The Onerous Specialty Prescribing Process Hurts Patients and Tires Doctors. What Can Be Done?

It really should be so simple—getting a patient on a specialty therapy. The doctor and patient have chosen the best therapy; the patient is in great need.

But according to our recent survey of 500 prescribers, on average it can take nearly 8 days to start patients on specialty medications, which are used to treat challenging chronic conditions such as cancer, multiple sclerosis and rheumatoid arthritis. Sometimes the delays are even worse. I recently learned of a patient whose long-dormant illness began to present symptoms in January of this year. Her neurologist told her she could not afford to wait to begin therapy. Still, nearly four and half months passed before she was able to begin her therapy. A lack of clinical interoperability between her neurologist, her other specialists and the specialty pharmacy created a delay in determining and dispensing the right therapy. Their electronic health record systems and pharmacy systems couldn’t talk to one another, so they couldn’t quickly see her clinical history from other settings, nor could they electronically share or exchange her clinical data and test results.

Not being able to begin her therapy when she knew she needed it, left her in “a lot of psychological pain,” she said.

By way of contrast, I think of my recent experience with a non-specialty prescription. My doctor entered the prescription into my electronic health record and sent it electronically to my pharmacy. The prescription was ready at my pharmacy within a half hour.

Not so with specialty prescriptions, for a variety of reasons. Specialty therapies are expensive, with over half of them exceeding $100,000 per year. They often require special handling and management, and the patients that receive them suffer from complex diseases and require regular follow-up. Because of their complexity and cost, the process to get patients on specialty medications, which are projected to approach half of U.S. drug spending by 2021, is, sadly, inefficient and riddled with administrative delays and rework.

As revealed in our survey, prescribers and their staff spend a lot of time on manual administrative tasks each week, including:

• Obtaining documentation needed to start a therapy (1.6 hours)
• Filling out documentation for specialty medications (1.4 hours)
• Understanding medication pricing for patients (1 hour)
• Identifying or obtaining enrollment or intake forms (.8 hours)
• Determining where to send authorization for specialty medication (.8 hours)
• Obtaining prior authorizations for specialty medications (1.7 hours)

These manual processes create a number of problems. They delay start to therapy. They require an enormous amount of administrative work and rework--the kind of work that takes a skilled person, such as a nurse or doctor, away from patient care in order to perform these tasks.  This work sometimes seems endless, which can create malaise among prescriber and staff. Meanwhile, the patient, for whom they have a tremendous amount of empathy, has left the office feeling optimistic, anxious, or both, and is then told to “hurry up and wait”—just like the patient I described above.

As a doctor myself, I’m working hard with my colleagues at Surescripts to ease these burdens and I know that technology can play a critical role in addressing them. It can present the prescriber with the price of the medication for the patient as well as potentially less expensive alternatives.  It can speed prior authorizations. Ultimately, technology can help streamline and automate the specialty prescribing process, which means prescribers and staff have more time with patients and ensure that they get the care they need.

Learn more about how existing technologies can help relieve administrative burden and speed patients to therapy, and check out our survey data brief for more detail.