One of the challenges of specialty pharmacies is the need to improve the patient experience. Incomplete patient data, interoperability issues between the prescriber and pharmacy, and the lengthy prior authorization process are just a few of the potential pitfalls that can create friction for everyone involved. In an interview, Surescripts’ Clinical Product Advisor Cecelia Byers, Pharm.D., shared how her experience as a specialty pharmacist prepared her for her current role at Surescripts and how the company is working to simplify prescribing and obtaining specialty medications.
The average specialty prescription takes at least four days to fill. Even before physicians get to this point, it can take hours of paperwork to start patients on specialty medications.
Cecelia Byers
Byers said the top priority has been to create a safe but efficient process, driven by technology from the time the prescription comes to the pharmacy to the moment the patient picks up the medication. Her background as a pharmacist includes 15 years working in pharmacies and specialty pharmacies, specifically as a pharmacy manager, before joining Surescripts in 2019. Byers appreciates Surescripts’ tech-driven approach to helping specialty pharmacies fill prescriptions faster with safety and efficiency in mind.
“These are very complex medications, not only in how they’re administered and how they impact the body, but also from a coverage perspective. Personally, I have spent a lot of time on the phone with insurance companies understanding what it was going to cost for the patient, prior authorization requirements and potential alternatives.”
Many of the medications one would expect to find in a specialty pharmacy need to be injected. In other cases, patients can’t miss a dose if they don’t want to risk compromising the medication’s effect. The medication also tends to be more expensive than traditional prescriptions, requiring a cumbersome prior authorization process.
Byers had the opportunity to sit with a benefits specialist for a Surescripts Network Alliance partner pharmacy. The amount of work that the partner put into the conversation with the insurance company to just make sure that patients could afford the therapy, not only for that first fill, but on an ongoing basis was amazing, Byers said.
Part of patients’ stress involved trying to figure out how much they had to pay, Byers said, reflecting back on her pharmacy experience. The cost of specialty medications rose 43% between 2016 and 2021. Byers noted that even when specialty therapies are covered by insurance, they can still have a high out-of-pocket cost — another source of stress for patients. Pharmacies can step in to help patients shoulder these prices with options for financial support.
“Cost isn’t always discussed at the doctor’s office because there is so much opportunity to help that patient find assistance to cover that medication,” Byers noted. “If the medications have high co-pays or there are other financial barriers, pharmacies help the patient navigate the different support programs available.”
Byers noted that considerable time is spent playing phone tag with the prescribing physician and payer, which means it takes longer for patients to obtain the medication to treat their condition. Automation technology leverages interoperability and is designed to close information gaps so pharmacists can get patients started on their treatment more quickly. Surescripts Specialty Medications Gateway allows a pharmacist or a delegate to search for specific data from a patient’s EHR to ensure that they have the right information at the right time to expedite processes which would have otherwise required a phone call or a fax back to the doctor.
“The specialty prescribing process is often like a roller coaster for patients and clinicians. Specialty Medications Gateway is designed to remove some of the twists and turns making the process more efficient and getting patients started on their therapies sooner,” Byers explained.
Pharmacists can use it to pull patient clinical information without contacting the prescriber. This includes the patients’ height and weight, lab results, allergies, medical conditions and medication list, an approach that reduces phone calls, faxes and paperwork and gives pharmacists electronic access to the information they need to dispense medications, improving the experience for everyone.
Surescripts Specialty Medications Gateway also facilitates tasks like drug utilization review, medication reconciliation, dose verification and adjustments as part of the specialty pharmacy’s dispensing processes.
“The goal is to create efficiencies that allow clinicians to have more meaningful and impactful conversations with each other and their patients,” noted Byers. “We are seeing specialty pharmacies using these tools who have cut an average of two days from the time they receive the prescription to the time it is ready to fill.”
Additionally, e-prescribing has made the prescription process more efficient by reducing paperwork. But combined with tools that automate elements of the specialty prescribing and filling process is eliminating what may have taken prescribers three hours of paperwork to start patients on specialty medications. Surescripts Clinical Direct Messaging is also helping to facilitate how clinicians and prescribers can send and receive HIPAA-compliant information across multiple care collaboration scenarios, within existing workflows. It helps streamline the specialty prescribing process by simplifying how clinicians, payers, and pharmacists work together to care for patients, according to Byers.
“Most people may not even believe that the fax machine and phone calls are still the main way communication happens in the specialty pharmacy space. That’s why we are looking to expand our use of existing technologies, like Clinical Direct Messaging, to streamline communication between the patient’s EHR, doctors and pharmacists – eliminating the need for fax machines altogether.
“Having been a specialty pharmacist and working with patients through this roller coaster, these technologies make it easier for prescribers and pharmacists to fill a prescription more quickly meaning patients spend less time waiting and have an overall better experience,” Byers said.
Photo: ClaudioVentrella, Getty Images
