In healthcare, whether you’re a technology vendor, provider, hospital executive or clinical staff member, the collective goal is to help patients get better by efficiently working together. While the healthcare sector is making progress in many areas, unfortunately, a substantial portion of the industry is still playing technology “catch-up” to other markets. As a result, many areas in healthcare are using outdated technology and operational processes.
In specialty pharmacy, the stakes of treating patients are extremely high. These patients are living with rare, debilitating, and often life-threatening diseases that require specialty medication to survive. At ZappRx, we work with providers who treat patients suffering from chronic diseases such as Cystic Fibrosis or Pulmonary Arterial Hypertension (PAH), whose health can quickly decline as time goes on. The process of getting specialty medications to patients in need can be an extremely slow process. A majority of the delay can be attributed to the ineffective communications workflows between key players, who typically rely on outdated and ineffective tools when they process prior authorizations (PAs), prescriptions, and other services that may be required.
Outdated Processes Lead to Poor Patient Care
Once a patient is diagnosed, it can take several weeks for them to receive their specialty medication. As a result, some patients remain in the hospital for weeks awaiting prior authorizations for their outpatient medication. During this waiting period for medication, a patient’s health can seriously deteriorate.
Here’s a quick overview of the life-cycle (and points of delay) for a specialty prescription:
- A specialty prescription is issued by a provider (written or ePrescribed)
Once issued, it’s not uncommon that the prescription will be sent to a pharmacy unable to fill the order. Even during this early stage, the process can be delayed days by just trying to find the right specialty pharmacy. Most pharmacies and providers operate via phone and fax, delaying communications even further. Once an ePrescription has landed at the correct pharmacy, an enrollment form is often required to collect additional clinical information which cannot be conveyed via an ePrescription.
- The specialty pharmacy receives the enrollment form or prescription
The enrollment form (or prescription) is usually submitted by the prescriber via fax. The pharmacy iterates with the prescriber’s office until the form is filled out completely and accurately, which can happen by phone, fax, or email, and the prescription is entered into the pharmacies dispensing system.
- Exploration of benefits with the insurer
This step involves communication and information exchange between the specialty pharmacy and the pharmacy benefits manager (PBM) or health plan. Depending on the type of drug and the complexity of the therapy, this process can take days.
- Prior Authorization
While delays can occur during the first few steps mentioned, typically those don’t take more than a couple of days. Prior authorization however, can result in delays that span weeks. Completing PA forms pull providers away from clinical care, and pharmacists away from priority tasks, because they’re busy dealing with paperwork, fax machines and phone calls.
- Final Steps
Once benefits have been verified, a financial solution has been put in place if needed, and a provider gets through the hurdle of prior authorization, the process can be straightforward. The claim is paid by the insurer, the order is fulfilled and shipped by the specialty pharmacy, and the patient or practice receives the medication.
Specialty drugs are groundbreaking and are helping to save countless lives. That said, the impact of these innovative therapies is only as great as our ability to get them to patients in a timely manner. This is an area where we, as an industry, are currently falling short and we must do a better job. By examining specialty prescribing step-by-step, our hope is to illuminate the opportunities where technology and automation can streamline the process.
Putting Paper in the Rear View
As healthcare continues to expand its technological abilities, and disruptive players like ZappRx come into play, we will be able to resolve today’s inefficiencies within specialty care. ZappRx’s solution is working to alleviate the administrative burden and improve patient care for Pulmonary (including Cystic Fibrosis (CF), Pulmonary Arterial Hypertension (PAH), and Pulmonary Hypertension), Cardiology (including Hyperlipidemia and Congestive Heart Failure), and Gastroenterology (including Crohn’s Disease and Ulcerative Colitis). As the company grows, ZappRx plans to expand into other areas, including Rheumatology, Neurology, Oncology, and other rare diseases.
It is ZappRx’s mission to get patients on their intended treatments faster. By providing a platform for providers and pharmacists that can digitize, automate, capture, and communicate patient and pharmacy data, the prescribing and prior authorization process hurdles will slowly diminish. It is not enough to simply replace the phone and fax machine as the primary “tools” for prescribing. By utilizing smart technology that streamlines the administrative process, providers and pharmacists can focus on their core competencies and improve patient outcomes.