When CVS Health released its 2021’s annual Drug Trend Report, it revealed that specialty medications accounted for more than half (52% to be exact) of total drug spend in 2020.
This widespread use of specialty pharmaceuticals and novel treatment regimens is prompting a rise in multifaceted product access models, as such complex treatments often require equally intricate fulfillment methods. This is leading manufacturers to make significant additions to the patient services they offer in support of these complex treatments, including a deeper consideration of the providers themselves, who are frequently tangled in administrative and logistical webs while trying to facilitate this complicated care access for their patients who need these novel therapies. It’s important to remember that in practice, providers are often the ones patients turn to for support when navigating these challenging tasks.
With an understanding of the complexity of current provider workflows, CareMetx is launching a new provider portal—one that truly considers the experience of that end user—the medical care provider . This simple, efficient new portal has been strategically designed to consider the daily experience of providers prescribing specialty therapies, which can ensure patient adherence to care.
The CareMetx Provider Portal: How it Works
Today, each specialty therapy and manufacturer has a distinct portal and user experience that supports their brand. So for providers who see dozens of patients prescribed different medications throughout a given day, this often means organizing separate portal tabs bookmarked on their computers, remembering a plethora of usernames and entering numerous different passwords throughout the day as they toggle from portal to portal. Put simply, CareMetx feels that this administrative standard is just not sustainable in the long term.
“What makes the new CareMetx provider portal radically efficient is that it is completely brand-agnostic,” says Chad Thompson, CareMetx’s Vice President of Prescriber Networks.
“Instead of the typical, cumbersome need to toggle between 10+ different processes and portals—one for each specific brand—through our solution, providers can simply utilize one single web application to manage them all.”
The development of this new portal was driven by a widespread need in the industry. It’s been reported that 86% of healthcare providers say administrative burdens for their offices are high or extremely high. This results in inordinate numbers of patients experiencing prior authorization-related delays in receiving treatment. As the reliance on notoriously complex specialty treatment continues to rise, this burden will likely continue to grow unless proactively managed with practical, efficient solutions.
“In the specialty space, there are new products and indications coming to market every year,” Thompson continues. “With the introduction of each new brand, providers and their staff members are required to familiarize themselves with a new interface, navigate a new hub service provider, create all new portal logins, and so on. As this dynamic currently stands, we are burdening individuals whose primary responsibility is treating patients, and whose time would be better spent with those patients.”
Prescribing specialty medications already takes a great deal of time and effort from a provider’s schedule and they often need to designate one full-time employee or an entire team to manage the many tasks that are required to get these complex medications to their patients. These tasks typically include:
- Investigating a patient’s insurance benefits for the prescribed medication
- Submitting a prior authorization to the payer in order to confirm if said medication will be covered and approved
- If an authorization is denied, navigating an appeal of the decision
- Finding the correct specialty pharmacy for that patient based on their insurance
- Sending the prescription to the appropriate pharmacy after it has been approved
Once those steps have been completed—which often can take weeks—the provider’s staff must also determine whether a copay program is offered in support of that medication, or they have to try to connect the patient with other financial support programs that may be available. To date, many practices haven’t had a way to track all of these fragmented processes in one place.
This much-needed, efficient new CareMetx provider portal is a solution that addresses all of that with one single process for all products. It allows providers to complete all of the aforementioned tasks quickly and efficiently, all while providing full visibility, in real time, to the entire prescription journey. This is the kind of efficiency that can reduce the time it takes for patients to access therapy from weeks to days.
With the new provider portal, CareMetx can:
- Receive the prescription from the electronic medical record (eliminating the need to initiate a prescription via fax or manually on a unique brand portal)
- Perform the benefit investigation
- Process the prior authorization
- Assist in the appeal process
- Locate the correct specialty pharmacy and transfer the prescription there
- Connect patients with copay programs and patient support services for all products
For those most directly involved in these processes—patients and providers—the new CareMetx portal addresses two of the most common issues that complicate delivery models—cost and speed.
“Behind every prescription is a patient who needs access to a potentially life-saving therapy,” Thompson continues. “These patients need to begin treatment as soon as possible, and deserve to do so at the lowest possible cost. This solution empowers and equips providers to get patients their therapy in the fastest and most efficient way possible, and connects patients with the resources that can help them adhere to their therapy and have the best outcome.”
Additionally, today’s manufacturers spend considerable resources on programs that are meant to help patients access and adhere to therapy: things like copay cards, free drug programs/samples, free nursing support, disease education, etc.
“But in many cases,” Thompson points out, “patients are unaware that these resources are even out there—so the unfortunate reality is they don’t utilize said resources, and thus never start therapy—or they discontinue therapy too soon.”
The growing number of treatments and medications requiring prior payer authorization have clearly become a major source of administrative frustration for providers and their staff. In service to our longstanding mission—that patients are the priority—CareMetx has designed this new provider portal to seamlessly connect providers to the resources that will help their patients have the best possible treatment experience.
To learn more about this long-awaited, radically efficient portal solution, reach out to your CareMetx account representative to book a demo today.