Inaccurate and Incomplete Data Delays Specialty Treatment for Patients and is Top Stressor for Health Care Providers

ARLINGTON, Va. – September 12, 2022 – Prescribers of specialty medications identified delays or denied approvals as the most challenging part of their job and determining if a patient’s insurance will cover their prescription was the top challenge specialty pharmacists say they face according to a new Surescripts survey.

Nearly two-thirds of specialty prescribers and almost three-quarters of specialty pharmacists also agree that improperly filled out patient forms are a top impediment to obtaining prior authorization and are the leading cause of delays that impact how quickly patients can start their new specialty therapy. Starting patients on a specialty medication should take less time according to 82% of specialty prescribers and 87% of specialty pharmacists.

“Imagine being told by your doctor that the health condition you’ve been diagnosed with requires a specialty medication, but you might not be able to start treatment for up to a month due to the outdated process and paperwork required for prior authorization,” said Cecelia Byers, Pharm.D., Clinical Product Advisor for Specialty at Surescripts. “There is a natural sense of urgency to want to begin treatment right away for both providers and patients. The technology available today can help to close the gaps in patient health information, speeding up the time it takes from a patient's initial diagnosis to starting treatment with specialty medications.”

The COVID-19 pandemic demanded health care providers take on even more responsibility, adding to an already challenging workload. The result is many providers are facing significant burnout, with one study indicating that 1 in 5 physicians intend to leave their practice and a third of healthcare workers planned to reduce their work hours within the next two years.

“As the workforce shrinks, we will continue to see health care professionals doing more with less,” said Frank Harvey, Chief Executive Officer of Surescripts. “Simplifying the process of specialty prescribing and closing the gaps in patient information is one way to eliminate the burdensome administrative tasks that can take a providers’ attention away from their patients. This clinical intelligence also helps patients start treatments faster, improving their care journey and allows pharmacists and prescribers to shift their focus back to their most essential responsibility of delivering quality care to their patients.”

The Association of American Medical Colleges projects that in just 12 years, the U.S. will face a shortage of up to 124,000 physicians, on top of increased job turnover due to the COVID-19 pandemic, making time-consuming administrative tasks, like those required for specialty prescribing and fulfillment, even more problematic for delivering timely treatments for patients.

Specialty medications made up the majority of new medications introduced in the past five years, according to an IQVIA Institute report. These therapies require providers with specialized expertise to collect more detailed patient information through an error-prone and outdated, manual administrative process, before a patient can even begin treatment. These medicines can also be extremely expensive: Retail prices for widely used specialty drugs rose at three times the rate of general inflation in 2020, according to AARP, and the Wall Street Journal reported drug prices increased an average of 6.6% in January 2022.

Survey Highlights

Missing Information Causes Delays:

• 64% of prescribers of specialty medications and 70% of specialty pharmacists see missing patient information as a top impediment to obtaining prior authorization.
• 80% of prescribers say accelerating speed to therapy is a very important benefit when seeking to enroll a patient in a specialty medication program.
• Two-thirds of prescribers and three-fourths of specialty pharmacists report that improperly filled out forms are an issue when obtaining prior authorization.

Time to Therapy Should Be Faster:

• More than 80% of specialty prescribers and pharmacists say it should take two weeks or less to get a patient started on a new specialty therapy, but only 20-30% say it does and the rest say it takes between 3–4 weeks.
• More than half of prescribers say the challenges of identifying the right pharmacy to send a specialty prescription can reduce patient medication adherence (55%) and delay the start of treatment (52%), while 44% say it creates additional administrative work.

Accessing Patient Benefits & Coverage Is a Top Job Stressor:

• Among prescribers of specialty medications, delayed or denied approvals is the most challenging day-to-day job responsibility.
• Specialty pharmacists said determining if the patient’s insurance will cover their prescription is the most challenging day-to-day job responsibility.
• Almost all specialty pharmacists surveyed agree that having patient-specific benefit information would help them and their teams when getting patients started on a new specialty therapy.

Surescripts partnered with APCO Insight™ to conduct a survey from June 15 to July 1, 2022, to understand the opinions and attitudes of specialty pharmacists and prescribers of specialty medications on a variety of topics, such as job priorities and challenges, trusted sources for clinical information and filling prescriptions. The survey was distributed online and over the phone (mixed-method). The completion rate for the survey was 88%, with a total of 501 individuals participating.

Learn how Surescripts is helping to simplify specialty medication workflows, saving patients and those who care for them precious time.