Megan discusses upcoming specialty medication launches. As she explains, patients will need extra help to overcome the challenges of access, affordability, and adherence.
Click here to learn about CoverMyMeds' patient-centric technology solutions for specialty medications..
Read on for Megan’s insights.
Innovation Brings Unwavering Patient Support in a New Era of Specialty Medicine
By Megan Marchal, Director of Specialty Pharmacy Strategy, CoverMyMeds
While people living with complex conditions may have more medication options, these specialty medications often come with variables such as high out-of-pocket costs and utilization management requirements. Patients’ benefit design, health system and location can prove to further complicate the journey to specialty medication access. Compared to 2013, specialty patients in 2022 are 20% more likely to not fill a prescription.
With growing realignment and vertical integration trends proliferating the healthcare industry, many stakeholders are now attempting to manage the entire specialty patient journey. While these plan designs may narrow patient choice, they may also improve efficiency and provide clearer next steps that could help patients receive the medications they need. Still, however, patients run into roadblocks: In 2021, only 1 in 4 new-to-brand patients were able to fill a prescription for a newly launched medication.
No matter their path to specialty medication access, patients need informed, efficient care teams to support their journey. Innovative technology solutions should offer on-ramps to affordability, access and adherence options to best support specialty patients. By handing off time-intensive, data-laden tasks to technology, clinical experts can find more time to treat complicated diagnosis and coordinate the right treatment.
SUPPORTING THE ACCESS JOURNEY THROUGH ALL BENEFIT ROUTES
An increase in specialty medication volume has the potential to increase the number of access challenges care teams and patients must solve. Access challenges in greater number and difficulty can increase the time to therapy for many patients. Part of this delay can be due to benefit verification (BV) and benefit investigation (BI) because specialty drugs can be covered by mixed and medical benefits, in addition to prescription drug benefits. In 2021, 82% of patients said they experienced a delay in accessing their medication, with over half citing insurance or administrative processes as the reason. Some of these patients may never fill their prescription.
Uncovering which channel a medication is covered under can be time consuming on its own, followed by additional prior authorization, affordability and distribution processes for care teams and pharmacists.
Care teams need solutions to improve specialty medication workflows for both medical and pharmacy prior authorization, BV and BI. Solutions with these capabilities can help patients receive therapy an average of 34% faster than the industry standard, in some cases. (CoverMyMeds data on file, 2021)
ADHERENCE SUPPORT TRANSFORMATION PUTS PATIENTS FIRST
Challenges for patients on specialty medications don’t cease once access is achieved. Tributaries of socioeconomic challenges, healthcare literacy, complicated regimens and adverse side effects converge into a river of adherence challenges that can flood a patient’s journey to improved outcomes. Studies estimate approximately 50% of patients treating chronic disease with a medication do not take it as prescribed.
An increase in at-home oral formulations of specialty medications such as oral chemotherapies further compound previously existing adherence challenges: Patients may not take medications due to forgetfulness or unpleasant side effects, further complicating an at-home care plan that may also include other medications.
Patient-centric solutions need to go beyond reminders and support patients, no matter if they’re moving through an all-in-one health journey or piecing a path together through disparate systems. Easy, intuitive connections to brand experts with clinical backgrounds can address individual complications in specialty medications. Patients receiving personalized support for their medications experienced 25 percent increase in therapy adherence and 31 more days on therapy.
THE FUTURE OF SPECIALTY MEDICATIONS IS PATIENT-CENTRIC
The merits and detriments of patient journey management can be debated, but the core truth remains: Everyone loses when patients can’t get the medications they need.
Opening access and affordability channels to specialty medications is critical to help patients achieve better outcomes with new specialty therapies and a shifting healthcare ecosystem. Innovations in specialty medicine will need to keep pace with the speed of change to efficiently manage complications while remaining patient-centric. These solutions should automate administrative tasks so care teams can give patients individualized attention to navigate benefit and medication speed bumps along their journey.
Learn how CoverMyMeds is improving the specialty patient journey to medication access.
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