By your side

BioMatrix Specialty Pharmacy is the trusted companion for patients with complex chronic conditions

Complex chronic medical conditions and disease states require a daunting level of management for patients, physicians, and insurance payers. Once a diagnosis is made, pharmacists stand on the front line of patient care, providing critical access to life sustaining medication and equipment. BioMatrix Specialty Pharmacy is one such provider, an independent organization dedicated to supporting care challenges with deep knowledge, a patient-centric model, cutting edge technology and data management, and an abiding commitment to excellence.

The BioMatrix enterprise is headquartered in Plantation, Fla., with a national footprint of 10 specialty pharmacies dedicated to dispensing oral, injectable, and biologic medications in all 50 states, is accredited by the American Commission on Health Care (ACHC), and is only the second specialty pharmacy in the nation to receive enterprise level accreditation from URAC, the Utilization Review Accreditation Commission. BioMatrix was also recognized as a 2019 "Best and Brightest" company to work for in the nation by the National Association for Business Resources and was just awarded placement on the Inc. 5000 list of fastest growing private companies in America.

Chronic diseases and conditions often require expensive treatments whose reliable procurement and ongoing management can add a significant level of stress on patients and families already coping with life-altering diagnoses. BioMatrix provides critical help at every step, from navigating byzantine insurance coverage issues, working closely with insurers and manufacturers to make sure patients can access treatment and helping them understand reimbursement, to ordering supplies, offering training for medication or infusion protocols, finding therapy sites outside the home, and coordinating on-site nursing and home health care services.

In addition to offering treatments used in bleeding and autoimmune disorders, solid organ transplantation, oncologic and neurologic therapies, and many other conditions, BioMatrix specializes in dispensing and care management for individuals with rare or orphan diseases.

Not your average pharmacy

As CEO, Nick Karalis explained, “Our philosophy of putting our patients first affords us the ability to focus on one patient at a time. Our customized clinical medication management provides a better patient journey that ultimately drives the best possible outcomes. This patient-centric approach allows us to advocate and participate in our patients’ care and differentiates BioMatrix from other specialty pharmacies.”

COO Meagan Sampogna (PhD, MBA, RHIA) added, “In many instances, retail pharmacies might not be positioned to order or access a specialty drug. When pharmaceutical manufacturers select channels by which their product is available in the market, they may opt for a limited channel through licensed specialty pharmacies,” she explained.

Another difference may be insurance and benefit coverage. “In a retail setting prescriptions are often covered by a patient’s pharmacy benefit, where benefit transactions can occur in a matter of minutes,” Sampogna said.

For specialty or biologics products, benefit coverage can vary based on how the services and products are administered. Some products may be administered in the patient's home or in the physician's practice and therefore covered under the patient's medical benefits. This medical benefit process is navigated very differently, billed very differently, and reimbursed very differently than a real-time pharmacy benefit transaction.

Bundled services—medications, product administration, infusion equipment, coordination of in-home nursing—require a host of different insurance activities, and BioMatrix is positioned to connect the myriad dots to offer patients a streamlined process that lets them focus on navigating their lives instead of the red tape that surrounds them.

“We not only have the ability to connect patients to co-pay services or financial funding programs, but we can also coordinate their nursing services, or find them an alternate site of care for their therapy. As a specialty pharmacy, we do so much more than just dispense, fill, and ship a prescription to a patient. There are a lot of other high-touch service we can provide that you would not find in retail," Sampogna added. “What also makes us unique is that we are independent, not owned or operated by an insurance company or pharmacy benefit manager. This gives us some diversification to serve patients with commercial coverage as well as those with coverage supplied by the government like Medicare, Medicaid, and other exchanges."

Karalis stressed, “We are making a difference by providing critical lifesaving medication to patients across multiple segments of specialty pharmacy.  Our unique offerings to hospital systems, transplant centers, providers and third-party payers are delivering value-based programs to our stakeholders.”

Patient-centric care, driven by data

Outcomes are the currency of modern healthcare. As such, BioMatrix leverages an impressive data gathering and analysis operation to ensure that manufacturers and prescribers have an accurate perspective on efficacy at every step of each treatment journey.

“Prior to therapy we conduct a clinical assessment, and during therapy our clinicians, pharmacists, and nurses are constantly connecting with patients to continue to gather clinical data. These data sets help us help the patient manage their side effects and it allows us to pull the provider into their care as well,” she stressed.

BioMatrix leverages a number of key strategic technology partners and their products to navigate the operational workflow of a prescription through their processes. Each step in the process results in data that can be captured to drive patient therapy decisions, outreach and communications, and demonstrate value of specialty high-touch services.

“We are an advocate for the patient, often touching base with them clinically beyond what the prescriber may have the ability to. Being that extra set of eyes and ears and holding hands in addition to our clinical support is what helps patients endure their therapy while achieving anticipated outcomes from it. We strive to help our patients manage their treatment in a way that provides a quality of life with the clinical outcomes."

BioMatrix connects with patients in the environment most convenient for them. Whether it’s by phone, email, or through their HIPAA-compliant texting/messaging application launched in response to COVID-19, BioMatrix puts the patient in control of mechanism and frequency of pharmacy intervention.

Different stakeholders look for different outcomes. Providers need to know if the patient is accessing therapy and getting the hoped-for clinical outcomes. Insurers and payers seek to understand the value they’re getting from the care being provided, if side effects are being managed, and if the covered treatment is minimizing or preventing the need for hospitalization or other patient care expenses.

As an independent specialty pharmacy, BioMatrix provides insight at any step of the journey, from the start of the referral process to post-clinical data collection. “These data sets definitely tell a lot about services our patients need, how they're progressing through therapy, and how we can support them through change in their therapy journey. Through our network of pharmacies, we provide end to end service within our single setting while producing cohesive data that leads to valuable patient care insights."

BioMatrix navigates one patient, one prescription, and one provider at a time. “That might mean hours and hours of work associated with getting a patient on therapy and then helping them stay compliant to their therapy. BioMatrix is an organization that really desires to establish key relationships with our patients and support them in as streamlined a way as possible allowing us to advocate for their needs and be a companion on their therapy journey. We take a patient-centric approach to what we're doing, and we love being independent in the space. This allows us to meet our patients where they're at—no matter what level of effort it takes."