Quanum Practice Solutions is excited to present this article, reprinted with permission from Melissa Nix, editorial director at Surescripts^®.

If you’ve been prescribed a specialty medication, or care for someone who has, the story is a familiar one: the journey from prescribing to fulfillment is riddled with antiquated processes that leave many guessing just how and when the prescription will be ready—and at what price. But existing technologies are beginning to streamline the process and there’s plenty of room for continued innovation.

The number of novel Food and Drug Administration (FDA) drug approvals could approach a record high in 2021, topping the record set in 2020 with 53 new approvals. According to CVSHealth, specialty medications account for 75% of the approximately 7,000 drugs in development. Meanwhile, the Centers for Disease Control and Prevention reports that four in 10 adults have two or more chronic conditions, increasing pressure on an inefficient system that struggles to get seriously ill patients on therapy quickly.

“The innovations coming out of the life sciences are simply amazing,” said Andrew Mellin, MD, and Surescripts Vice President and Chief Medical Information Officer. “Diseases that were incurable when I was training in internal medicine, like hepatitis C, are now curable. At the same time, though, the specialty medications journey is the most complicated, convoluted and complex process I have ever studied.”

The Disconnect

With the average specialty medication costing $79,000 a year—compounded by the concurrent specialty population growth—health plans must try to manage this spend efficiently, predicted to top $500 billion last year. Prescribing and reporting requirements are complex and involve inputs from a plethora of players: health plans, hubs, specialty pharmacists and providers, as well as patients. And outdated, manual processes pervade the specialty space, which means timely access to information is often lacking to keep prescriptions moving.

A 2019 American Medical Association study reported that specialty providers spend 15 hours a week on prior authorization requests.

“The current data sharing system is fragmented and disconnected, with clinical data trapped across silos,” said Joel Helle, Vice President of Physician Services at CVS Specialty.

The disconnect negatively impacts every stakeholder—each with their own information requirements and often using different tech platforms—but most especially patients, who may experience a potentially life-altering delay in care.

Avoiding Black Holes by Going Digital

Jeffrey Spafford, President and Chief Executive Officer at AssistRx, a specialty hub, is of like mind. We are witnessing an industry going through a much-needed transformation, he said.

One of the biggest frustrations he hears from providers is lack of visibility. They complete a specialty enrollment form and fax it into a specialty hub, and it goes into a black hole, he said. And they don’t even know if their patient has begun therapy.

He reflected on the benefits of leaving the analog world behind. In a tech-enabled world, you can leverage electronic patient enrollment, which helps augment and validate a patient’s benefits, he shared. You can “quick start” or electronically triage a prescription directly to a specialty pharmacy, or if need be, complete a prior authorization electronically.

And moving from a resource-heavy, time intensive manual system to digital pays clear dividends, he said, “as studies show that the longer it takes a patient to get on therapy, the more likely they are never to initiate therapy or at least abandon the prescription.” Spafford reports of reducing a patient’s quick start from seven days to 48 hours and halving the time from written prescription to fill from two weeks to seven days.

Don’t Forget the Patient

Sometimes the patients don’t even know what the barrier is, said Steffany Stern, Associate Vice President of Advocacy and Policy at the National Multiple Sclerosis Society.

“We need to streamline communications between the stakeholders, rather than the burden being on the patient to individually call and connect with the specialty pharmacy and physician and health plan and the hub to understand the delay,” she said.

Stern added that technology designed with the patient experience in mind is critical, especially to help them understand utilization requirements and out-of-pocket costs at every point in the process.

Spafford agrees.

“We all know that technology can help improve the process, but we also need to be mindful about how information is delivered and presented,” he said. “The industry needs to really align on a patient-first mentality in order to understand their needs and develop that highly customizable, personal approach to helping them achieve successful outcomes.”

Quanum Practice Solutions from Quest Diagnostics offers a full range of products and services to support the needs of physicians and patients. Our real-time prescription benefit embedded in Quanum ePrescribing, part of our Quanum EHR solution, gives users the power of price transparency while helping improve specialty medication prescribing and medication adherence. Learn more by calling 1.888.835.3409 or contact us via email.

Melissa Nix is editorial director at Surescripts.

Disclaimer: The views expressed in this blog post do not necessarily reflect the views of Quest Diagnostics^®, or any of its employees.