By Andrew Mellin
July 27, 2021 at 5:00 am ET
The future of modern medicine is here – ready to tackle complex and chronic conditions. These medications, called specialty drugs, are welcome news to patients and their families – the majority of American adults – who are impacted by chronic disease or critical conditions.
Specialty drugs are the fastest-growing area of pharmacy spend, accounting for nearly half of total drug expenditure. And there are more on the way, with specialty medications accounting for 75 percent of the approximately 7,000 drugs in development.
But the process of filling a prescription for a specialty medication is much more complex than filling a regular prescription. In my more than 20 years in health IT and 15 years of experience as a provider, this is the most complicated process I’ve ever seen to start a patient on a therapy.
Most of us are used to going to the doctor and picking up a medication at the pharmacy the same day. For patients on specialty medications, however, this process is not as simple. Filling a specialty medication requires much more patient and clinical information than the average prescription and involves multiple stakeholders — a health plan, a patient support program (commonly used for financial assistance), a specialty pharmacy and a provider. Regularly, these medications cost thousands of dollars a month and require prior authorization, a notoriously error-prone process that is a major source of delays when initiated manually.
Each stakeholder in the process often has their own information requirements and uses different technology platforms that cannot easily share patient information. This disconnect negatively impacts every stakeholder, especially patients, who may experience a potentially life-altering delay in care. According to one survey, nearly 40 percent of prescribers reported a two-week wait to get the average patient started on a new specialty drug. A separate study revealed that nearly 70 percent of specialty pharmacists said that administrative tasks interfere with providing patient care.
For the patient, this process adds stress to one of the most uncertain moments in their lives. Imagine you or a loved one having to wait, worry and wonder when you will start treatment because someone is manually reaching out to multiple sources for everything from clinical to financial information.
When there are delays, patients begin to second-guess the therapy or simply give up, leading to abandonment. And when a critical therapy is deserted, a person cannot achieve optimal health outcomes.
Specialty medications are changing and saving people’s lives. And as the pace of innovation in therapies accelerates, prescribing them will only become more complex. That’s why technology must become an essential element of the specialty medication journey.
Fortunately, there are existing technologies that follow new industry standards for information exchange and can automate and streamline the process, giving time back to care providers and getting their patients on their therapies more quickly.
Emerging innovative health information technology solutions and standards can automate gathering clinical information from a provider’s electronic health record software to send to specialty pharmacies and, with patient consent, to patient support programs. Digitizing these processes allows physicians, nurses and pharmacists to eliminate phone calls, faxes and other manual communications to focus on the more valuable parts of the process, like patient care, education and support.
For patients, streamlined processes on the pharmacy side can significantly increase speed to therapy. Simply put, technology can help avoid delay of treatment due to antiquated communication practices of unanswered phone messages and illegible, handwritten faxes. This ultimately improves patient adherence, outcomes and overall quality of care as even a one-day delay in access to life altering treatment can greatly impact patient’s health
While specialty medications add complexity to patient care, technology can help providers ensure the focus remains on helping patients get on the optimal therapy as fast as possible. Adoption of new information exchange standards in health care has historically been a prolonged process, but with the increasing burdens on patients and providers and with the rapid growth and importance of specialty medications, there is no time to wait.
Andrew Mellin, MD, MBA, is VP, chief medical information officer at Surescripts, where he helps the Surescripts Network Alliance improve the care experience for both providers and patients with a focus on technology and smart workflow solutions.
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