“The patients we’re helping in this space have often just received a terrifying diagnosis, and then they are made to wait to start treatment,” said Tom Skelton, chief executive officer of Surescripts. “By bringing the three critical aspects of the prescribing process together—the cost, the prior authorization and the enrollment form—we are addressing a major challenge in healthcare today, and helping prescribers and pharmacists put much-needed specialty medications into their patients’ hands faster.”
The existing specialty prescribing process relies heavily on lengthy paper forms, as well as faxes and phone calls to manage prior authorization requests and approvals. This places a hefty administrative burden on prescribers, nurses, pharmacies and staff, and the process can take from one to two weeks to complete for a growing number of patients with serious illnesses like cancer, multiple sclerosis and HIV.
“Because specialty medications often require demographic information, clinical information, diagnostic results and in some cases, financial information, along with the prescription information, the specialty prescribing process is complex,” explained Pooja Babbrah, Senior Consultant of Point-of-Care Partners and co-chair of the NCPDP Specialty Workgroup. “While data elements were recently added into SCRIPT standard v2017071, allowing more comprehensive information required by a pharmacy or specialty hub to flow electronically is a giant leap forward and will help enable the right information to be available more quickly and increase speed to therapy for patients.”
A number of electronic health records (EHR) vendors have contracted for the service, including Cerner, eMDs, NEMO Health, NewCrop, Office Ally, Quanum (Quest Diagnostics), RXNT and STI. Based on market size data from the Drug Channels Institute’s 2019 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, nearly 53% of the specialty pharmacy market, including Accredo and Kroger, among others, have signed on to offer the solution, plus a number of specialty hub organizations, such as AssistRx, CareMetx and PharmaCord. Thanks to this widespread adoption, Surescripts has successfully processed more than 15,000 specialty patient enrollment forms electronically.
Specialty Patient Enrollment empowers EHR vendors to greatly improve efficiency for end users who are caring for patients with serious and complex illnesses. With the electronic form integrated into their EHR software, prescribers can remain in their e-prescribing workflow to submit the form, and use Real-Time Prescription Benefit to view prescription costs and Electronic Prior Authorization to obtain necessary approvals.
“We are excited to be able to provide prescribers and their patients with a streamlined, automated workflow for specialty medications,” said Neil Simon, Chief Operating Officer at eMDs. “Innovation that keeps clinicians off the phone and in their workflow saves significant time and resources in an area of the market that’s rightfully concerned about rising healthcare and prescription drug costs.”
Specialty pharmacies benefit from replacing a manual process on the receiving end with an electronic workflow that provides more complete and accurate information from prescribers. By alleviating the need for back-and-forth communications, they can help speed time to therapy and redirect their focus to serving and engaging with specialty patients.
“The complexities of specialty medications require pharmacies to gather additional information beyond the basics of strength, frequency, dose and directions,” said Brian Seiz, President of Accredo. “Our collaboration with Surescripts is a complement to our existing solutions and further enhances our ability to reduce turnaround time, improve the prescriber experience and ensure access to medication for patients.”
Specialty patient solution organizations (also known as specialty hubs) play a critical role in supporting patients who are prescribed specialty medications. By leveraging data and serving as a central point of contact for patients and providers, specialty hubs help manage patient populations and increase patient access to specialty drugs.
“The high cost of nonadherence is avoidable, and one of the best opportunities to improve adherence is at the point of care,” said Jeff Spafford, Chief Executive Officer of AssistRx. “Healthcare providers want intelligent tools—implemented into their workflow—to help patients get on prescribed therapy faster and stay on therapy. With digital tools like Surescripts Specialty Patient Enrollment, we connect patients to programs that support them throughout their treatment journey.”
Specialty medications differ from traditional medications in a number of ways. They usually require sensitive conditions for storage, handling, administration and monitoring. They can include biologics, injectables, or infused therapies, but may also be oral medications. Specialty medications are commonly used to treat complex and chronic conditions like cancer, rheumatoid arthritis, and multiple sclerosis, and are often priced much higher than traditional drugs.
Digitizing the specialty prescribing process supports a number of the federal government’s goals and strategies outlined in the draft 2020–2025 Federal Health IT Strategic Plan recently released by the Office of the National Coordinator for Health Information Technology (ONC). By bringing together EHR vendors, health systems, pharmacy benefit managers, health plans and pharmacies from across the Surescripts Network Alliance, Surescripts is working to improve interactions between patients and the people who care for them by building a fully connected health system that leverages technology to safely and securely use and share health information.
EHR vendors, specialty hubs and pharmacies can go online to learn more about Surescripts Specialty Patient Enrollment and find out how to get started streamlining the patient enrollment process today. To learn more about the critical need to improve specialty medication prescribing, visit Intelligence in Action.