by Jeff Spafford, President & CEO at AssistRx
July 2017 – Poor patient compliance and adherence to specialty and highly managed medication is a growing problem that costs the healthcare system more than $300 billion annually.
Compliance is taking medication correctly as prescribed by a doctor, while adherence is taking and filling prescriptions on one’s own. Patient adherence is especially challenging within the growing specialty drug market due to communication and technology gaps among the many groups involved, including physicians, manufacturers, insurers, specialty pharmacies, and reimbursement providers. Unlike traditional medications, specialty drugs are derived from living cells that are prescribed to treat rare or complex chronic conditions.
Patient-centric healthcare technology applications provide the best chance to solve the current challenges and reduce non-adherence (aka prescription abandonment), increase therapy compliance, and improve patient outcomes. Healthcare providers (HCPs) are looking for technologies to be integrated into their EHR workflow to streamline and simplify specialty patient prescription, enrollment, training and tracking. The enrollment, training and tracking process refers to the patient’s onboarding experience, the act of familiarizing new patients to their new specialty medication.
However, EHRs weren’t necessarily developed to meet the needs of patients requiring highly managed and specialty drugs, but rather for traditional oral meds that would be prescribed and filled at a retail pharmacy. This deficiency has physicians resorting to a manual, fax-based prescription and therapy onboarding process outside of their EHR, causing frustration, time delays, and process gaps. Unlike more traditional medications, specialty medications often have a complicated patient initiation process and require training, clinical follow-up, and other patient services that are only available through a specialty distribution channel.
Healthcare technology apps integrate with the EHR and third-party networks to enable HCPs to onboard patients onto a specialty therapy through a workflow of configured services, including ePA (electronic Prior Authorization), eConsent (electronic patient consent), and electronic verification of patient benefits. They also connect patients to additional services and can reduce costs, close communication gaps, alleviate the administrative burden for stakeholders across patient care, and accelerate time-to-therapy. This technology also helps reduce non-adherence.
For example, an observational study examined over 52,000 referrals over seven months for a women’s health product. Patients whose drug initiation was submitted through this technology were 78 times less likely to abandon their therapy at initial fill or after their first month of treatment. The abandonment rate was .23 percent compared to 18.1 percent for referrals done through the fax-based process, which is 78 times lower than fax-based processes.
In another example, a retrospective analysis looked at a dermatology drug with over 15,000 referrals over six months. Patients whose drug requests were initiated via a fax-based process had abandoned their medication before being sent for fulfillment 60.4 percent of the time, compared to 25.8 percent for those initiated through this technology. Broader adoption of this technology has the potential to improve patient compliance and adherence, reduce administrative costs, and improve patient care and outcomes.
Let’s look at what the three top healthcare players, HCPs, payers, and pharma, should consider when pursuing these technology programs:
On average, physicians spend $80,000 to $100,000 in administration costs for staff to perform manual paperwork, including filling out enrollment and prescription forms. Converting these forms to a technology-based application can reduce staff costs as physicians can be directly integrated into healthcare providers’ EHR systems. Technology solutions also enable HCPs to make better treatment decisions by having their patients’ medical history on file and receiving real-time patient status, including notifications of side-effects and other developments requiring physician intervention.
Insurers spend tremendous amounts of money on drugs that may or may not work as expected or have diminished efficacy if not taken as prescribed. As in other parts of the world, payers are looking to implement outcomes-based reimbursement contracts with drug manufacturers. Manufacturers seem willing to tie reimbursement to patient outcomes, but all stakeholders need to connect into a central, comprehensive patient record, and EHRs offer the best chance of achieving this. Connecting to this comprehensive EHR offers all parties, including payers, insight into treatment outcomes, which facilitate real-world evidence required for outcomes-based reimbursement. Industry experts believe this is where the market will go and that payers will embrace technologies capable of tracking the full treatment lifecycle and the impact on patient outcomes.
Clinicians are spending more and more time in their EHR every day, making the EHR a viable and effective way to communicate with, and support, HCPs. Pharma companies should be exploring ways to leverage technology, especially technology that integrates with the HCP’s EHR, to educate on the benefits of therapy, but also support the providers and patients through their treatment journey. A secondary benefit to ensuring EHRs are the central repository of patient data is the generation of real-world evidence (RWE). RWE has the potential to help pharma understand factors beyond drug therapy that impact patient outcomes.
Healthcare is rapidly changing, embracing new technology to reduce cost, reduce waste and improve patient care. However, despite incredible growth in volume and healthcare activity, the specialty and highly-managed drug sector seems to be lagging behind. Specialty medications continue to address unmet medical needs in complex, often rare diseases and underserved patient populations. Technology offers all stakeholders the opportunity to enhance the diagnosis, treatment, and outcomes for those living with these diseases, all while reducing costs and improving the patient experience.
About the Author
Jeff Spafford has served as AssistRx’s President and CEO since co-founding the firm with Mr. Hensley in 2009. Mr. Spafford has more than 15 years of experience in leadership roles within the specialty pharmaceutical industry.
In 1998, Mr. Spafford established OncoScripts, one of the first specialty pharmacies. OncoScripts developed a Chemotherapy Drug Management Model and contracted directly with large, national payers. OncoScripts was soon acquired by CuraScript, a Florida-based specialty pharmacy whose primary focus is on managing specialty drugs on behalf of managed care payers. In 2001, Mr. Spafford relocated to central Florida and transitioned into his new role as Executive Vice President for CuraScript, in which he was responsible for sales and marketing.
In 2004, Mr. Spafford co-founded and served as President and CEO of Advanced Care Scripts. After three successful years, he sold the company and shifted management of the business to Omnicare. In 2009, Mr. Spafford co-founded AssistRx.
Mr. Spafford earned a bachelor’s degree in Economics from St. Lawrence University, and an MBA from Harvard Business School. He currently resides in Windermere, Florida with his wife, Amy, and their four children.