Patient Access

Oncology patient access and reimbursement strategy

Patient assistance, copay, and foundation navigation, benefits investigation, and prior authorization workflow design for oncology and specialty therapies. The measure that matters is days from referral to first dose, and how many patients fall out of the process before they get there.

What this covers

Patient access work is operational. It ends in a workflow, an owner, and a number you can watch move.

Patient assistance, copay, and foundation navigation

A working program, not a binder: who owns enrollment, how it is tracked, and what happens when funding closes.

  • Manufacturer patient assistance program enrollment workflow
  • Copay assistance and accumulator or maximizer exposure
  • Independent foundation fund monitoring and re-enrollment
  • Uninsured, underinsured, and charity care pathway design

Benefits investigation and prior authorization

Most of the delay is upstream of the payer. Design the intake and the denial loop and the days come back.

  • Benefits investigation intake and completeness standards
  • Prior authorization workflow, staffing model, and escalation
  • Denial, appeal, and peer-to-peer turnaround design
  • Medical versus pharmacy benefit routing decisions

340B-enabled patient access

Connecting program savings to what the patient actually pays, in a way that survives audit.

  • 340B-enabled patient access and affordability program design
  • Contract pharmacy program design for patient-facing access
  • Eligibility and qualification documentation
  • Governance and reporting on how savings are applied

Hub and access-vendor evaluation

Provider-side evaluation of whether a hub or access platform actually removes work or just moves it.

  • Hub, copay vendor, and access platform evaluation
  • Data exchange, status visibility, and turnaround commitments
  • Workflow fit against existing clinic and pharmacy staffing
  • Contract, service level, and reporting review

Access barrier analytics

You cannot fix what you are not measuring. These are the four measures worth standing up first.

  • Time from referral to first dose
  • Prescription abandonment and fall-off points
  • Denial rate and denial reason trending
  • Financial clearance cycle time by payer and regimen

Clinic and infusion workflow

Where access work actually happens: the clinic, the scheduler, the infusion chair.

  • Financial clearance before scheduling, not after
  • Navigator, pharmacy technician, and pharmacist role design
  • Scheduling and chair-time protection
  • Documentation standards that hold up under review
Weaver Crest, Salix Compass

Support: I support Salix Compass, a nonprofit medication navigation service. We share the goal of helping patients get access to their medications and better understand the process of getting there.

What you get

Deliverables are short by design. The test is whether your team can run them after I leave.

Deliverables

  • A current-state map of the referral-to-first-dose pathway with the delay points named
  • A prioritized access barrier fix list with an owner and a target metric per item
  • Workflow and role design for benefits investigation, prior authorization, and assistance enrollment
  • A reporting package your team can run monthly without external support

When people call

  • Time-to-therapy is drifting and nobody can say exactly where the days go
  • Prior authorization volume outgrew the staffing model
  • A new high-cost oncology or specialty therapy is coming and the pathway is not ready
  • Copay accumulator or maximizer policies changed patient out-of-pocket exposure
  • You are evaluating a hub or access vendor and want a provider-side read

Start with a 30-minute call

Bring the audit finding, the number that is not adding up, or the workflow that keeps stalling. If I can help I will tell you how. If I cannot, I will point you to someone who can.