Revamping the Specialty Pharma Customer Experience: Digital Best Practices for Patient and Physician Engagement

Speeding Patient Onboarding

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The journey of the specialty pharmacy patient is a complex and expensive process, as any prescriber, pharmacist, manufacturer, wholesaler, distributor, insurer and pharmacy benefit manager (PBM) knows. The journey starts when the patient is diagnosed with a life-changing chronic or complicated condition, receives the order for a specialty drug, and then navigates the complex manual processes, slowing the start of treatment.

Due to the high costs of specialty meds, patients are often challenged with any number of hurdles in their journey to therapy, which includes satisfying insurance requirements for prescription enrollment and payment. Assisting the patient are hub services that act to traverse the many complexities and serve as an intermediary between the physician, patient, payer and drug manufacturer.

Even with the assistance of these intermediaries, challenges abound ─ manual processes and virtually no standards-based infrastructure. With no clear roadmap to success, hub service companies are challenged to help physicians and patients effectively navigate the specialty approval and fulfillment process.

This white paper examines the hub’s processes that can be digitized so patients receive the often lifesaving or life-enhancing care they need in a more timely and efficient manner.

US Drug Expenditures in 2021

On a macro level, the U.S. spent approximately $577 billion in prescription drug expenditures in 2021. Approximately half of this spend ($285 billion) was attributable to specialty medications.¹
Specialty medications represent <4% of the total Rx witten but more than 50% of the total US drug spend.²

Getting a patient to initiate therapy is increasingly difficult

Specialty medication costs and use are skyrocketing as evidenced by:

  • Drug Spending is Led by Specialty Drugs
    Health plan and PBM experts who manage drug costs spoke at the 2022 Asembia Specialty Pharmacy Summit in Las Vegas, reporting that specialty drugs now account for 50% or greater of the total prescription spending they manage. In some cases, employer clients are seeing specialty costs account for 60% or even greater of their total drug spending.
  • Soaring Cost of Non-Adherence.
    Patients, who are already vulnerable in shock over their diagnosis are understandably overwhelmed managing the unforeseen administrative hurdles and the cost of therapy. For this and other reasons, they are at risk of giving up and not filling their prescription. Medication adherence in the patient journey is a serious problem posing a heavy financial and human toll on the patient, the healthcare system and the pharmaceutical manufacturer, the founder of hub services.
  • Black Hole of Patient Onboarding.
    The evolving mix of hub service stakeholders ─ provider, health plan, drug manufacturer, dispensing pharmacy and multiple service organizations ─ participate in a complex set of manual touchpoints, transactions and handoffs to address patient enrollment, access and ongoing management of high-cost specialty meds. As manufacturers look to develop increasingly complex drug products, including gene and cell therapies, so too will hubs require a higher degree of specialization and flexibility.6
Figure 1: Participants involved from order to medication receipt of specialty medication.

Three Challenges of Specialty Medications

  • Late Patient Engagement
    Specialty drugs are vastly more expensive than their traditional drug counterparts, often costing more than $2,000 per month per patient. Patient engagement occurs too late inthe fulfillment process where the inability for the patient to pay maybecome a barrier to treatment.
  • High Prescription Drug Costs
    Prescription abandonment rates are less than 5% when the prescription carries no out-of-pocket cost; it rises to 45% when the cost is over $125 and to 60% when the cost is more than $500.³
  • High Rates of Non-Adherence
    High rates of non-adherence are believed to result in $300 billion of avoidable healthcare costs.⁴ As an example, three out of every four hospital admissions in oncology are due to non-compliance with the patient’s drug therapy.5

Outdated Enrollment Modes

Before patients can fulfill their prescriptions, they must rely on complex antiquated, redundant and inefficient manual communication such as phone, fax, and paper manual processes for prior authorization using a specialty pharmacy or hub associated with the drug’s manufacturer-specific medication. Typically, these patients have polychronic conditions that require multiple specialty drugs, each with its own associated enrollment process, thereby adding more stress to an already stressful situation.7

Shift to Lower-Cost Sites of Care

Infused therapies make up approximately one-third of specialty medications. Traditionally administered in outpatient facilities or physician offices, they are now moving to lower-cost sites of care, for example, the patient’s home, adding to the logistical complexity.

