INTELLIGENCE IN ACTION

Specialty Medication Insights from a Prescriber and a Patient Assistance Program

There is incredible innovation happening in prescription medicine right now—especially with specialty medications that can be costly and require special handling. According to CVS Health, specialty medications account for 75% of the approximately 7,000 drugs in development. But as I’ve mentioned before, this is the most complicated process I’ve ever seen for getting a patient onto therapy in my more than 20 years in health IT.

This complicated process leads to delays and frustration. According to two Surescripts surveys, nearly 40% of prescribers reported a two-week wait to get the average patient started on a new specialty drug, while less than one-third of providers are extremely or very satisfied with their organization’s efficiency when prescribing specialty medication.

So what should be done about it?

I recently sat down with Jeffrey Spafford, president and CEO of AssistRx, and James Hamrick, M.D., M.P.H., senior medical director of Clinical Oncology at Flatiron Health, both of whom offered unique perspectives from the view of specialty hubs and prescribers. In our conversation, we discussed industry opportunities and challenges and how technology can improve the specialty medications journey. Here’s what they shared:

Can you talk about the changes you’ve seen with specialty medications over the past few years?

Hamrick: The advancements in this space have been genuinely game-changing – oncology is replete with this explosion of innovation, targeted therapies and immunotherapy. I now can have conversations with stage four patients about long-term remissions, which has been amazing.

At the same time, it’s an incredibly complex process both for the provider and patient. Caring for a patient dealing with a terrible illness is challenging enough, but there’s another layer of executing clinical care and delivering these medications. That’s where we’ve got work to do.

As you suggest, there are multiple steps for getting a patient started on a specialty medication. Can you talk about the implications of this complex process?

Hamrick: All of these steps net out to potential delays in care, and to some degree, possibly an undermining of confidence in the whole system. And when you remember that there’s a patient at the end of this, who might be very afraid and has lost a lot of the autonomy that we all enjoy when we’re healthy, that’s a big deal.

So with my prescribing hat on, I’m trying to be sensitive to that experience and make sure that there are no more surprises for the patient than there need to be. I always feel bad when I have to say, “We can’t start you Monday as we had hoped. In fact, I now need to get you to a surgeon to get a port.” That can be disconcerting for the patient.

Spafford: One of the biggest complaints that we hear from our healthcare providers is that when they complete that specialty enrollment form and fax it to a specialty hub, it goes into a black hole. They don’t know where that script ended up or if the patient began therapy. Often they don’t find out until the patient comes back in months later for a follow-up visit. And by then, they might have lost valuable time at treating the disease.

How can technology help smooth this arduous process?

Spafford: Patient assistance programs, also known as specialty hubs, are working towards providing complete visibility into a patient’s status, where they are in the process and what barriers they’re facing. Additionally, specialty hubs are improving bi-directional communication between the various stakeholders so that they can proactively versus retroactively intervene in getting that patient on therapy.

As we developed our platform at AssistRx, we understood that its true value is to connect all stakeholders onto one common platform. And adoption and utilization depend on meeting patients and healthcare providers where they’re in their lives and workflow. That’s why the ability to embed our technology solutions – whether it is with partners like Surescripts or directly into a healthcare provider’s EHR and patient portals – is essential.

Hamrick: I couldn’t agree more. I think it’s really important to remember that you want the patient to have the resources they need to navigate patient assistance to make sure they don’t walk up to a pharmacy counter and be told they can’t have their medication unless they produce a suitcase full of cash. And you want to make sure as they go through the prior authorization and patient assistance journey that it’s not a painful experience for them.

Can you talk about how we need to do more than just provide technology; we need to get the information “right”?

Spafford: Yes! We all know that technology can help improve the process, but it’s really about how it’s delivered. What information are you presenting, and how?

We’ve garnered a few insights over the years. Our healthcare providers and patients want information at the point of care. They want to understand the requirements, what’s needed and next steps at the point of prescribing so that they don’t have to go back, revisit and rework the referrals. Ensuring providers have all the information they need to make the right decision upfront is critically important.

Additionally, as patients have become much more engaged in their healthcare, they are looking for tools that help them make better-informed decisions. They want to understand their benefits, the price of these products and the alternatives, and available programs and services. This information is critical in keeping patients engaged in the process and is very effective in helping them get through the specialty patient journey.

What’s your perspective on how we can get the information “right”?

Hamrick: I’m speaking from the standpoint of a technology vendor, but embracing standardization will help improve the process. So before an organization thinks about building a very bespoke portal for prior authorization or patient assistance, think about whether you could boil it down to some standard elements that matter the most. Standardization underpins automating data exchange and communications that allow the patient to get the proper treatment. So embracing standardization may be painful upfront, but it will likely pay off through more efficient care delivery in the backend.

Do you have any parting thoughts?

Hamrick: I am glad there’s federal legislation focused on increasing interoperability standards to allow diverse systems to talk to each other – like an electronic handshake. So that’s a reason for optimism.

Spafford: As an industry, we need to align on that patient-first mentality, understand their needs and develop a highly customizable, personalized approach to help them achieve successful outcomes.

At the same time, the industry is going through a transformation; we’re converting from a very manual people-intensive business to a much more tech-enabled business.

Let’s empower our people with information that comes from our technology solutions so that they can spend much more time engaging their patients, understanding their individual needs and supporting them throughout this process.

As the specialty medication market continues to grow, the continued growth and adoption of tools like Specialty Patient Enrollment and Specialty Medications Gateway will help the industry keep up.

In 2020, Surescripts saw significant progress with Specialty Patient Enrollment, including a 214% increase in prescribers enabled, a 167% increase in specialty hubs contracted and a 69% increase in medications covered by the service—including the addition of five new disease states, such as Crohn’s Disease and Osteoporosis.

And the adoption of these solutions is having an impact. Three physician practices using Specialty Patient Enrollment saved roughly one to two hours per week on related administrative tasks involving phone calls, faxes and paperwork. Separately, with Specialty Medications Gateway, one specialty pharmacy decreased the average time to fill a specialty prescription by approximately two days, and phone calls to prescribers for missing clinical data decreased by nearly half.

With critical data delivered where and when it’s needed, seamless communication channels and optimized, friction-free workflows, we can ease the journey for patients and all of the specialty stakeholders who support them.

Visit “Remapping the Specialty Medication Journey” to learn more about the impact of Surescripts specialty solutions for providers, and more importantly, patients.

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