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Behind the scenes: Helping patients access specialty medications

Specialty drugs are prescription medications used to treat rare, complex and chronic conditions, such as diabetes, cancer and multiple sclerosis – they are often the only option for some patients. According to IQVIA, they represented around 51% of market sales in 2023, and are projected to continue growing.

But the process for filling a specialty prescription can take weeks, or even months, as insurance companies often require step edits, prior authorizations and at times multiple levels of appeals for these high-cost therapies. Sometimes, patients forego or can’t complete prescribed therapy because of complicated qualification processes, high costs, or uncertainty about their medications. That’s where Cardinal Health™ Sonexus™ Access and Patient Support comes in: The business is dedicated to helping patients quickly access specialty medications.

“Sonexus Access and Patient Support collaborates with specialty manufacturers to help patients get on – and stay on – therapies to treat cancer, rheumatoid arthritis and rare diseases, to name a few,” said Josh Marsh, vice president and general manager of Sonexus Access and Patient Support. “Our case managers and patient navigators play such a critical role in the care team of specialty patients; they are essential in helping patients access their medication.”

These patient-centric roles are mostly behind the scenes, completing patient enrollment and education, verifying benefits and researching sites of care. At Sonexus Access and Patient Support, case managers and patient navigators work with specific manufacturers’ products, so they’re able to gain deep knowledge of those products.

Here, we introduce two of these important providers.

Janae Herndon, case manager

Herndon has been in her role for six years, and has supported a wide variety of different medications and patient populations. As a case manager, Herndon helps to enroll patients in the specific support program for their prescriptions; she reaches out to patients if there is any missing information needed to complete enrollment. Once the patient is enrolled, she performs a comprehensive benefit investigation for each patient, which may require long phone conversations with insurance companies to verify coverage and determine what is needed to get the patient on therapy. When she’s verified benefits, Herndon researches sites of care near the patient to learn which facilities will take the patient’s insurance and administer the specific medication the patient needs. For the medication program she is currently supporting, this means researching infusion centers.

“I was a nurse assistant and home health aide; and I became a licensed vocational nurse,” she said. “Having both a medical background and customer service experience in previous jobs helped me to excel in this position.”

A big part of Herndon’s role is evaluating patients for patient assistance programs (PAPs), sponsored by specialty pharmaceutical manufacturers, which provide free or reduced-cost medications to uninsured and underinsured patients who qualify. In fiscal 2023, the Sonexus Access and Patient Support non-commercial pharmacy dispersed more than 440,000 shipments to patients who qualified for a PAP program, totaling more than $5.1B in free medications. She also helps patients to identify and apply for coverage from other funding options, by connecting them to foundations and other forms of financial assistance.

“I work as if the patient is my family or my friend to get things done – that’s my mindset,” Herndon said. “My favorite part of my job is knowing that I’m thorough in obtaining information that will move the patient forward in their treatment process.”

Once she has completed her part, Herndon relays the information she gathered to a patient navigator; the patient navigator then relays the information to the patient and the patient’s caregiver, healthcare provider and the infusion center.

Lisa Buckley, patient navigator

Buckley said that a huge part of her role is building rapport and relationships with families and their caregivers. “A lot of patient navigators have experience in the medical field or in social work, and are empathetic and compassionate – traits that are critical to doing this job well,” she said.

Before her role with Sonexus Access and Patient Support, Buckley was a nurse at a multi-specialty clinic, but wanted a change. She still wanted to work with patients, but in a different capacity.

Buckley spends a lot of time on the phone with patients and their caregivers. Typically, Sonexus Access and Patient Support provides multiple touchpoints with each patient – a welcome call, outreach following benefit investigation, an appointment reminder and a follow-up call after the appointment. The patient navigator continues to follow up with patients throughout their entire treatment journey.

“A lot of my patients get to know me by name, and, when I call, they’ll share what they’re doing for that day, whether they’re on a walk or taking a trip. The patients I work with become like family to me,” she said.

Buckley supports a program for a specialty neurology product. “The patients I work with are going through a very challenging diagnosis, one that’s changing their world forever,” she said. “My favorite part of my role is providing support and encouragement in any way I can. Patients really do appreciate someone simply reaching out to say ‘Hey, just following up on your infusion appointment. What can I do to help?’”

Patient navigators support their patients’ families and other caregivers, too. “Caregivers of patients with serious illnesses often feel overwhelmed. They might have to learn how to do things that their ill spouse used to take care of. Other family members might live in a different state, so they have to decide whether to move or to relocate their loved ones closer to them. I can’t solve their problems, but I can support them and let them know they’re doing a great job,” Buckley said. 

Of course, there still are complex diseases that specialty medications cannot completely cure, and that can weigh on the patient’s care team. “That is really tough,” Buckley said. "I'm a person of faith, so I process everything by praying for my patients. Hopefully, that’s enough to encourage and give them some strength along their journey.”

Marsh said, “We have a number of people like Janae and Lisa who work diligently behind the scenes to ensure each specialty patient can access their prescription. Case managers and patient navigators are truly unsung heroes in healthcare. They are kindhearted, empathetic people who care deeply about helping patients.”

To learn more about the services that Sonexus Access and Patient Support provides, please visit us here.

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Cardinal Health is a distributor of pharmaceuticals, a global manufacturer and distributor of medical and laboratory products, and a provider of performance and data solutions for healthcare facilities. Subscribe to our News Alerts to get all of our latest news.