Patient support programme reviews
Assurance that patient support reaches the patients it was designed for, with leakage and compliance risks identified.
Testing of patient assistance and support programmes for eligibility, genuine patients, claims and communications.
Patient assistance and support programmes give free or subsidised medicines, diagnostics, counselling or adherence services to patients who need them. They run through vendors, hospitals and field teams, and they handle sensitive personal data. That combination creates risk: patients who do not exist, eligibility rules that are bent, services billed but not delivered, and programmes that become a channel for inducements.
We test patient cases against the eligibility criteria and supporting documents, run analytics on enrolment, claims, dispensing and services to find duplicates and patterns, and review vendor contracts and invoices against what was delivered. A review of programme communications checks that they stay within the rules on promotion.
Because programmes process health data, the review is designed for privacy from the start. Findings show where benefits leaked, which controls failed and how to fix them.
You run patient assistance, access or support programmes and need to know that benefits reach genuine patients.
Signs we see most often
- 01Enrolments rise faster than prescriptions or diagnoses would suggest.
- 02The same patients, doctors or addresses recur across many cases.
- 03Vendor invoices cannot be matched to services delivered.
- 04Field teams have influence over enrolment or eligibility.
- 05Programme communications may stray into promotion.
Scoped in writing, run by one accountable team.
Every engagement starts with agreed questions, a reporting line and a confidentiality protocol. The steps below are how this service usually runs; we adapt them to your matter.
- 01UnderstandMap the programme, its eligibility rules, vendors and data flows.
- 02TestTest patient cases for eligibility and documentation.
- 03AnalyseRun analytics on enrolment, claims, dispensing and services.
- 04VerifyReview vendor contracts, invoices and service delivery.
- 05ReviewReview communications and the protection of patient data.
- 06ReportReport leakage, control gaps and fixes.
Assurance that the programme reaches the patients it was designed for, with leakage identified.
- A case testing report
- Analytics findings with the cases behind them
- A review of vendors and invoices
- Observations on privacy and communications
- A control improvement plan
The law and frameworks this work is aligned to
- UCPMP 2024, Department of Pharmaceuticals
- DPDP Act, 2023 for the processing of patients' health data
- Aligned to the IFPMA Code of Practice
References show the standard the work is built to. They do not imply accreditation or endorsement by the bodies that publish them.
This is a summary of the service. For a deeper understanding of how it would work for your organisation, please reach out to us.
Talk to a BDI partnerQuestions clients ask before we start.
Will patients be contacted?
Only where the programme's consent and your policies allow it, and only as far as the review needs. Most testing works from case files and data.
Can you review programmes run by vendors?
Yes. Most programmes are run by vendors, so their records, invoices and controls are central to the review.
Does this cover diagnostic and adherence programmes?
Yes. The same approach applies to free medicines, diagnostics, counselling and adherence support.