From Bottlenecks to Breakthroughs: Using Technology to Transform Specialty Medication Access and Affordability
Specialty drugs are often used to treat complex conditions, often in life-saving situations. But the robust process for enrolling a patient with a specialty drug highlights the urgent need to modernize healthcare technology, eliminate manual labor, and improve the patient experience.
In an ideal world, a physician would prescribe a specialty drug after learning the details and cost of the patient’s coverage, select the best compliance 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 there is limited friction between the time of order and delivery to the patient. Financial assistance programs would also emerge to support patients with affordability and access. But it is almost never that simple.
With thousands of specialty drugs on the market today, each with its own set of forms, paperwork is largely manual, time-consuming, and error-prone. Unfortunately, 69% of doctors find it difficult or extremely difficult to start a patient on a specialized drug. Key challenges in onboarding 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 available only to a select group of patients who meet eligibility requirements.
- Prior authorization is a major problem in the specialty drug onboarding process, as phone calls and manual labor slow down the patient journey. 94% of doctors say prior authorization leads to delays in care and 89% say it has a negative impact on clinical outcomes.
- There is usually no visibility into the entire patient access process! That means there’s no single source of truth for all parties and nowhere to see what’s getting stuck at what point in the process. This causes substantial delays in getting the medicines patients need.
The future of specialty pharmacy
If you think today’s healthcare landscape is complex, brace yourself because tomorrow’s will be even more complicated. At the 2023 Academy of Managed Care Pharmacy meeting, IPD Analytics threw some interesting numbers into the mix. They report that nearly 80% of drugs expected to be approved by the FDA 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 speeds, courtesy of a system that offers complete visibility. Imagine getting crucial medications in a matter of hours instead of enduring an agonizing month-long wait.
Solving bottlenecks in the healthcare system: a unified digital solution
The solution lies in addressing the lack of digitization, visibility, and interoperability across the ecosystem. We need a streamlined approach where stakeholders can perform all critical tasks, from patient enrollment and consent to preauthorization, from real-time benefits verification to financial assistance, on a central platform powered by a business rules engine, automated and real-time workflows, and analytics. This unified ecosystem would connect all key stakeholders, including health systems and provider groups, patients, pharmaceutical manufacturers, specialty pharmacies, payers, foundations, and centers. Each would have visibility into the entire patient journey promoting transparency and collaboration while allowing intervention when obstacles arise.
Digitizing the process would also reduce administrative burden and privacy concerns as faxes and phone calls would be largely unnecessary. Fortunately, significant legislative tailwinds are supporting the drive toward interoperability data access and transparency making digital experiences the norm in healthcare.
The combination of technological advances interconnected systems and sheer necessity has made now the best time to act. There are systems that are revolutionizing the industry, drastically shortening the time it takes for patients to access specialized medicines.
Mastering the Maze: Specialty Pharmacy Made Simple
As the specialty pharmacy field continues to expand and evolve, the need for a unified comprehensive drug 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 drug access and delivery process.
A centralized and interoperable system could address these challenges by streamlining communication and sharing data among 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 the right drug reaches the right patient at the right time. This type of system would also support patient engagement, affordability, and adherence by 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 paramount, an integrated system becomes not just a tool for improvement but a necessity for successful patient care. It is a solution that empowers all stakeholders, from provider to patient, to navigate the intricate world of specialty pharmaceutical drugs.
Photo: Irina_Strelnikova, Getty Images
According to MedCity News.