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
Specialty medication costs and use are skyrocketing as evidenced by:
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
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.
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.
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
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.
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:
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:
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.