Shields "Care Corner" Blog

Getting Back on Track

Lisa, a patient with a chronic condition, was recently told by her physician that she would need to start a specific medication therapy for her disease soon. Unfortunately, when her provider sent the prescription over to the hospital specialty pharmacy, he found out that Lisa’s current insurance didn’t cover this type of therapy for her chronic illness. In a panic and not knowing how to get this situation figured out quickly, Lisa’s physician contacted the in-clinic pharmacy Liaison dedicated to Lisa’s case and asked for assistance in making sure Lisa would be able to receive this necessary medication. Her Liaison took over the case from there and submitted the necessary forms along with clinical notes to the drug manufacturer in order to get financial coverage for this medication. She also worked with a case manager from the drug manufacturer to ensure that no small details were missed and that Lisa’s case would be taken care of in a timely manner. Since Lisa’s insurance did not offer any coverage for this type of therapy and she did not have the ability to switch insurance providers, Lisa would’ve had to pay out-of-pocket in order to access this extremely expensive medication.


After a period of waiting and continuous follow-up on the part of her Liaison, Lisa was finally approved for continued coverage of the medication therapy through the drug manufacturer. Her liaison received the good news and notified Lisa that she would be fully covered for one year of her therapy with a $0 copay, saving her over $130,000 in out of pocket expenses. Because the liaison was promptly able to fill out the appropriate paperwork, work with a case manager, and continue to stay on top of her case, Lisa can now afford her necessary medication therapy. She can now get on the right track to a healthier lifestyle, and expensive co-pays will no longer get in the way between her condition and a life-saving therapy.

Subscribe To The Care Corner Blog Here!