Erica discusses access challenges that specialty medications pose for the providers who prescribe these medications. She describes AMP: Access for More Patients from CoverMyMeds and RxCrossroads by McKesson, a tech-enabled hub service designed to help providers and patients.
To learn more, connect with CoverMyMeds at HIMSS20 in Orlando.
Read on for Erica’s insights.
Connecting the Dots for Specialty Medications–Improving Provider Workflows Through Technology
By Erica Conroy, Ph.D., Vice President of Specialty, CoverMyMeds
Equipping providers with the tools they need to be a force for change in healthcare is a key theme at HIMSS this year. Understanding the challenges providers face with specialty medications is important for building effective solutions that can help in this area.
So far, empowering providers with technology throughout the specialty prescribing process has already helped to reduce time-to-therapy by 27 percent for patients.
WHAT’S SO SPECIAL?
Specialty therapies can offer providers a chance to go beyond managing a patient’s symptoms to treating the root causes of disease. For many rare diseases, the only medications available simply help patients to deal with the pain or inflammation their illness causes (e.g., corticosteroids), but do nothing to address the underlying cause of their disease. In contrast, targeted specialty therapies can offer a true chance to live a healthier life for many patients.
The trouble is, these medications can be associated with significant health risks (e.g., side effects or adverse events) and healthcare complexity (e.g., clinical testing, unique administration, complicated distribution, etc.). In addition, medical innovation can come at a high cost for patients. For these reasons, specialty medications are often tightly controlled to ensure patient safety and appropriate utilization.
Many of the standardized and electronic processes that streamline access for traditional medications do not exist for specialty therapies. As a result, manual workflows for complicated tasks contribute to administrative headaches for healthcare providers that can keep patients from the specialty medications they need to live healthy lives.
WHERE DOES IT HURT?
For a patient to begin a specialty therapy, a benefits investigation is needed to confirm eligibility and insurance coverage. While this task may seem simple enough, over one third of surveyed providers expressed that it can be very, or even extremely, difficult. For many, this task requires back-and-forth communication and information exchange with the health plan via phone calls and faxes.
Often times, insurance plans will also require prior authorization (PA) for these expensive and complex medications. While PA for traditional medications is heavily cited as a healthcare pain point, it can be even more complicated for specialty therapies, requiring additional clinical data.
Electronic prior authorization (ePA) technology and transaction standards (e.g., NCPDP SCRIPT standard) have significantly improved the PA process for traditional medications covered through the pharmacy benefit, but it’s not always clear how specialty therapies will be billed (i.e., the pharmacy benefit or medical benefit). Beyond this confusion, workflows for medical benefit reimbursement are typically manual (e.g., phone calls and fax forms), which can slow down completion of the PA request and delay time-to-therapy for patients.
It can also be difficult for providers to know where to send specialty prescriptions. Traditional medications are primarily dispensed through open-distribution networks which include all retail pharmacies. Specialty medications are typically indicated for smaller patient populations with dispense controlled through limited distribution networks of specialty pharmacies to accommodate supply and demand, as well as unique storage and handling considerations. As a result, prescriptions are regularly sent to the wrong pharmacy and frustrated providers must sometimes restart the entire process from the beginning.
Collectively, these pain points with specialty medications can factor into providers’ treatment choices. A recent survey found that over two thirds of providers will alter their original prescription order if an access barrier is encountered – three out of four of these providers simply switch to an alternative medication. Such data show how specialty medications can create burdens that conflict with providers urgency to quickly start their patients on therapy. As a result, patients may not be receiving their providers’ first choice of treatment, which could have an impact on their health.
WHAT CAN BE DONE?
While patient support services, or hubs, already exist to provide assistance for starting specialty medications, they are not optimized to make life easier for providers. Traditional hubs function as call centers to help providers manually complete administrative work.
Completely reliant on phone calls and faxes, communication and information exchange through traditional hubs is slow. As a result, connectivity among healthcare stakeholders and shared visibility into patient case work is lacking.
Across the industry, attempts to integrate technology within the specialty prescribing process have largely focused on patient enrollment into hub services. Such narrow improvements can still leave providers vulnerable to a fragmented specialty prescribing experience – involving inconsistent technology, multiple vendors and limited visibility into patient cases.
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Ensuring an end-to-end electronic specialty prescribing experience for providers may help to avoid or alleviate all manual work and inefficiencies.
Just as ePA empowers providers with a self-service platform to complete PA requests electronically, similar technology can be integrated within existing specialty workflows and expanded to all steps of the specialty process. Through electronic connections with network stakeholders and real-time exchange of information, providers can more easily manage complex prescriptions and help their patients begin therapy.
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For example, by e-prescribing specialty medications to a specific pharmacy, providers can automatically trigger patient enrollment into electronic hub services. Information from the e-prescription can then be used to auto-populate the enrollment form before it is shared into provider office workflows. Subsequent steps like patient eligibility, benefits investigation, benefits verification and PA can be completed online with support of electronic hub services through a central, self-service platform. “Clean” prescriptions can then be electronically sent to the preferred specialty pharmacy without any confusion for the provider.
Tech-enabled hub services, like AMP: Access for More Patients from CoverMyMeds and RxCrossroads by McKesson, have already made a positive impact for providers and patients. A recent case study demonstrated that providers are willing to adopt electronic workflows for specialty medications and operational efficiencies contributed to a 27 percent reduction in time-to-therapy for patients.
To learn more about how technology is improving provider workflows for specialty medications, connect with us at HIMSS20 in Orlando.
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