By NORA TSIVGAS
SVP, Access Services Strategies
Ogilvy CommonHealth Worldwide, a WPP Health & Wellness Company
A very high percentage of Prior Authorization (PA) requests are approved…but about 40% of these prescriptions are abandoned during the PA process. That’s around 74.4 million prescriptions a year.
This matters because patients are not receiving their needed medication, HCPs are getting frustrated with the process, and companies are not deriving revenue from the prescriptions that are being written.
Specialty pharmacy is one of the fastest-growing segments of the industry. Last year, FDA approved 23 NDAs—all for specialty products requiring a PA. Projections show that in 2020, 9 out of the 10 best-selling drugs by revenue will be specialty drugs. Compare that to 7 drugs in 2014 and just 3 in 2010. [SPCMA.org/The management of specialty drugs/p4]
Health plans have a vested interest in ensuring that these expensive specialty products are utilized appropriately, within label and their medical policy guidelines. In turn, that means more paperwork and staff time to complete PA requests, more requests for assistance, and more resources needed on the part of the pharmaceutical companies who fulfill the requests.
So What About All Those Abandoned Prescriptions?
It generally takes between 20 and 30 days for a specialty PA to process through a traditional HUB program. Although most are eventually approved, research shows that HCPs and patients lose patience with the process after 14 days. Patients expect their new treatment to be available within a reasonable timeframe, especially in the case of serious diseases like most cancers, and may even consider delays to be indicative of a problem with the drug. That’s when they start to consider second-choice alternatives, or even give up completely and forego treatment.
The PA Process Is Labor-Intensive, Linear—and Antiquated
The majority of access support programs are administered by a third-party HUB vendor—usually a call center staffed with administrative workers who handle incoming phone calls and faxes (yes, they still do exist!); perform data entry; make outbound phone calls to health plans, HCPs, and patients to collect information; and provide phone and fax updates to prescribers and patients.
The current manual process is linear and each step of the PA process must be completed before the next step can be started. This can lead to significant inefficiencies:
- One company, with a single drug in market, spends over $7,400 per patient enrolled in their access services program—but only 50% of the enrolled patients actually received medication.
- An assessment of process automation opportunities for this company identified an opportunity to reduce costs from $7,400 to $2,800 per enrolled patient (62%) while increasing the number of patients receiving medication to 75%. Delivery of the automated services directly into the Electronic Health Record (EHR) system at the point of care enables multiple processes to launch immediately, eliminating the time lags caused by traditional manual processing as well as the data entry required by portal-based services. For this manufacturer, the EHR approach works out to a 25% increase in sales revenue, in addition to the 62% reduction in program administration costs.
Pharma Manufacturers Can Reduce PA Cycle Time While Saving Money and Improving Satisfaction
Manufacturers have multiple opportunities to improve the PA cycle, many of which utilize systems and processes that are already in place or easily modifiable, such as EHR systems.
- Access services can be delivered via EHR systems that are already in wide use by 90% of HCPs. The PA form can be pre-populated by leveraging existing data within the EHR such as physician and patient demographics, the patient’s health insurance and e-prescription details, as well as required clinical information for the PA.
- Automated systems can be leveraged to verify benefit eligibility and send the digitally completed PA form to the appropriate health system either as a digital file or fax.
- Experienced Access Services Consultants, like Ogilvy, can design and configure the process automation, select appropriate aggregators, negotiate EHR access, program the business rules and integrate the data, helping companies realize cost and staffing efficiencies.
Patients who take specialty medications—and the physicians who prescribe them—need a holistic and flexible support model that meets their needs, while at the same time ensuring that prescriptions get filled. As marketers, we need to work with manufacturers to automate the PA process, helping them deliver timely access to patients who need their medications.