Case Study: Supporting a Patient’s Access to Life-Changing Medication

At My Concierge Pharmacy, our mission is simple: to go the extra mile so patients can access the medications and health services they need—without the hassle. This month, we are thrilled to share a real-life example of how we helped one of our valued patients secure their vital infusion therapy. Here's how we turned a potentially stressful experience into a smooth, cost-effective solution:

Case Study: Supporting a Patient’s Access to Life-Changing Medication

• Medication: Xolair 150mg/ml syringe
• Cost: $1,400.00 for 2 syringes per month
• Service Provided: Prior Authorization Coordination & Infusion Delivery

The Challenge: Our patient relies on monthly Xolair injections to manage their condition, but with the high cost of $1,400 for a month's supply, accessing this medication can be a financial burden. When we received the prescription, our team immediately stepped in to ensure they received the medication with minimal out-of-pocket expenses.

Step 1: Navigating Prior Authorization

Upon receiving the prescription, our insurance pharmacist proactively reached out to the patient’s physician's office to kick off the prior authorization process. Unfortunately, the initial submission was denied by the insurance company. But we weren't ready to take "no" for an answer.

How We Overcame the Denial: Our pharmacist engaged directly with the physician's Medical Assistant, providing detailed feedback and recommendations for optimizing the insurance submission. This collaborative approach led to a revised application that was submitted promptly.

Step 2: Second Submission Success

With our guidance, the second prior authorization submission was approved! The result? A dramatic reduction in the patient’s out-of-pocket cost—down to just $40. That’s a savings of over $1,300 per month, making the therapy significantly more affordable.

Step 3: Ensuring Fast, Reliable Delivery

With insurance approval secured, we quickly arranged for the medication to be shipped through the patient’s specialty pharmacy. Thanks to our team’s coordination, the infusion medication was delivered within just 2 business days, ensuring the patient did not miss their scheduled dose.

The Results: Saving Time, Reducing Stress

• Total Turnaround Time: 28 days despite standard insurance and physician office delays (7-10 days per follow-up), we efficiently managed the process to minimize wait times.
• Labor Hours Saved for the Physician: 4 hours by handling the prior authorization and communication, we saved the physician's office hours of administrative work. This allowed their team to focus on what truly matters—patient care.

The Added Value of Our Executive Membership

For this patient, the entire prior authorization process was covered under their executive membership with My Concierge Pharmacy. This comprehensive support came at no extra cost, demonstrating the true value of our membership packages.

Why Choose My Concierge Pharmacy?

At My Concierge Pharmacy, we are more than just a pharmacy; we’re your trusted healthcare partner. By managing complex insurance processes, coordinating care, and ensuring timely medication delivery, we simplify healthcare for both patients and providers.

Whether you're a patient in need of personalized support or a provider looking to streamline administrative tasks, our concierge service ensures you receive unmatched, hands-on assistance.

Let us take care of the details, so you can focus on your health.

Interested in learning more about how we can help you or your patients? Contact us today @ 855-200-7177 for a complimentary consult or visit our website www.myconciergepharmacy.com to explore our package options and discover the difference personalized pharmacy care can make. Base Membership begins at $200 a year!

This case study highlights the difference our dedicated service can make. Share this article with your network or schedule a consultation to see how we can assist you. Let's transform how you experience healthcare—together!

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