Greater Need for Patient Resources

Specialty drugs involve complex treatment regimens that typically require pharmacists and personnel to provide ongoing clinical monitoring and considerable patient education to promote adherence beyond traditional dispensing activities. Multiple languages and methods of education must be accessible to patients to ensure proper drug use. Treatment of diseases or conditions can be marked by long-term or severe symptoms or high drug interactions that need proactive monitoring and management.

High Worker Turnover

Compounding these challenges are staffing challenges where double-digit contact center staff turnover coupled with more than 30-40% of organizations reporting they can’t locate and hire enough candidates to fill open positions has created a crisis for pharmacy leaders.8

& eSignatures
Reduce Time Spent Chasing Consents
Patient Assistance
Support Program
Awareness & Activation
Offer Guided Service to Relevant Videos, PDFs, etc.
Refill Reminders, Coordinate Delivery, Assess Adherence
Welcome Kit
Enable First Access to Hub Platform. Educate and Welcome Patients
Deliver Coupons and Related Program Activation Opportunities
Identify and Engage with Potentially High-Risk Patients
Call Center
Offer Convenient 24/7 Self-Service Options
Figure 2. The patient’s journey to receive a specialty medication.

Accelerate Time to Therapy with Digital Technologies

Once you understand the factors contributing to slowdowns in the process and worse ─ causing people to abandon their specialty prescriptions, which harmfully affects positive clinical outcomes ─ you can create an efficient and effective tech-driven patient access strategy to accelerate time to therapy. The No. 1 priority is getting the therapy to the patient as soon as possible so they can begin their treatment.

The solution is optimizing key points along the patient journey with digital engagement chatbots, virtual visits and secure, two-way chat to speed throughput and streamline the multi-layered communication across the various hub service participants. The following examples illustrate where digitization can help the patient, providers and services hub participants.

Engaging Patients Digitally

Chatbots automate routine administrative tasks that allow your contact center agents to solve higher-level complex problems.  For example, you can trigger campaign outreach upon enrollment in your portal to automatically:

Initiate Patient Engagement Early

Speed entry into patient assistance programs. Use digital outreach to obtain consent and provide program information.
Offer guided assistance to relevant patient education materials. Provide multimedia options to reinforce a patient’s understanding and self-care.
Distribute branded welcome packets. Automatically provide digital content.
Enroll in therapy support programs. Provide information about relevant support groups.
Deliver branded coupons or copay offers. Supplement with accessible digital material.
Capture missing patient consent to close gaps in missing documentation.
Update insurance information. Enable patients to scan their current health plan card.

Reduce Provider Burnout

Capture Missing
Physician Signatures.
Send physician education materials to high-volume specialty physicians.
Automate payer authorization requests for additional information.
Replace phone tag with secure two-way text messaging

Opportunities for Hubs to Provide Convenient Inbound Patient Self-service Options

There is no shortage of operative ways for hub services to speed up a patient’s access to life-saving drug therapy. When engaging patients digitally at every step of the hub experience, hubs can:

  • Enable redirection of inbound calls to powerful conversational digital and self-service channels. Callers can interact naturally with human-centered chatbots 24/7 at their convenience. This fast and affordable high-touch, self-service engagement creates a more individual-centric, concierge experience.9
  • Reduce inbound waiting times, dramatically decrease call volumes and frustrations, and free up hub specialists to focus on more complex priority tasks as part of the process.
  • Disseminate information about the specialty medication and program. The chatbot can include the option to escalate the interaction to a virtual visit if the patient desires to speak with a knowledgeable resource.
  • Collect a patient’s copay while offering accessible instructional materials, clinical support and patient support programs.

Humanizing the Patient Experience Is in Your Hands

Every patient’s journey is unique and full of unknown, distinct interactions that can, for better or worse, influence the outcome of their treatment. To that end, hub services play an important role helping the patient navigate logistical complexities and eliminate points of confusion to promptly access the highly valuable therapy and encourage adherence.

As the digital footprint deepens in healthcare, hubs are at the forefront of new tech-driven strategies that can help provide a superior level of human-centered services to these patients who are already in distress. Giving the patient the best channel and personalized, convenient, end-to-end support possible will drive the best health outcome.

We invite you to see for yourself an example of how healthcare chatbots can streamline onboarding.

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