2025 The Year of Change and Adaptation By Alisa Redmon
Feb 3, 2025
2025 – The Year of Change and Adaptation
By Alisa Redmon
2025 has already proven to be a year of challenges and adjustments, with plan changes, shifting formularies, evolving patient assistance programs, and the growing presence of biosimilars. Now more than ever, keeping field reps on speed dial will be crucial for ensuring patient access.
As biologic coordinators, our community will serve as a vital resource—especially among those navigating the same state-specific changes. Many insurance adjustments have been made across the board, but their impact varies by location.
State-Specific Changes: The Alabama Example
In Alabama, at least two insurance plans have switched PBM contracts. Often, we don’t even become aware of these changes until a prior authorization (PA) is denied—forcing us to navigate an unfamiliar PA process on the fly. This delays approvals and adds even more work to an already full plate.
The Fight to Keep Patients on Therapy
With formulary updates and biosimilar introductions, one of the biggest battles we face this year will be keeping patients on their current, effective treatments. The last thing we want is for an insurance change to disrupt a successful therapy regimen, potentially causing symptom flare-ups and declines in quality of life.
At the end of 2024, a state plan in Alabama removed AbbVie products from their formulary, threatening to disrupt treatment for numerous patients.
What We Learned:
✅ Getting ahead of the game isn’t always effective – The plan wouldn’t process letters of medical necessity before the official effective date. Timing is everything.
✅ Patient communication is key – Patients need clear updates and a proactive plan to ease their anxiety about possible treatment gaps.
✅ Keeping samples on hand helps – This not only reassured patients but also provided peace of mind that they wouldn’t experience a therapy lapse while we worked through coverage issues.
✅ Field Reimbursement Managers (FRMs) are essential partners – Alerting FRMs about impacted patients helped us explore ‘bridge’ assistance programs for those facing coverage denials.
✅ There’s always a solution – With the help of an FRM, we found a specific form that consistently secured approvals, ensuring all affected patients stayed on their prescribed therapy.
Collaboration is the Key to Success
This process will always be case by case, plan by plan. But having a strong network of peers makes navigating these challenges more efficient and effective.
The Power of the BC Collaborative
💡 BC Collaborative offers a nationwide network of patient access leaders—regionally and nationally. Whether you're in the Northeast, South, Midwest, or West, you can always connect with fellow BCs and FRMs to share insights, exchange best practices, and optimize patient outcomes.
2025: The Year for Collaboration & Advocacy
This year, our success will rely on staying connected, informed, and proactive. By leveraging our community and advocating for patient access, we can ensure every patient receives the care they need—without disruption.
🚀 Let’s collaborate. Let’s advocate. Let’s make 2025 a year of progress!
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At BC Educators, we are dedicated to empowering biologic coordinators, healthcare professionals, and patient advocates with the education, tools, and resources needed to optimize patient care. From expert-led webinars to hands-on training, we provide comprehensive support to help you navigate the ever-evolving landscape of specialty medications and prior authorizations.