Using Technology to Transform Specialty Medication Access and Affordability
We need a streamlined approach where stakeholders can perform all critical tasks — from enrollment and patient consent to prior authorization, from real-time benefit checks to financial assistance — on a central platform powered by a business rules engine, automated workflows, and real-time analytics.
By Julia Regan | Original Article
Specialty medications are often used to treat complex diseases, many times in life-saving situations. But the robust process to onboard a patient on a specialty medication highlights an urgent need to modernize healthcare technology, eliminate manual work, and enhance the patient experience.
In an ideal world, a doctor would prescribe a specialty medication after knowing patient coverage details and cost, select the best fulfillment option for the patient (a local specialty pharmacy or mail-order option), and support the patient throughout their onboarding journey. Information would move seamlessly between the prescriber, the patient, the patient’s insurance, and the pharmacy so that there is limited friction between the time of the order and patient delivery. Financial assistance programs would also be surfaced to support patients with affordability and access. But it’s almost never that straightforward.
With thousands of specialty drugs on the market today, each with its own set of forms, paperwork is largely manual, time-consuming, and prone to errors. Unfortunately, 69% of physicians say it’s difficult or extremely difficult to start a patient on a specialty medication. Key challenges to onboard a new patient include affordability, prior authorization, and visibility into the process:
Manufacturers often sponsor patient assistance programs to provide free or low-cost options for patients, while foundations can provide similar support. Unfortunately, most of these programs require additional paperwork, qualification steps, and follow-up. Some are also only available to a select group of patients that meet eligibility requirements.
Prior authorization is a major pain point in the specialty medication onboarding process, with phone calls and manual work slowing down the patient journey. 94% of physicians say prior authorization leads to care delays and 89% say it has a negative impact on clinical outcomes.
There is typically zero visibility into the complete patient access journey! That means there’s no single source of truth for all parties, and nowhere to see what’s getting stuck at which point in the process. This causes substantial delays in getting patients the medications they need.
The future of specialty pharmacy
If you think today’s healthcare landscape is complex, brace yourself, because tomorrow’s is set to become even more convoluted. At the 2023 Academy of Managed Care Pharmacy meeting, IPD Analytics threw some interesting numbers into the mix. They report that nearly 80% of the drugs the FDA is expected to approve in 2023 are specialty drugs, up from 68% in 2020.
I have no doubt that the future will be more challenging, and how the industry navigates this wave of specialty drug approvals could significantly influence patient care. But imagine if we lived in a world where patients could receive their prescriptions at lightning speed, courtesy of a system that offers complete visibility. Picture getting crucial medications in a matter of hours, rather than enduring an agonizing month-long wait.
Fixing health system bottlenecks: A unified, digital solution
The solution lies in tackling the lack of digitization, visibility, and interoperability across the ecosystem. We need a streamlined approach where stakeholders can perform all critical tasks — from enrollment and patient consent to prior authorization, from real-time benefit checks to financial assistance — on a central platform powered by a business rules engine, automated workflows, and real-time analytics. This unified ecosystem would connect all key stakeholders, including health systems and provider groups, patients, pharma manufacturers, specialty pharmacies, payers, foundations, and hubs. Each would have visibility into the entire patient journey, promoting transparency and collaboration, while enabling intervention when hurdles arise.
Digitizing the process would also reduce administrative burden – and privacy issues – since faxes and phone calls would be largely unnecessary. Fortunately, significant legislative tailwinds are supporting the push toward interoperability, data access, and transparency, making digital experiences the norm in healthcare.
The combination of technological advancements, interconnected systems, and sheer necessity have made now the best time to act. Systems are in place that are revolutionizing the industry, dramatically shortening the time it takes for patients to access specialty medications.
Mastering the maze: Specialty pharmacy simplified
As the field of specialty pharmacy continues to expand and evolve, the need for a unified, comprehensive medication onboarding platform becomes increasingly important. Each new drug approval not only increases the variety of treatments available, but also adds a new layer of complexity to the medication access and delivery process.
A centralized, interoperable system could address these challenges by streamlining communication and sharing data across all stakeholders. It would provide real-time access to critical information about each specialty drug, making it easier for providers and patients to navigate the complicated approval process and ensure that the right medication reaches the right patient at the right time. This type of system would also support patient engagement, affordability, and adherence, providing teams with up-to-date information on financial support programs and treatment progress.
In an industry where treatment complexity is the norm and patient outcomes are of the utmost importance, an integrated system becomes not just a tool for improvement, but a necessity for successful patient care. It’s a solution that empowers every stakeholder, from the provider to the patient, to navigate the intricate world of specialty pharmacy medications.