While specialty drugs ─ classified as high-cost, high-complexity, or high-touch prescription medications ─ are gaining significant traction in the pharmaceutical industry, they can also present significant challenges for prescribers. Specialty drugs often cost $2,000 or more per patient per month, triggering requirements for prior authorization and potentially step therapy by insurers. Additionally, they may require special handling through injections or infusions, and medical oversight may be necessary to administer them.
Demand continues to grow exponentially, with spending on generic versions of specialty drugs alone representing the largest segments of the healthcare industry, valued at $73.8 billion. The U.S. spent approximately $577 billion in prescription drug expenditures in 2021, with approximately half or $285 billion attributable to specialty medications including generic versions.
Healthcare providers struggle to meet complex approval requirements which vary by insurer and medication. While the desire to control costs is understandable, the experience of procuring specialty medications is often manual, bureaucratic, slow and maddening for the prescriber and patient, including requirements for:
Hub services assist patients to obtain specialty drugs. They act to traverse the many complex requirements and manual processes and serve as an intermediary between the physician, patient, payer, and drug manufacturer. However, hubs also present unique concerns due to manual processes and virtually no standards-based infrastructure.
Without a clear roadmap to success, hub service companies are challenged to help physicians and patients effectively navigate the specialty approval and fulfillment process.
Healthcare personnel (HCP) staffing shortages also have led to backlogs in gathering and submitting necessary PA requirements for both medical and pharmacy benefits, putting additional pressure on already stressed medical office teams.
The rise of specialty medications demands digital innovation. Pharma manufacturers, including hub services, are automating key points along the patient journey with healthcare chatbots, virtual visits, and two-way HIPAA-compliant secure messaging.
The emerging reliance on artificial intelligence (AI) equips hubs with new capabilities to drive down costs. Organizations that are accessing digital services are:
What can forward-looking hubs do to quickly ramp up? To follow is a short list of where AI can help:
The shift is underway. Now is the time to embrace digital. Digital hubs that deliver the “right messages to the right patients at the right time” not only speed access to life-saving therapies, they can also make sure meds are taken as prescribed for the duration of the treatment plan.
We invite you to see for yourself an example of how healthcare chatbots can streamline onboarding.
Ready to learn how QliqSOFT can help automate your pharmacy hub services? Contact us today to discuss your challenges and allow us to craft a personalized solution for you.
Krishna Kurapati is the Founder and CEO of QliqSOFT. He has more than two decades of technology entrepreneurship experience. Kurapati started QliqSOFT with the strong desire to solve clinical collaboration and workflow challenges using artificial intelligence (AI)-powered digital technologies across the U.S. healthcare system.
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