Spring brings not only warmer weather and allergy season but also a wave of formulary changes that can significantly impact patient access to biologic treatments. As a Biologic Coordinator in dermatology, staying proactive with these changes is essential to ensuring patients continue to receive their prescribed therapies without delays or disruptions. Understanding formulary updates, step therapy laws, and the role of Field Reimbursement Managers (FRMs) can help navigate these seasonal adjustments effectively.

Monitor and Understand Formulary Updates

Insurance formularies typically undergo revisions at the beginning of each quarter, with significant changes often rolling out in the spring. These changes may include:

• Tier adjustments that impact patient copays
• Prior authorization (PA) requirements
• New step therapy protocols
• Preferred versus non-preferred product designations

To stay ahead, regularly check insurance plan updates and communicate with payers to understand how these changes will impact your patients. Many insurers release their updated formularies online, and manufacturer support programs may also provide insight into coverage shifts.

Leverage Your Field Reimbursement Manager (FRM)

FRMs play a critical role in navigating access challenges. These professionals provide in-depth knowledge of payer policies, assist in obtaining prior authorizations, and help appeal denials. Biologic Coordinators should maintain regular contact with their FRM to:

• Gain insights into upcoming policy changes
• Expedite approvals and resolve claim issues
• Identify alternative access solutions, such as copay assistance or patient support programs

Stay Informed on State Step Therapy Laws

Step therapy, or “fail-first” policies, require patients to try and fail insurer-preferred treatments before accessing certain biologics. However, many states have passed laws regulating step therapy practices, providing exceptions based on:

• Disease severity
• Provider attestation of previous treatment failures
• Patient stability on an existing biologic

Biologic Coordinators should familiarize themselves with their state’s step therapy regulations to advocate for exemptions when appropriate. The National Psoriasis Foundation and other advocacy groups maintain updated resources on state-specific legislation.

Enhancing Patient Communication and Support

Spring formulary changes can be frustrating for patients, especially when unexpected barriers arise. To mitigate stress and ensure continuity of care:

• Proactively notify patients of potential coverage changes
• Educate them on how to navigate new requirements
• Work closely with providers to expedite appeals and alternative treatment pathways

Conclusion

Formulary changes in the spring can be challenging, but with a proactive approach, Biologic Coordinators can ensure that dermatology patients receive uninterrupted access to critical biologic therapies. By staying informed on policy updates, leveraging FRMs, and understanding state step therapy laws, you can streamline the access process and improve patient outcomes. Preparedness is key—stay ahead to keep your patients on track with their treatments.