Outsourcing access + reimbursement responsibilities help biopharma companies navigate payer requirements, secure patient access to costly specialty drugs, and reduce financial risks. 

Why it matters: Specialty drugs now represent over 50% of pharmaceutical spending in the United States.¹ And they continue to be an increasingly larger piece of the new drug landscape. In 2023, specialty drugs made up 80% of new FDA approvals.² This has caused payers to apply more utilization management tools to control costs, leading to growing administrative burdens for healthcare providers (HCPs) and their staff, which often delays patient access to treatment. 

Zoom in: Contract access + reimbursement support teams streamline prior authorization pathways, reduce claim denials, and shorten time-to-fill, leading to faster treatment + better provider relationships. Here are the top 5 advantages of outsourcing:
 

1. Flexibility + scalability: Outsourcing lets biopharma companies adjust team sizes to meet demand without long-term commitments, which is especially helpful during product launches when payer access is uncertain. This allows for better resource allocation, and makes it easier to adapt to changes in reimbursement policies or formularies.
    
2. Specialized knowledge: Contract access and reimbursement experts are pros in navigating complex payer policies and resolving access challenges. Their market access know-how, built from regular interactions with payers, providers, and patients, helps them assess issues quickly and provide effective solutions.
    
3. Reduced burden: HCPs and their staff are often overwhelmed with the process of filling a prescription for a specialty drug. The time spent addressing claim requirements can distract from patient care. Access and reimbursement teams provide guidance on insurance issues so providers can focus on what matters most — the patient.
    
4. Resource optimization: Building an in-house team is costly and time-consuming. Outsourcing reduces overhead, so companies can invest more strategically in marketing and sales efforts. Plus, outsourcing eliminates the need for in-house infrastructure, saving on salaries + benefits.
    
5. Ensured compliance: Complex reimbursement regulations can be a minefield. Outsourced access and reimbursement experts help navigate these waters, ensuring compliance and avoiding costly penalties and potential delays.  

Bottom line: Outsourcing access + reimbursement teams is a smart strategy that improves patient outcomes + empowers companies to stay agile and compliant. Amplity has a history of building top-quality teams that support reimbursement processes and tackle patient access barriers. 

Sources

1. https://www.businessgrouphealth.org/resources/specialty-drugs-and-gene-therapies

2. https://www.managedhealthcareexecutive.com/view/tis-full-and-very-very-expensive-the-2023-specialty-drug-pipeline-amcp-2023