The initiation of specialized medication therapy is a crucial priority for patients, providers, manufacturers, and pharmacies alike. However, multiple processes and obstacles hinder timely access to these treatments, particularly after the completion of prescription enrollment forms.
Access, affordability, and engagement challenges significantly reduce the likelihood of patients successfully starting their prescribed medication regimens. This article examines the common barriers encountered in these key areas.
Access
Throughout the medication enrollment process, stakeholders supporting patients often face substantial access hurdles. The initial challenge lies in finding, completing, and submitting the correct medication form. Whether through a hub, a specialty pharmacy, or a member of the access team, ensuring a complete and error-free enrollment can be arduous. Numerous subsequent steps are required to fully support treatment initiation, and inefficiencies in form submission processes can drive up costs due to miscommunications, missing information, and unviable applications.
For example, when a hub receives a patient assistance program (PAP) enrollment form, eligibility checks are frequently conducted manually through credit or income verification processes. However, it raises the question: why should the hub bear the responsibility of determining eligibility when upstream processes could automatically alert teams prior to the actual submission of the PAP?
Furthermore, understanding whether the patient’s insurance covers prescribed medications, which pharmacies can provide these treatments, and any additional restrictions or authorizations required before treatment begins contributes to a backlog of work for teams striving to facilitate expedited access to medications.
Implementing a unified, automated, and transparent access workflow for hubs, formulary review managers (FRMs), providers, and patients could significantly enhance treatment timelines by eliminating barriers, siloed data, and manual steps that delay care.
Affordability
Beyond the diverse access challenges that must be overcome to process a prescription, the availability of transparent, cost-effective options is a critical factor in patient conversion. If a patient cannot afford a medication or is unaware of less expensive alternatives, they are less likely to adhere to treatment.
Patients and providers need cost information at the point of service to make informed decisions about next steps. Technologies offering real-time benefit checks—usually integrated into electronic health record workflows—can display out-of-pocket costs while highlighting applicable pharmacies and coverage restrictions. This information equips stakeholders with the necessary details to navigate the support required to initiate prescribed therapy.
Manufacturer-provided copay assistance and PAP can drastically reduce or eliminate the patient’s personal financial responsibility, though they often demand additional research, administrative effort, and time. Foundation grants from nonprofit organizations may also aid affordability but only if patients are aware of the available funds and apply in a timely manner.
While various mechanisms exist to assist in patient affordability, they manifest in diverse forms, creating an uncoordinated experience. This complexity generates frustration and burdens for patients as they attempt to understand their options and make swift decisions. Integrating affordable options into a single, centralized portal would allow stakeholders unprecedented access to review and apply for assistance.
Engagement
Effectively supporting patients mandates obtaining their consent, regardless of where the enrollment form is sent. Typically, consent is collected by the hub to assist the patient throughout enrollment, prior authorization, and execution phases. Nevertheless, many enrollment forms are sent directly to specialty pharmacies, bypassing the crucial step of collecting patient consent. Best practices suggest that providers should collect consent in advance, enabling manufacturer and support center teams to involve patients in assistance services, no matter where the enrollment form is directed.
Additional resources focused on patient engagement can be immensely beneficial in facilitating treatment initiation and increasing conversion rates. Moreover, patient satisfaction and adherence rise significantly when supportive services are available. So, why do we not advocate for consent collection for every request at the point of intervention? Incorporating consent collection capabilities into prescription and enrollment workflows could greatly enhance patient conversion rates and overall health outcomes.
What’s Next?
Fragmented technological systems have exacerbated confusion and frustration throughout the specialized medication onboarding process. Instead, purpose-built ecosystems that unite stakeholders and data towards a common goal—accelerating treatment initiation and medication conversions—hold the potential to profoundly impact the overall health of our population.
Integrated, intuitive, and secure technologies that facilitate access, affordability, and engagement are intended to revolutionize patient care access. We can no longer view enrollment forms as the sole barrier to therapy initiation; instead, we must consider the entire patient journey as a web of interlinked challenges needing resolution. Achieving this objective is well within our reach.
Photo: cagkansayin, Getty Images
