Spending Less Time On the Specialty Medication Roller Coaster

When a patient requires a specialty medication, any delay in starting treatment—whether cost or enrollment-related—can have a serious impact on a patient's health.

But with specialty medications now accounting for more than half of medicine spending in the United States and more than a quarter of U.S. adults facing multiple common chronic conditions, overcoming hurdles around patient enrollment and prior authorization and decreasing time between a patient’s diagnosis and treatment is imperative.

In a recent webinar, Surescripts’ Andrew Mellin, M.D., VP Chief Medical Information Officer and Cecelia Byers, Pharm.D., Clinical Product Advisor for Specialty, shared how technology is automating the specialty prescribing process, reducing friction and helping patients get started on potentially life-saving medications faster.

The specialty medication journey is a roller coaster

The journey of a specialty prescription through prior authorization, enrollment and fulfillment is not a straight line.

Cecelia Byers explained that as a specialty pharmacist, she experienced this complex journey every day, “it honestly looks like a roller coaster, when you draw out this journey, all of the twists and turns.  And if you're like me, I hate roller coasters. But this isn't about me, it’s about the patient who is on this roller coaster journey to get started on the medication.”

These twists and turns add up to delays that keep patients from starting treatment. According to a recent survey, a majority of specialty prescribers and pharmacists say it can take between 3-4 weeks for a patient to get started on a specialty medication.

There are “many more places for things to go awry, for rework and places to introduce delays,” said Andrew Mellin.

Delays in fulfillment threaten adherence and outcomes as patients anxiously await medications needed to keep serious or chronic conditions from worsening.

Costs add twists and turns to the specialty journey

Specialty medications now account for more than half of medicine spending in the United States, due in part to the prevalence of chronic conditions and the ongoing innovation of life-saving therapies.

“These are not the four-dollar medications. These are the $10,000 medications”

Andrew Mellin

M.D., VP Chief Medical Information Officer

“There's nothing worse for a patient and a prescriber than being in the room, having a conversation, then finding out three days later they could not afford the medication that was too expensive or off formulary,” said Mellin.

“They must go back and start all over. So, we're really focused on getting providers the financial and payer information they need at the point of care,” adds Mellin.

Aligning stakeholders and establishing an automated specialty process results in fewer phone calls and faxes for patient information, meaning fewer frustrations for prescribers, pharmacists and their patients.

Replacing twists and turns with technology

Technology is transforming the specialty medication journey, including prescribing, onboarding and medication fulfillment for prescribers, pharmacists and patients.

Filling information gaps and automating the process with access to patient-specific medication benefits information in workflow helps determine cost and therapeutic alternatives and can help expedite prior authorization. Fewer manual inputs mean less frustration, fewer delays and more patients starting therapy sooner.

“Each time we see one of our solutions deployed, we see an improvement. A conversation with the patient about cost, really understanding what that patient safety is, having clinical information available for the pharmacy when they need it”

Cecelia Byers

Pharm.D., Clinical Product Advisor

Simplifying the specialty medication experience with shared intelligence means patients can start their medications sooner and healthcare professionals can spend less time on paperwork, giving them more time to manage patients’ care.

• Specialty Patient Enrollment automates the specialty enrollment process by the specialty enrollment process by automatically exchanging clinical information in the e-prescribing workflow and securely sending required information to specialty pharmacies.
• Specialty Medications Gateway empowers specialty pharmacists to access the clinical information needed from the patient's electronic health record without relying on communication with the prescriber. Leveraging the Carequality interoperability framework, it expedites enrollment by automating clinical information gathering.
• Real-Time Prescription Benefit delivers patient-specific benefit and cost information into the electronic workflow. This solution empowers prescribers, pharmacists and technicians to address specialty prescription cost concerns and make informed decisions that boost adherence and operational efficiencies.