Patients of all socioeconomic backgrounds are struggling to pay for high-cost specialty drugs. The average annual price of these medications reached an astonishing $84,442, more than 10 times the cost of standard prescription drugs. In fact, experts predict that specialty drugs could represent 43% of global spending and 56% of spending in developed markets by 2027.
At a time when about one in four adults in the United States say they or a family member have not filled a prescription, cut pills in half, or skipped doses in the last year because of cost, specialty medications may seem completely out of reach.
Health-system speciality pharmacies (HSSPs) play a critical role in helping patients access these life-changing and, in many cases, lifesaving medications. Nine out of 10 hospitals in the United States now operate a specialty pharmacy, up from less than 9% in 2015.
Providing care that goes far beyond filling prescriptions, HSSPs support patients in all aspects of their treatment—including guiding them through the often complex and confusing world of financial assistance.
Along with making a massive difference in the lives of patients, improving affordability provides many benefits to the pharmacy and the health system as a whole, including:
Reducing Prescription Abandonment
When you remove financial barriers to care, you lessen the chance that a patient will abandon their specialty medication. Poor adherence is linked to 125,000 potentially preventable deaths and up to 10% of hospitalizations annually in the United States, and conservative estimates indicate abandoned prescriptions cost pharmacies more than $500 million a year.
Specialty therapies are abandoned more frequently than any other type of medication during a patient’s health plan deductible period. Given that many specialty drugs are quite literally lifesaving, the consequences of nonadherence can be particularly dire.
One survey of over 400 oncology patients found that 10% of participants stopped taking their medication, 7% never filled their original prescription, and 9% did not regularly refill their medication. And about 18% of patients abandon their prescribed therapy for diabetes, anticoagulants, and cancer drugs due to cost.
Specialty medications are so expensive that even patients who meet their plan’s deductible may be unable to afford them. For example: If a 30-day supply of medication is $10,000 and the patient is responsible for covering 5% of cost, they’ll still be expected to pay $500 a month. While 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 60% when the cost is over $500.
Improving Patient Outcomes and Experiences
When patients can afford their specialty medications, they are more likely to use them as directed—and achieve better outcomes as a result. Better outcomes mean happier patients.
For 90% of respondents to a recent healthcare survey, finances were the number one factor when it came to having a positive patient experience. Another study looking at the impact of assistance on specialty pharmacy patients found that removing financial barriers to care was the key to patients receiving and maintaining treatment.
Increasing Health Systems’ Bottom Lines
U.S. health systems and hospitals are dealing with the worst financial crisis since the start of the COVID-19 pandemic, according to a recent report prepared by Kaufman Hall for the American Hospital Association.
Driven by inflation and labor shortages, hospital and health system expenses were expected to increase by nearly $135 billion in 2022, and even optimistic projections showed over half of hospitals were operating in the red.
HSSPs that improve patient access and adherence to specialty medications can help increase revenue for health systems that may otherwise be struggling.
Taking Financial Assistance to the Next Level
Health-system specialty pharmacies may recognize the value of helping patients afford high-cost medications. However, pharmacists, pharmacy technicians, medication assistance advocates, and other staff who are tasked with providing financial support often rely on manual, labor-intensive processes.
In addition, pharmacies may be working alongside other departments within the health system but lack a centralized space to coordinate efforts. Fortunately, new technologies can optimize and automate financial navigation by:
Identifying Patients in Need
HSSPs may not know of a need for financial assistance until after a prescription has been billed and the patient can’t afford the copay. Using the power of predictive analytics, pharmacy staff can leverage data to flag patients who are at risk of financial hardship before their prescription is adjudicated and the medication is ordered.
Optimizing Available Funding
Time spent manually running reports to match patients with financial resources may mean missed opportunities, especially when windows of funding often close quickly. Financial navigation platforms provide comprehensive information on relevant resources such as:
- Drug manufacturer copay assistance
- Disease-specific charitable funds
- Free and replacement drug programs
- Health systems’ internal funds
Maximizing Efficiency
HSSPs already benefit from the increased efficiency that comes from in-house access to health systems’ electronic medical records (EMRs) and a relationship with their providers. Adding a solution that helps pharmacy staff quickly and easily connect patients with financial assistance further streamlines care, freeing up time for staff to focus on their patients.
A financial navigation platform eliminates the often massive amount of paperwork associated with helping patients secure assistance for specialty medications, saving time and resources.
Managing Free and Replacement Drug Orders
Technology can also boost efficiency for HSSPs by managing free and replacement drug orders. Automation and tracking tools enable pharmacy staff to view and monitor relevant details—such as when a drug was ordered, when it will be administered next, and when it needs to be reordered—in one centralized, easy-to-navigate space.
Boosting Morale and Preventing Burnout
The work of specialty pharmacists is, well, specialized. They care for patients who have complex, chronic, and rare conditions that require guidance on how to use their medications, along with ongoing monitoring. The drugs themselves often have special storage or handling requirements. Then there’s the matter of helping patients pay for them.
Leveraging technology to lighten the bureaucratic load can help prevent burnout, which is hitting pharmacies hard. A 2022 analysis that included more than 11,000 pharmacists found that over half (51%) reported experiencing burnout—and that this level of burnout may negatively affect patient care. And 75% of pharmacists who responded to a recent workplace survey said they don’t have the time and staff they need to do their jobs safely.
Streamlined Assistance Helps Patients, Specialty Pharmacies, and Health Systems
To provide the highest level of care, health system specialty pharmacies need high-level solutions. Improving affordability reduces prescription abandonment, which leads to better outcomes for patients and a more robust bottom line for health systems.
With the support of a technology solution, HSSP staff can optimize funding opportunities and maximize efficiency. Most importantly, they can focus on what really matters—their patients.
