This document discusses the future of benefit verification (BV) processes and the role of electronic benefit verification (eBV) in improving the patient and provider experience. It notes that while eBV aims to make BVs more efficient, success requires balancing automation with human review to address the diversity of products and payers. An optimal eBV approach uses artificial intelligence to process most BVs in real-time while referring more complex cases to counselors. If implemented well around patient and provider needs, eBV can strengthen brands, increase speed to therapy, improve accuracy, and minimize financial burdens on patients and providers. Manufacturers should consider their product fit and integration strategy when evaluating eBV solutions.

1. RETHINK:
The Future of
Benefit Verification
eBV’s role in the patient and provider experience

2. 1. The Basics
The benefit verification, or BV, is a critical step in a patient’s treatment journey. It occurs after a patient is
prescribed medication but before a patient can receive the medication. The BV provides information about a
patient’s coverage, their out-of-pocket responsibility for a medication, and it can set in motion additional steps
that impact the patient’s speed to therapy.
Quality
review
Qualitative
guidance
Eligibility
Check
Product Benefit
Determination
Coordination
of benefits
A comprehensive BV includes five components:

3. – Mark Spykerman
SVP, Lash Group
“Clinicians have told us they just want
a seamless process from the time
medicines are prescribed to the time
patients receive it …anything less
disrupts care. So a well-executed BV
must always put patient needs first.”

4. 2. The Challenge
Today, most BVs in the United States are performed by
reimbursement counselors via phone calls to payers.
That adds up to millions of calls each year to
support millions of patients.
What obstacles exist for scale, speed, efficiency
and effectiveness?

5. 3. The Thinking
No surprise: manufacturers and their partners look to
technology to accomplish each of the five core components
of a comprehensive BV.
Referred to as electronic benefit verification, or eBV, it aims to
make the BV process more efficient without negatively
impacting its effectiveness.
When successful, these solutions increase accuracy and speed
to therapy while reducing manufacturer costs.
“When successful”
is the key qualifier…

6. 4. More to the Story
Today, no fully automated solution exists to address all five components of a
comprehensive BV for all types of products and patients.
Why?
Diversity of Products and Payers
Products in new classes of
treatment, or introduced into
new or unfamiliar sites of care,
create provider uncertainty and
BV complexity.
Lack of System Connectivity
Automated components often
do not integrate data effectively
to create a single, actionable
view—which can cause delays
or missed information.

7. 5. Rethink: Approach
If the goal is to continue to enable appropriate access to therapy with speed and clarity for every patient, then it’s
important to recognize that not all eBV solutions are created equal.
Positive disruption in BV, then, doesn’t mean moving from fully manual to fully automated—it means moving to a
model fully built around patient and provider needs; one that results in a better patient and provider experience.
Here’s how it works best:
1 2 3
Artificial intelligence and machine
learning algorithms mine real-time data
and determine coverage. Coverage
predictions are continuously modeled.
BVs are processed
real-time, on-demand.
BVs are sent to
counselors for
manual intervention.
Evaluate
complexity
High-tech for
"high confidence"
High-touch for
"low confidence"

8. 6. Rethink: Results
With a BV approach built around the patient and provide experience, success metrics shift from sheer efficiency
and automation to more holistic measures that impact business outcomes and patient outcomes. What does
technology-empowered BV success look like?
Strengthen brand loyalty
Increase speed to therapy
Decrease time and intervention required from
providers and patients to clear access hurdles
Improve accuracy of benefits information for providers
Minimize financial hardship for patient and providers

9. 7. Rethink: Next Steps
As eBV continues to evolve and mature, it becomes a more useful tool for more products and patients. For now,
wise manufacturers ask three primary questions when considering solutions:
1 Is my product a good fit for eBV?
2 How do I incorporate eBV into my overall reimbursement offering?
3 What’s my ability to monitor accuracy rates of eBV?
What to consider:
High BV
volume
Relatively
mature product
Stable coverage
environment
Payer
mix

10. EBV_Slide_
Lash Group, the leader in patient support services and an
AmerisourceBergen company, provides eBV solutions tailored to
the goals of your product and the needs of your patients. In
collaboration with a network of technology partners, Lash Group
delivers a comprehensive set of solutions to address the evolving
requirements of patient care. Start a conversation to learn more.
Learn More