Specialty medications provide hope for hundreds of thousands of patients in the United States, but this hope often comes at a high cost, in terms of both money and time.
Patients face more barriers to accessing specialty pharmacy than typical retail pharmacy, including higher prices, increased prior authorization requirements, and complex treatment regimens that require greater health literacy. This could be why up to 30% of prescriptions for chronic diseases are never filled, and 50% of these medications are not taken as prescribed.
Patients with chronic and serious illnesses are often dealing with stress, lack of energy, and lack of time. Access barriers add yet another challenge – and an unnecessary one at that. The good news is that a technology-enabled hub can play a role in breaking down the most common barriers and ending the wait for patients.
Lack of Provider Experience With Specialty Therapies
The use of specialty therapies is becoming more common, but not yet nearly as common as retail pharmacy. Many providers see only a few patients that require specialty care, so they may not be as educated about these therapies. At the same time, specialty care is often more complex, requiring education about new behaviors like visiting an outpatient facility or using a device.
A technology-enabled hub can arm providers with the data they need to effectively treat patients and help them get on therapy faster. Provider-facing portals can enable self-service patient access solutions, using a configurable services architecture that is purpose-built to client specifications. Additional solutions like eSignature can help simplify provider workflows even further.
Lack of Patient Knowledge
Health literacy defines a person’s ability to obtain and understand the information they need in order to make good health care decisions, and it is essential to patient access and adherence. Yet even in the best-educated counties in the US, up to 27% of residents have limited health literacy. That number rises to 59% in counties with the lowest literacy. . These patients consequently require greater support during their healthcare journeys. A technology-enabled patient support hub can automate many processes, thus leaving time for case managers to provide this help to the patients who need it most.
Many patients also aren’t aware they have services available to them through the manufacturer to help face barriers with enrollment and consent. Solutions like eEnrollment and eConsent simplify this process for these patients, eliminating the need for cumbersome, manual forms.
Complex Prior Authorization Requirements
As costs increase, payers are creating more complex prior authorization requirements, which have a very real effect on patient access. New patients in specialty pharmacy now reportedly wait anywhere from 14-20 days to begin their treatment, and the PA is a big part of why: 54% of physicians say the PA process always or often delays access to care, and 57% say it at least sometimes leads to treatment abandonment.
Solutions such as real-time prescription benefit (RTPB), electronic prior authorization (ePA), and intelligent pharmacy workflows can help smooth the patient access journey. And with embedded provider workflows, providers can directly access these transactions to perform service requests from their native technologies.
Specialty therapies have always been more expensive than traditional retail, but costs are rising due to shifts like the use of biologics and a desire for more personalized care. Economic recession, unemployment, and the resulting changes in health insurance coverage can exacerbate affordability issues. Patient assistance programs help mitigate these barriers, but awareness and enrollment are challenges for manufacturers.
Technology-enabled hubs can help, with solutions like ePAP, virtual copay cards, and real-time benefits verification. Provider-facing portals can be configured to assess and enroll qualified patients into financial assistance programs, while digital copays provide better alternatives to traditional paper-based, manually driven copay programs.
Breaking down patient access barriers often starts with payers – if they aren’t willing to reimburse a medication, patient access has hit a roadblock before it’s even started. To gain favorable reimbursement, manufacturers need to prove the value of their therapy with robust, quality data and analytics.
Patients, caregivers, and manufacturers alike dream of the day when the wait is over for specialty therapies. A technology-enabled hub can help you reach that goal faster by automating and streamlining processes – and breaking down patient access barriers once and for all.