The benefits of getting patients on specialty medications quickly are numerous, from improved adherence and clinical outcomes to reduced anxiety, panelists said at Asembia’s AXS23 Summit, in Las Vegas. All participants in the process need to be aligned to make that happen, they said.
“The day a patient is told they need to start a specialty medication can be the [scariest] day of their life,” said Ameet Wattamwar, PharmD, the director of specialty pharmacy programs at NYU Langone Health System, in New York City. “The only thing that they might remember in that conversation with a doctor, among all the confusion and chaos, is that the doctor said they have to start this medication because it can save their life. So then, asking that same patient to wait for two to three weeks until that medication becomes accessible is just not an acceptable approach.”
Clinicians, payors and drugmakers need to think of how to expedite therapy “starts” to put patients on the road to recovery, Dr. Wattamwar said. About 20% to 30% of prescriptions ordered are never filled, he noted. “Delays in completing that prior authorization [PA] process significantly increase the likelihood of a patient falling within that 20% to 30% bucket. If you can’t get the medication in their hands, then you’ve already set yourself up for failure.”
Looking at technologies outside of healthcare, how is it that customers can track when their pizza from Domino’s left the oven and was put into a box, but there isn’t more visibility in specialty pharmacy regarding prescription processing? That question was posed by Kelly Price, BSN, the U.S. head of rare disease for HRA Pharma. Building portals for physicians isn’t the best solution, said Ms. Price, who noted that she has built several of them and utilization was less than 5%.
“The question is then, are we all aligned? Does everybody in the value chain really want this patient to get the medication quickly? I don’t think we’re there yet. I think there are some places where we’re being held back, and we’re not aligned on a common goal,” she said.
Starting treatment quickly is associated with how well patients fare, said Christen Hawthorne, RN, BSN, BMT-CN, a clinical trial nurse navigator for the Leukemia and Lymphoma Society. “When we’re looking at either infection, chronic diseases or a malignancy diagnosis, quick intervention is really going to correlate to better patient outcome, not only clinically but also psychologically, to that wait time of beginning a treatment that’s been prescribed.”
Pharmacists are uniquely positioned to reinforce to patients the need for specialty therapies, said Jaime Bond, PharmD, a pharmacist manager for a Walgreens community-based specialty pharmacy in Las Vegas. “If we delay that, they can think, ‘I can wait, I’ll call in six months,’” she said. “But we know that when patients start treatment quickly, we can delay disease progression. We can minimize costs to the healthcare system and to our patients … because it [lessens] the risk for additional treatments, hospitalizations and surgeries.”
The need for fast access to drug treatment is universal across disease states, Dr. Bond said, from patients with chronic diseases such as hypertension and diabetes to those with cancer who need to reverse or halt disease progression. It also applies to people with bacterial infections who need therapy to prevent bloodstream infections, as well as those with HIV who need antiviral therapy to reach seronegativity and long-term remission. Fast treatment starts also are needed in transplant patients to prevent rejection of transplanted organs. Another example is patients with acute myeloid leukemia, Ms. Hawthorne said. The disease has a rapid onset and generally there’s a delay in making the diagnosis. Starting treatment is imperative to patient survival because the cancer can be fatal within four weeks—if not sooner—if it’s not treated, she said. A study in the British Medical Journal bears that out. According to the investigators, every month delayed in cancer treatment can raise the risk for death by around 10% (BMJ 2020;371:m4087).
People with rare diseases—and their caregivers—also can be harmed by delays in initiating therapy, Ms. Price said. “It’s our responsibility to help bolster their mental health, not impact it negatively. If you have an adrenal insufficiency, and you can die at any moment, knowing that you don’t have what you need to prevent your death is incredibly difficult to deal with.”
Barriers to Quick Therapy Starts
The obstacles in getting patients on treatments more rapidly are several, according to the panelists. “There’s quite an administrative burden associated with starting patients on therapy,” Dr. Wattamwar said. “Depending upon the medication and the insurance plan, there’s a lot of data that need to be transmitted.”
Physicians often will choose a drug that does not have a PA over one that does, Ms. Price added. If more physicians would outsource the administrative work of PAs like they do billing, it could free them for more clinical work, she said.
Ms. Hawthorne said she sees a number of other barriers:
Delayed diagnoses. These delays can occur because a patient seeks care at an emergency room versus a primary care physician versus a specialist.
Staffing constraints. There may be insufficient providers or nurses to see patients, which decreases the number of available appointments.
Lack of knowledge. This can be a barrier, too, depending on whether a patient is being diagnosed by a community provider versus a specialist who knows about a particular disease and the best treatments in depth.
Patient challenges. Patients may have some systemic barriers, such as if they provide care for children or an older parent or can’t leave work for a medical visit, so they delay seeking care. They also have to frequently deal with the intricacies of financial assistance, Dr. Bond added. Helping patients get grants from foundations or obtain copay and discount cards can be helpful to them, but is very time-consuming.
Potential solutions include hiring a dedicated team of subject matter experts to do PAs or partnering with health departments to provide screenings and education for patients, as well as policy reforms that cut the prices of patient copays, the panelists said.
Integrating data from electronic health records (EHRs) and other systems also could help. At NYU, the EHR vendor, Epic Systems, has an ambulatory pharmacy module that more easily enables submission of pharmacy information for the PA process, Dr. Wattamwar said.
“Right now, we’re not optimally positioned to do this as best we can,” he said. “But that’s what we’re working toward, with a number of different third parties right now to solve some of these issues.”
The sources reported no relevant financial disclosures other than their employment.
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