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Many of the market’s leading specialty Buy and Bill therapies are covered under a patient’s medical insurance.


Before administering a Buy and Bill therapy, the doctor needs to understand how the patient’s insurance covers treatment. Why? Two words – “financial risk.” The provider needs to make certain that the therapy he has already acquired will be covered by the patient’s insurance. That means having access to patient’s insurance status, product coverage details, payer requirements and patient cost share.


In today’s access environment, the provider has to call the manufacturer’s HUB to obtain information on the patient’s insurance. In turn, the HUB has to reach out to the Payer, and then reconnect to the Provider with the necessary coverage details. All the while, the patient waits to go onto therapy. Unless…the provider is able to access the patients benefits on-demand. That’s why VirMedica’s eAccessMed technology has been used for several years by some of the world’s leading biopharmaceutical manufacturers.



Solution Highlights

  • Automates the complex benefit verification process for high-volume Buy and Bill therapies covered under a patient’s medical benefit.
  • Incorporates VMI’s MedeBV transaction to deliver real-time, product-specific coverage details to the user.
    • VirMedica’s medical electronic benefit verification (MEDeBV) delivers real-time benefits transparency. Typically, eBV responses are returned to the provider portal or call center user interface within seconds and include:
      • Insurance eligibility status (Active/Inactive)
      • Product coverage status (Covered/Not Covered)
      • Patient cost share (Co-Pay/Coninsurance/Deductible/Max OOP)
      • Step edits required (Yes/No)
      • Prior authorization required (Yes/No)
  • Improves speed to therapy and customer service by eliminating the need for the provider to call/fax the HUB and/or eliminating the phone call from the HUB to the health plan.



Delivery Options


Provider-Facing Portal

In order to eliminate financial risk from the Buy and Bill business model it’s important to deliver reimbursement certainty to the provider.


To accomplish this, VirMedica offers manufacturers a branded provider portal which not only captures a manufacturer’s specific enrollment and consent forms, but also automates the benefit verification process.


By imbedding our MEDeBV transaction in the provider portal, the doctor can access robust, product-specific benefits data in seconds thereby gaining clarity on reimbursement.



VirMedica recognizes that some manufacturers are satisfied with their overall existing access infrastructure, but are interested in adding technology to improve customer service while lowering program support costs. To accommodate this approach, VirMedica has developed a robust API that allows Call Center personnel to leverage our proprietary transaction sets to complete common support tasks.


The impact to HUB workflows is profound. Call Center agents are able to instantly access a patient’s benefits and understand unique payer requirements (eg, Prior Authorization/Step Edits, Product Access Requirements) thereby eliminating time consuming back and forth calls and faxes to a payer’s help center. Providers can receive guidance and information typically in one call, empowering them to get their patients on therapy sooner and with less administrative processing.