Field reimbursement managers (FRMs) are the backbone of a life science organization. FRMs support commercial (i.e., sales teams) with the patient reimbursement journey, ensuring patients receive therapy in a timely and cost-effective manner and assisting life science organizations with their primary objective of improving patient lives.

Becoming an FRM lacks a predetermined career path, instead, FRMs possess diverse educational backgrounds and professional experiences. Nevertheless, all FRMs must understand the complex United States healthcare system, composed of health insurance companies (payers), pharmacy benefit managers (PBMs), providers, and patients. Since reimbursement policies vary geographically, FRMs are typically reimbursement specialists within one region or state.

Let’s discuss the role of FRMs and 5 tips to become a successful field reimbursement manager.

What Is a Field Reimbursement Manager?

As the key contact for access and reimbursement, FRMs act as liaisons among life science organizations, provider offices, and patients. Within the field reimbursement team, each FRM provides insight to external and internal stakeholders on the impact of region-specific health policy and managed care guidelines for market access, i.e., the ability of patients to get a particular drug. FRMs collaborate with external stakeholders throughout a product’s lifecycle, but they are especially important in the prelaunch and launch phases. 

During the drug launch period, FRMs provide comprehensive education and training on reimbursement processes for the new therapy ensuring accurate and complete claims submissions. Today, many life science organizations implement a patient-centric approach during the launch phase, with medical science liaisons (MSLs) educating providers on clinical trial data and FRMs educating providers on patient enrollment.

With the emergence of more sophisticated and expensive therapies, such as gene therapies, elaborate reimbursement processes are becoming more common. As a result, successful field teams will increasingly rely on FRMs. FRMs assist physicians’ offices with reimbursement paperwork, especially for specialty products such as biologics. In addition to reducing the administrative burden caused by specialty drugs, FRMs ensure providers have enough time to provide quality care.

While FRMs assist providers, they also facilitate patient access to drugs by identifying barriers related to insurance coverage. Common barriers include prior authorizations (PAs) and step therapy (ST), two cost management tools utilized by health insurance companies preventing timely access to appropriate medications. ST requires a patient to try a lower-cost medication before a more expensive medication is approved. PAs require providers to obtain approval from health insurance companies before the insurance will reimburse them for medication. 

When insurance approvals fail, an FRM can determine whether a patient qualifies for a patient assistance program sponsored by the life science organization. Although these programs can help eligible patients obtain medication for free or at a reduced price, the process is often time-consuming and tedious. 

In addition to knowledge of patient support services, FRMs understand more nuanced approaches to patient access, such as brown-bagging, white-bagging, and buy and bill. Brown-bagging is the practice of patients picking up their drugs through their pharmacy benefit and taking them to the doctor’s office for administration, while white-bagging refers to the specialty pharmacy bringing the medication to the doctor’s office for administration.

Buy and bill occurs when a physician’s office acts as a pharmacy by buying, storing, administering, and billing specialty medications directly. While this process may allow the patient to obtain drugs more quickly, buy and bill is more expensive for providers due to the overhead associated with buying and storing expensive drugs. Brown-bagging, white-bagging, and buy and bill each have different advantages and disadvantages, and FRMs help the provider’s office determine which approach is best for a particular patient.

Brown-bagging, white-bagging, and buy and bill are access and reimbursement options common for biologics which often require an injection or infusion by a doctor in a hospital or doctor’s office. By understanding these methods of billing and obtaining medications, FRMs can assist providers, office staff, and patients in determining the best method for starting a patient on therapy. FRMs can navigate access barriers for patients, while providers can focus on quality patient care. 

During the “patient pull-through” process, FRMs assist patients in obtaining insurance coverage (payment). However, even if the patient receives approval and coverage for a medication, according to Deena Ayoub, a field reimbursement specialist, “approved does not necessarily mean free, cheap, or affordable.” In addition to knowledge of health policy and market access, field reimbursement specialists should remain empathetic to patients’ frustrations during the entire reimbursement journey. 

Consequently, many healthcare professionals such as nurses are ideal candidates for the FRM role especially since they have experience handling sensitive protected health information (PHI). While medical affairs and commercial teams are not privy to private patient health information, FRMs receive access to some patient information and must remain HIPPA compliant. 

However, FRMs may have a business or public health background rather than a clinical one. Aspiring FRMs without a clinical background will require additional training and upskilling. Due to the diverse responsibilities of the FRM, FRMs need continuous education and upskilling opportunities as market trends change. 

In addition to upskilling, here are five tips for aspiring FRMs.

5 Tips to Become a Field Reimbursement Manager

1. Develop access and reimbursement knowledge and experiences

Though FRMs may have varied backgrounds including careers in healthcare, public health, or business, all FRMs are expected to possess a thorough understanding of the regulatory environment and market access trends, which include the following:

  • compliance rules when engaging with healthcare providers such as the PhRMA Code
  • real-time policy information
  • medical billing and coding 
  • prior authorization requirements
  • reimbursement barriers
  • health insurance for federal, state, and commercial plans
  • challenges across payers
  • copay support programs
  • barriers to specialty products
  • drug price tiering 

2. Cultivate soft skills

Aside from the knowledge and expertise required for the FRM’s role, soft skills are also essential, including:

  • working as a “team player” (experience working alongside sales teams)
  • developing and maintaining relationships
  • communicating effectively 
  • multitasking
  • practicing empathy when dealing with patients

When interviewing prospective employees, many employers consider transferrable skills. By giving examples of instances where you applied your soft skills effectively, you can demonstrate your ability to handle FRM responsibilities.

3. Establish a network of contacts

Networking is the key to making a career change. In fact, “up to 85% of jobs are filled via networking.” Attending virtual or in-person career fairs or applying to internships with life science organizations are methods to expand contacts.

4. Invest in upskilling

Becoming an FRM requires a growth mindset considering how health policy and market access trends are continually evolving. By continually investing in your skills as an FRM, you can remain competitive. In light of the growing specialty drug market, biologics education and expertise will play an important role in future career opportunities. 

The Accreditation Council for Medical Affairs (ACMA) created the first ever Board Certified Biologics and Biosimilars Specialist Program BCBBS® to assist life science professionals in navigating the evolving biologics and biosimilars market. Since biologics have more complex patient access challenges, an FRM with biologic expertise is especially valuable.

5. Become certified as a Prior Authorization Certified Specialist (PACS)

The National Board of Prior Authorization Specialists (NBPS) certifies aspiring FRMs as experts in access and reimbursement. The Prior Authorization Certified Specialist (PACS) program focuses exclusively on the information required for a successful FRM career. Learn more about the FRM role and discover how PACS certification can propel anyone into an FRM role by visiting the resources below. 

Field Reimbursement Manager Resources

 References

1. Isola S, Al Khalili Y. Protected Health Information. [Updated 2022 Feb 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.