Special focus on supporting members
Being diagnosed with a serious medical condition brings up many feelings. Once you move beyond the shock of diagnosis, you may be overwhelmed with the cost, how to access the treatment, how to get coverage approval and how to administer the complex treatment associated with the specialty drug that has been prescribed.
To help make this challenging time easier, we have enhanced our Prior Authorization approach by expanding the role of our on-staff registered nurses and health care professionals to actively engage with physicians, specialists, pharmacists and the patient support programs. This helps ensure an easier experience for members diagnosed with serious or chronic health conditions.
After diagnosis, your specialist will contact the Patient Support Program for your prescribed drug.
The Patient Support Program will be your key guide through the process, providing you with the information and support you need. Instead of you managing the Prior Authorization process for coverage approval, the Patient Support Program and Medavie Blue Cross will look after all paperwork and consultation. The Patient Support Program will confirm approval within 5 business days. At the end of your coverage period, Medavie Blue Cross will automatically manage your renewal assessment.
The Patient Support Program will coordinate your appointments at your preferred pharmacy. In some instances you may be directed to a Specialty Pharmacy that specialise in your prescribed drug treatment.
The Patient Support Program will provide you with everything you need to help you get the full health benefits from your treatment
You will be able to concentrate on your health and the things that are important to you.
Navigating her journey back to health
A 36-year-old wife and mother of two, Julie is a finance manager at the car dealership where she has worked for 10 years. When her doctor sent her for blood tests for a flu she couldn't shake, she was sent to a specialist who gave her the devastating news: a rare, fast-moving cancer.
A new medication has had very positive results.
Julie's challenge today:
Julie's physician helped her contact and join the Patient Support Program for her prescribed drug.
The Patient Support Program will be her point of contact, get her the information and support she needs, and work with Medavie Blue Cross to get coverage reviewed.
Julie is approved for coverage. Instead of Julie managing the process, her Patient Support Program and Medavie Blue Cross looked after all paperwork and consultation.
The Patient Support Program coordinates with Julie for her appointments at the pharmacy. Working together, the Program and pharmacist provide Julie with ongoing education and support to help her get the full health benefits from her treatment. Medavie Blue Cross will manage her renewal, if needed.
Julie has been able to concentrate on her health and the things that are important to her.
By their nature, specialty drugs are a challenge to effectively deliver. Read more about the practices we have in place that leverage our in-house expertise and external resources to ensure effective, efficient access to the drugs and support you need.