In recent years, due to the increase in chronic disease diagnosis and the increase in the number of new drugs on the market, the use of specialty drugs in the United States has soared.In fact, it is estimated that specialty drugs account for 75% of the approximately 7,000 prescription drugs currently in developmentBy 2022, more than 60% of the 600 drugs expected to be approved by the FDA will be specialty drugs.
Special therapies designed to treat very specific and complex diseases are undergoing earth-shaking changes. The challenge is that such drugs are often difficult to administer and very expensive. Professional pharmacies must now be prepared to not only meet the needs of patients, but also provide the support they need to ensure reimbursement, correct administration, and ensure compliance and best results.
The problem is that many specialty pharmacies currently do not have the right tools to support their patients. This is where the technology-driven hub service platform appears.
The cost of navigating special drugs
Although the use of specialty drugs has gained a firm foothold in the United States and other regions, they still account for only a small portion of the total prescription drugs, but account for more than 50% of national drug expenditures.As the price of specialty drugs is expected to rise, sales are expected to grow to Will reach US$217 billion by 2024It is more important than ever for professional pharmacies to help patients get these drugs more easily and show positive patient results, because this is a key factor in determining reimbursement.
However, one major obstacle to demonstrating positive clinical results is medication compliance. From lack of active patient outreach and education to failure to monitor results or provide supplementary reminders, there are many factors leading to low compliance rates. In the past, this level of active patient participation has been a challenge for many specialty pharmacies, one of the main reasons being that they did not have the technical infrastructure to continue and effectively execute on a large scale.
To ensure that the number of special drugs in the pipeline reaches the patients who need them most, and to help ensure positive results, the entire industry must undergo a digital transformation.
Use cloud-based technology to manage complexity
Today, specialty pharmacies are responsible for distributing therapeutic drugs to patients on behalf of manufacturers, so they need a centralized application to support the entire process of patient intake and distribution. As a professional pharmacy, the top priority is to provide patients with treatment as soon as possible so that they can start treatment. In most cases, the pharmacy will try to deliver the treatment to the patient within five to seven working days or less after the prescription is issued. However, during that time, many sequences must occur.
Determine prior authorization and qualifications
Data must be collected from the prescriber, entered and verified, and then the specialty pharmacy must work with the payer to see the patient’s coverage and whether the coverage supports the treatment. If not, what options are there to support it?
If it requires prior authorization (PA), the specialty pharmacy must cooperate between the provider and the payer to obtain treatment. This usually requires multiple follow-ups. Once it is covered, specialized pharmacies will help provide treatment to patients.
This must all happen quickly, because most patients who require these types of professional interventions usually experience more serious health problems. They need more direct intervention and need to receive treatment as soon as possible.
Processing claims and reimbursements
Another barrier to compliance is cost. Specialized pharmacies that have established procedures to help reduce the financial burden on patients and reduce claims processing time generally increase compliance rates.
Helping patients understand and assess the affordability of professional treatment, and helping uninsured and underinsured patients to obtain treatment through financial assistance programs, may bring challenging and time-consuming complexities to the reimbursement process. Cloud-based technology can alleviate most of the burden of this process-confirm patient eligibility requirements and even look for alternative funding options.
These tools can also navigate billing codes, take over arduous tasks such as benefit investigation and verification, and shorten the adjudication time for claims processing. They can also be configured to provide self-service capabilities to patients, enabling them to find and apply for financial assistance programs.
Long-term support for patients
Nevertheless, once the treatment is delivered to the patient, it does not end. Then, specialty pharmacies must follow up with supplementary medications or provide support and education to patients to ensure that they administer them correctly and adhere to treatment.
Most specialty drugs on the market require patients to follow a fairly complex treatment plan. They may have to learn how to self-inject drugs or be able to recognize side effects, which may create another compliance barrier. Using cloud-based technology, professional pharmacies can provide comprehensive on-demand support. This can be through SMS or automatic notifications sent by apps to remind them of the time or instructions for dosing, prescription monitoring and automatic replenishment, and even patient-accessible portals containing educational modules, training videos, and other forms of support.
In addition to growing demand, all these touch points between multiple stakeholders (patients, suppliers, and payers) are increasingly becoming reasons for professional pharmacies to undergo digital transformation. The tools previously used are no longer sufficient to navigate and simplify the complexity of special drugs.
Achieve digital transformation
Professional pharmacies are no strangers to cloud-based technology. However, until recently, they mainly relied on very specific software to manage their core business-prescription process and management. These tools are still necessary in professional pharmacies, but they are not built to manage and automate the entire patient journey.
Usually, professional pharmacies will try to use their existing systems as a “temporary” central service platform, but this can cause problems because these systems are not designed to manage these complexities on a large scale. Workarounds may be sufficient in a short period of time, but if the number increases, they will lose the level of visibility needed to effectively manage patient-specific data, such as how many patients are using drugs, whether they are using the drugs correctly, and they are waiting at the stage of use .
The solution is to integrate existing pharmacy software with technology-driven central service solutions to manage all aspects of professional pharmacies-from back office and administrative tasks to patient-oriented operations. Results tracking and reporting as well as medication compliance and patient education are critical to making these medications more accessible to everyone. The industry must take active steps to create a level playing field so that these important therapies can benefit the patients who need them most.
Photo: Ridofranz, Getty Images
