There’s a version of patient support that treats benefit verification as a box to check before a prescription moves forward. Daniel Lozano has spent his career proving that this misses the whole point.
In this episode of The GTN Edge Podcast, Daniel Lozano, SVP of Client Strategy and Product Innovation and founding member of RIS Rx, joins Gerard and Stephen to talk about electronic benefit verification (eBV), and why identifying patient coverage earlier in the patient/prescriber journey changes everything downstream: time to therapy, the patient experience, and whether a doctor trusts the process enough to keep prescribing through it.
Daniel sees eBV as the blueprint, or the map, for a patient’s streamlined path to therapy. With coverage flagged correctly upfront, everything else follows: a happy patient, a satisfied doctor, no barriers to getting on therapy. When eBV doesn’t do this, a patient can be blocked from coverage they were eligible for, and doctors can lose confidence in a program that keeps surprising them with unexpected denials.
Daniel walks through the eBV breakthrough as a pharmacy technician, observing that ‘reject code 75’ was a mystery to pharmacists until he explained what that specific rejection meant for a specific insurance type and what to do next. That pattern recognition made it possible to turn a cryptic rejection code into clear patient eligibility data. Instead of a pharmacist encountering a confusing rejection, the system recognizes it, translates it, and automatically suggests the next step or option.
That same insight later became a full product. Once reject code 75 turned into plain language a doctor and patient could understand at the point of prescribing, this translation became a cost estimator tool. The tool became, in providers’ own words, their new homepage, a place where a doctor could punch in a patient’s information and know in seconds whether a medication was covered, and what to do if it wasn’t.
Daniel and Gerard also get into what the eBV map looks like today with increased GTN erosion and GLP-1 demand accelerating past what a traditional call center benefits check can handle. Plus, why medical benefit verification is becoming as important as pharmacy benefit verification, and what Daniel thinks market access leaders should look for when evaluating eBV vendors before trusting them with patient data.
