing your brand according to your procedures and processes. By accessing patient information in your EHR, our team of registered nurses can assess a patient’s symptoms in context with existing health conditions and relevant medical history. This allows us to effectively triage the patient’s needs and recommend the appropriate level of care. Our team can also route messages to the provider, schedule appointments, provide prescription refills, and coordinate admissions and discharges. We ensure your patients get the care they need when they need it while reducing that burden on your staff.